Abstracts

of the two groups, as shown in the table. Multivariable regression analysis revealed
that the only predictors of having an adenoma were male sex (OR Z 1.5, p!0.0001)
and age (OR Z 1.2 for every 5 year increment in age, p !0.0001). Conclusions: In
this large safety net hospital, lower SES, as measured by insurance type was not
associated with poorer bowel preparation or lower ADR. These data suggest that
ADR benchmarks do not need to be risk-adjusted based on SES or insurance type.
Greater access to colonoscopy by lower SES individuals is likely to result in substantial rates of adenoma detection and removal.

Comparison of Patients by Insurance Type

Variable
N
Percent male
Mean age (yr)
Fellow involvement
Completion Rate*
Prep Quality
Poor
Fair
Good/Excellent
ADR
Overall
Men R 50 yr
Women R 50 yr
Screening only
Surveillance only
Fecal occult blood
Mean number of polyps

Public Assistance

Private Insurance

2,378
42.9%
56.6
22.2%
96.7%
2.3%
8.0%
89.8%
33.8%
42.4%
32.8%
40.3%
40.8%
39.9%
1.48

1,052
40.2%
58.3
23.5%
96.2%
2.1%
8.1%
89.8%
32.1%
41.4%
30.0%
36.4%
46.4%
32.9%
1.48

.14
!.01
.41
.48
.82
.36
.80
.26
.40
.27
.19
.93

*Completion rate excludes obstructing mass, severe coliits, or poor prep where
completion was not attempted

Sa1418
Quality Requirements for Colonoscopy: Which Factors Inuence
the Cecal Intubation
Barbara V. Krevelen*, Claudia Verveer
Gastroenterology, Ikazia Hospital, Rotterdam, Netherlands
Introduction: In 2014 a nationwide bowel cancer screening starts in the Netherlands.
People aged between 55 and 75 years old will be screened every two years with an
immunochemical faecal occult blood test (iFOBT). When the test is positive a colonoscopy will be offered. The Dutch National Institute of Safety en Environment (RIVM)
has high quality standards for these colonoscopies, with a cecal intubation rate of at
least 90%. The average cecal intubation in the Ikazia Hospital in 2011 was 89,1%. The
purpose of this study is to identify factors that have a negative inuence on the cecal
intubation. Methods: Between November 1st 2012 en October 15th 2013 we included
1865 colonoscopies performed by gastroenterologists, surgeons, an internist and a
physician assistant. Exclusion criteria were emergency colonoscopies, colonoscopies
with general anesthetics, colonoscopies through the stoma, ASA- V classied patients,
patients younger then the age of 17 and colonoscopies performed by fellows. Characteristics of patients, clinical examination and endoscopist data were collected. Bi- and
multivariate analyses were performed. Results: In these 1865 colonoscopies a cecal
intubation rate of 93,5% was achieved. Patient related characteristics that independently correlated with cecal intubation were higher age (p!0.001) and ASA-classication (p!0.001). Examination related factors that correlated with cecal intubation were
the indication for colonoscopy, the diagnosis, the Gloucester comfort score and the
bowel preparation score. Good bowel preparation was associated with higher cecal
intubation compared with ill bowel preparation (p!0.001). Also the patients comfort
is associated with cecal intubation (p!0.001), as well as the indication for colonoscopy
(p!0.001) and the diagnosis (p!0.001). Endoscopist related variables such as experience (in years), the number of colonoscopies performed and the physicians background were also independently correlated with cecal intubation. The cecal intubation
is higher when physicians perform more colonoscopies (p!0.001). The multivariate
analysis shows that the bowel preparation is the strongest predictor of cecal intubation
(OR 143,4). Also the patints comfortscore is a signicant predictor (OR, 027), as well
as the diagnoses tumor (OR 21,4),diverticulosis/itis (OR 4,2) and the number of colonoscopies performed by endoscopists during this trial (OR 0,992). Conclusion: This
study shows that patients characteristics and examination related variables are associated (related) with cecal intubation rate. In addition there are also endoscopist related
factors that are associated with cecal intubation.

Sa1419
Impact of Education on Improving Documentation of Quality
Indicators in Colonoscopy Reports
Shreyas Saligram*, Diego Lim, Benjamin R. Alsop, Bhairvi Jani, Ajay Bansal,
Amit Rastogi
Gastroenterology, Kansas university of medical center, Kansas city, MO
Background: Several quality indicators of colonoscopy have been established. Their
documentation in the colonoscopy report serves as a marker for the quality of co-

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lonoscopy performed, and also as supporting evidence for defense in medico-legal

cases. Lack of proper documentation despite conducting a high quality colonoscopy,
can be used to insinuate the endoscopist of poor quality exam leading to unfavorable judgement. Aim: To assess the documentation of the quality indicators of colonoscopy in the procedure reports and the impact of an educational session on
improving this documentation. Methods: We reviewed consecutive colonoscopy
reports over a 3 month period to evaluate the documentation of the proposed
quality indicators of colonoscopy - 1) indication, 2) consent, 3) quality of bowel
preparation, 4) cecal landmarks, 5) photo documentation of cecum, and 6) withdrawal time. We also calculated the cecal intubation rates and the adenoma detection rates (ADR) as actual measures of the quality of colonoscopy. A formal
presentation was then made in a weekly conference enumerating the different
quality indicators and emphasizing the importance of their documentation.
Following this, we reviewed the colonoscopy reports prospectively for next 3
months for all the above variables. Documentation of the quality indicators before
and after the educational session was compared by Fishers exact test and a p value
of ! 0.05 was considered signicant. Results: 962 consecutive colonoscopies performed by 4 GI attendings with or without a trainee, over a 6 month period were
included. The mean age of subjects was 63 years and 96% of them were males. 485
procedures were performed before and 477 after the educational intervention.
Documentation of the indication of the procedure, consent for the procedure and
quality of bowel prep was very high and similar in both the pre and post education
groups (Table 1). The documentation of cecal landmarks and withdrawal time was
low in the pre-educational group - 20.5% and 0.2% respectively. This improved
signicantly to 59.3% and 68.5% respectively in the post-education group. The cecal
intubation rates were very high and similar in the pre and post education groups
(98.7% vs 98.3%; p Z 0.11). Similarly, the ADR were similar and exceeded the
recommended thresholds in both pre and post education groups (58.9% vs 58.9%; p
Z 0.98). Conclusion: Despite performing high quality colonoscopy as evidenced by
the high cecal intubation rates and high adenoma detection rates in the pre-education group, the documentation of some of the quality indicators of colonoscopy
was suboptimal. A short educational session led to a signicant improvement in the
documentation. However, further reinforcement may be necessary to achieve a
100% compliance with the documentation of quality indicators.

Table 1 Documentation of the Quality Indicators of Colonoscopy

Pre-education
Group N [ 485

Post-education
Group N [ 477

pvalue

Indication
Consent for the procedure obtained
Quality of bowel preparation
Cecal landmarks

485 (100%)
485 (100%)
481(99.1%)
98 (20.5%)

477 (100%)
477 (100%)
476 (99.7%)
279 (59.3%)

Photo documentation of the cecum

Withdrawal time

381(78.5%)
1 (0.2%)

393 (82.3%)
327 (68.5%)

472/478 (98.7%)

462/470 (98.3%)

NS
NS
0.18
!
0.001
0.13
!
0.001
0.11

286 (58.9%)
280 (60.3%):6 (30%)

281 (58.9%)
273 (59.7%): 8 (40%)

0.98
0.49

Quality Indicator

Cecal intubation rate (excluding patients

with right hemicolectomy)
Adenoma detection rate
Adenoma detection rate (male: female)

Sa1420
Can the Use of Endoscopy Report Writers Improve the Quality of
Colonoscopy?
Zeid F. Karadsheh*, Diana Winston, Sanjay Hegde, Harmony Allison
Division of Gastroenterology, Tufts Medical Center, Boston, MA
Background: Colorectal cancer (CRC) is the 2nd leading cause of cancer related
death in the U.S. [1]. Colonoscopy is the preferred screening method for CRC.
The effectiveness and safety of colonoscopy depends on the quality of the exam,
which can vary among endoscopists [2]. The American Society of Gastrointestinal
Endoscopy (ASGE) and the American College of Gastroenterology (ACG) task force
in 2006 proposed 14 quality indicators for colonoscopy to dene areas for quality
improvement [2]. Reporting on those measures can promote improvement in
quality and outcomes and reduce healthcare cost. Endoscopy report writers ("endowriters") are software that create and save reports, images, and videos and may be
used as a practice management tool [3]. Endowriters can assist with accurate and
timely collection of endoscopic quality indicators data [4]. Aim: To evaluate available
endowriters and determine their ability to meet the ASGE/ACG proposed quality
measures. Method: Data were collected through phone calls and meetings with
software representatives. Results: We reviewed 6 endowriters via phone calls (nZ1)
and face-to-face meetings (nZ5). Of the 14 quality markers proposed by the task
force, all endowriters reported on 8 measures (57.1%) which included 1-indication
of the procedure, 2-informed consent, 3-quality of bowel prep, 4-cecal intubation
with photodocumentation, 5-adenoma detection, 6-withdrawal time, 7-perforation
rate and 8-postpolypectomy bleeding. The use of recommended postpolypectomy
and post cancer resection surveillance was reported on by 3/6 endowriters. The
remaining 5 measures, which include: 1-the use of recommended inammatory
bowel disease (IBD) surveillance, 2-obtaining biopsies in patients with chronic
diarrhea, 3-number and distribution of biopsies in patients with IBD, 4-endoscopic

Volume 79, No. 5S : 2014 GASTROINTESTINAL ENDOSCOPY AB205