Cecal and ilial intubation rates in colonoscopy: Comparative study Cecal and ilial intubation rates in colonoscopy: Comparative study

Main Article Content

Osamah Tahir Muslim
Hasan Osamah Al-Obaidi



Background: Colonoscopy is the procedure of choice for both the diagnosis and treatment of large intestine and distal ilium in patients complaining of bowel symptoms, anemia resulting from malabsorption, radiographic colon abnormalities, screening for colorectal carcinoma, after polypectomy and cancer resection surveillance, ulcerative colitis surveillance, and those with suspicion of neoplastic masses. Inspection
of the whole colonic and distal portion of terminal ilial mucosa is usually feasible during colonoscopy. Quality examination of the large bowel includes intubation of the complete colon and mucosal visualization. The investigators demonstrate that terminal ilium intubation is possible in endoscopy practice and yields additional clinical details. Furthermore, it may be used as an indicator of colonoscopy completion.
Objectives: This study estimated the rate of cecal and ilial intubation by a single well-trained endoscopist and compared it with the results of a heterogeneous group of endoscopists.
Patients and Methods: This retrospective comparative study estimates the rate of cecal and ilial intubation in a private endoscopy center in which all the endoscopic procedures were conducted by a single consultant gastroenterologist, and compared it with the rates of a governmental center with by five colonoscopy endoscopists (general surgeons, general physicians, trained endoscopists, and gastroenterologists). The study population included 442 patients (245 males [55.42%] and 197 females [44.58%], ranging from 14 to 85 years of age.
Results: Overall cecal and ilial intubation rates were 88% and 47.5%, respectively. The adjusted rates for cecal and ilial intubations were 94.2% and 50.8%, respectively, after considering cases of anatomic colonic obstruction and when the clinical indications do not justify total colonic intubation. These figures were superior in comparison to the results of a multi-operator study in which the cecal- and the ilial intubation
rates were 51.81% and 30.69%, respectively.
Conclusion: Cecal and ilial intubation are important quality indicators for colonoscopy, and in this study, they were found to be superior in qualified gastroenterologists than in general surgeons and physicians. This outcome points to the importance of providing endoscopy units in Iraq, with qualified well-trained endoscopy personnel.

Abstract 337 | PDF Downloads 256 XML Downloads 92 HTML Downloads 196


1. Rex DK, Petrini JL, Baron TH, Chak A, Cohen J, Deal SE, Hoffman B, Jacobson BC, Mergener K, Petersen BT, Safdi MA, Faigel DO, Pike IM; ASGE/ACG Taskforce on Quality in Endoscopy.Am J Gastroenterol. 2006 Apr;101(4):873-85.
2. Peery AF, Dellon ES, Lund J Et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology 2012; 143:1179–1187.
3. McLachlan SA, Clements A, Austoker J. Patients' experiences and reported barriers to colonoscopy in the screening context—a systematic review of the literature. Patient Educ Couns 2012; 86:137–146.

4. Harewood GC, Sharma VK, de Garmo P. Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia. Gastrointest Endosc 2003; 58:76–79.

5. Froehlich F, Wietlisbach V, Gonvers JJ et al. Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study. Gastrointest Endosc 2005; 61:378–384.

6. Rex DK, Imperiale TF, Latinovich DR et al. Impact of bowel preparation on efficiency and cost of colonoscopy. Am J Gastroenterol 2002; 97:1696–1700.

7. Rex DK. Colonoscopic withdrawal technique is associated with adenoma miss rates. Gastrointest Endosc 2000; 51:33–36.

8. Lee RH, Tang RS, Muthusamy VR et al. Quality of colonoscopy withdrawal technique and variability in adenoma detection rates (with videos). Gastrointest Endosc 2011; 74:128–134.

9. Barclay R, Vicari JJ, Johanson JF et al. Variation in adenoma detection rates and colonoscopic withdrawal times during screening colonoscopy [abstract]. Gastrointest Endosc 2005;61: AB107.
10. Sanchez W, Harewood GC, Petersen BT. Evaluation of polyp detection in relation to procedure time of screening or surveillance colonoscopy. Am J Gastroenterol 2004; 99:1941–1945.

11. Fatima H, Rex DK, Rothstein R et al. Cecal insertion and withdrawal times with wide-angle versus standard colonoscopes: a randomized controlled trial. Clin Gastroenterol Hepatol 2008; 6:109–114.
12. Simmons DT, Harewood GC, Baron TH et al. Impact of endoscopist withdrawal speed on polyp yield: implications for optimal colonoscopy withdrawal time. Aliment Pharmacol Ther 2006; 24:965–971.

13. Lim G, Viney SK, Chapman BA et al. A prospective study of endoscopist-blinded colonoscopy withdrawal times and polyp detection rates in a tertiary hospital. N Z Med J 2012; 125:52–59.

14. Lin OS, Kozarek RA, Arai A et al. The effect of periodic monitoring and feedback on screening colonoscopy withdrawal times, polyp detec tion rates, and patient satisfaction scores. Gastrointest Endosc 2010; 71:1253–1259.

15. Lieberman DA, Rex DK, Winawer SJ et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012; 143:844–857.
16. Kaminski MF, Regula J, Kraszewska E Et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 2010; 362:1795–1803.
17. Rubin CE, Haggitt RC, Burmer GC et al. DNA aneuploidy in colonic biopsies predicts future development of dysplasia in ulcerative colitis. Gastroenterology 1992; 103:1611–1620.
18. Jess T, Simonsen J, Jorgensen KT et al. Decreasing risk of colorectal cancer in patients with inflammatory bowel disease over 30 years. Gastroenterology 2012; 143:375–381.
19. Kiesslich R, Fritsch J, Holtmann M Et al. Methylene blue-aided chromoendoscopy for the detection of intraepithelial neoplasia and colon cancer in ulcerative colitis. Gastroenterology 2003; 124:880–888.

20. Rutter MD, Saunders BP, Schofield G et al. Pancolonic indigo carmine dye spraying for the detection of dysplasia in ulcerative colitis. Gut 2004; 53:256–260.

21. Wu L, Li P, Wu J et al. The diagnostic accuracy of chromoendoscopy for dysplasia in ulcerative colitis: meta-analysis of six randomized controlled trials. Colorectal Dis 2012; 14:416–420.

22. Chukmaitov A, Bradley CJ, Dahman B Et al. Association of polypectomy techniques, endoscopist volume, and facility type with colonoscopy complications. Gastrointest Endosc 2013; 77:436–446.

23.Osamah T. Muslim, Overview on colonoscopy in Al-Diwaniyah gastroenterology Center-Iraq; European Journal of Molecular & Clinical Medicine; Volume 07, Issue 11,2020.7418-7426
24. John B. Marshall, James S. Barthel; The frequency of total colonoscopy and terminal ileal intubation in the 1990s; gastrointestinal Endosc. Volume 39, Issue 4, 1993, Pages 518-520

25. Aslinia, Florence M.D.; Uradomo, Lance M.D., M.P.H.; Steele, Allison M.S.N., C.R.N.P.; Greenwald, Bruce D. M.D.; Raufman, Jean-Pierre M.D., F.A.C.G. American Journal of Gastroenterology: April 2006 - Volume 101 - Issue 4 - p 721-731.
26. Kundrotas LW, Clement DJ, Kubik CM, Robinson AB, Wolfe PA.
A prospective evaluation of successful terminal ileum intubation during routine colonoscopy. Gastrointest Endosc. 1994 Sep-Oct;40(5):544-6.
27. Ipek Sapci , Alexandra Aiello , Emre Gorgun , Maged Rizk , Conor P Delaney , Scott R Steele , Michael A Valente; Screening colonoscopy: High quality regardless of endoscopist specialty; Am J Surg
. 2019 Mar;217(3):442-444.