Cleveland Clinic Children's Outcomes
Pediatric Gastroenterology
Pediatric Colonoscopy (N = 1611)
2017-2020
The Department of Pediatric Gastroenterology, Hepatology, and Nutrition annually reviews all pediatric colonoscopic procedures to confirm the documentation of the specific indications for colonoscopy and to determine the cecal intubation rate and the rate of completion of the examination to the terminal ileum (TI).
Procedures performed in patients with a history of prior colonic or ileal resections and colonoscopies that were planned as limited procedures were excluded. Cecal and ileal intubation rates were compared with reported outcomes in pediatric patients at other institutions. The department evaluated patient or procedural-related factors that limited rate of completion of the examination to the terminal ileum. Time to complete the procedure (“scope in/scope out”) as a potential surrogate quality indicator was also determined.
| 2017 | 2018 | 2019 | 2020 | |
|---|---|---|---|---|
| Colonoscopies, N | 368 | 389 | 462 | 392 |
| Colonoscopy complete to the terminal ileum, N (%) | 346 (94) | 346 (90) | 440 (93) | 350 (89) |
| Colonoscopy with cecal intubation, N (%) | 361 (98) | 361 (95) | 446(96) | 350 (89) |
| Unsuccessful TI intubation in patients with Crohn's disease, N (%) | 9 (2.4) | 19 (4.8) | 12(2.5) | 13 (3) |
| Incomplete colonoscopy due to inadequate bowel prep, N (%) | 5 (1.4) | 4 (1.0) | 2(0.4) | 4 (1) |
| Average colonoscopy procedure "scope in/scope out" time, min* | 39 | 39 | 42 | n/a |
| Average procedure time for complete colonoscopy to the TI, min* | 39 | 38 | 41 | n/a |
| Average procedure time for colonoscopy without TI intubation, min* | 44 | 54 | 29 | n/a |
IBD = inflammatory bowel disease
TI = terminal ileum
N=number
*data not collected for 2020
In 2019, the cecal intubation rate and the rate of completion of the examination to the TI were 96% and 93%, respectively. In 12 patients diagnosed with inflammatory bowel disease, colonoscopy was limited because of the presence of marked intestinal inflammation or a finding of colonic or ileal strictures. This contributed to the colonoscopy completion rate to the cecum and TI being less than 100% which is an expected finding in departments that take care of medically complex patients with ulcerative colitis and Crohn's disease. Our cecal and TI intubation rates significantly exceed those rates reported in other large multicenter series of children undergoing colonoscopy¹ (85% for cecal intubation and 69.4% for TI intubation). The average time was shorter in the group of patients undergoing a colonoscopy were the terminal ileum was not reached, and likely reflects the limited extent of exams possible in patients with IBD and/ or significant colonic inflammation/stricture.
