Quality indicators in pediatric colonoscopy

Abstract

Objectives: An ileal intubation rate ≥ 85% is one of the most important quality indicators in pediatric colonoscopy, particularly due to screening for inflammatory bowel disease. The primary objective of this study was to determine the ileal intubation rate. Secondary objectives included assessing other quality indicators, such as bowel preparation, type of sedation, and use of general anesthesia.

Patients and Methods: Observational, descriptive, cross-sectional study. All colonoscopies performed at two pediatric hospitals in Santiago, Chile, between September 2020 and November 2022 were included. Colonoscopies without the intention of ileal intubation were excluded. The following were evaluated: sociodemographic characteristics, procedure indication, type of sedation, bowel preparation regimen, Boston Bowel Preparation Scale score, endoscopist’s experience, whether a pediatric gastroenterology trainee was present during the procedure, ileal and cecal intubation rates, reasons for incomplete procedures, and complications.

Results: A total of 99 colonoscopies performed at two pediatric hospitals in Santiago, Chile, were included. Of the patients, 47.5% were male, with a median age of 12 years. Sedation was used in 51% of procedures, while 49% were performed under general anesthesia. Sodium picosulfate was the most frequently used bowel preparation agent (82.8%). The main indications for colonoscopy were rectal bleeding and suspected or follow-up of inflammatory bowel disease. The overall ileal intubation rate was 60.6%; stratified by intervention type, it was 45.8% with sedation and 82.5% with general anesthesia. In multivariate analysis, a Boston scale score ≥ 6 (OR: 5.6) and the use of general anesthesia (OR: 11.7) were significantly associated with a higher likelihood of ileal intubation.

Conclusions: Our findings suggest that optimizing bowel preparation and the use of general anesthesia can significantly improve ileal intubation rates, contributing to compliance with international quality standards and more efficient use of hospital resources.