{
  "abstract": "Background Completion of colonoscopy, defined by caecal intubation, is a key performance indicator in lower gastrointestinal endoscopy. The British Society of Gastroenterology (BSG) recommends a caecal intubation rate of ≥90% for standard practice. Completion may be influenced by patient characteristics, operator factors, and procedural practices such as sedation use. We aimed to identify potential factors that could be modified to improve caecal intubation.Methods We performed a retrospective multicentre analysis of diagnostic colonoscopies across three South Yorkshire centres over a five-year period. Completion was defined as successful caecal intubation. Patients were stratified by age (<70 vs ≥70 years). Multivariable logistic regression was used to assess independent associations between completion, patient age, operator role (gastroenterologist, surgeon, nurse endoscopist), and sedation use (midazolam and fentanyl).Results A total of 32,088 diagnostic colonoscopies were analysed (52.7% female; median age 61 years, IQR 49–71). Sedation use increased marginally following Introduction of BSG sedation guidance, with midazolam used in 34.6% vs 32.9% (p<0.001) and fentanyl in 37.4% vs 33.7% (p<0.001) of procedures . Patients aged ≥70 years were less likely to receive sedation and received lower doses of both midazolam and fentanyl (p<0.001).Caecal intubation rates were lower in patients aged ≥70 years compared with younger patients (88.2% vs 92.6%, p<0.001). Completion also differed by operator group, with gastroenterologists achieving the highest rates, followed by surgeons and nurse endoscopists (93.9% vs 92.5% vs 88.2%, p<0.001). The use of midazolam was higher in medical physicians, compared to surgeons and non-medical endoscopists (35.5% vs 30.7% vs 34.8%, p<0.001) as was the use of fentanyl (38.5% vs 36.2% vs 31.6%, p<0.001). Non-medical endoscopists used less midazolam than doctors and surgeons (1.5mg, SD:0.5mg vs 1.7mg, SD:0.5mg vs 1.7mg, SD:0.5mg, p<0.001) and less fentanyl (49.3mcg, SD:14.8mcg vs 60.4mcg, SD:21.7mcg vs 57.7mcg, SD: 19.1mcg, p<0.001). Although sedation practice varied between operator groups, neither midazolam nor fentanyl use was independently associated with increased likelihood of caecal intubation (p=0.70 and p=0.85, respectively).Conclusion Completion of diagnostic colonoscopy is influenced primarily by patient age and operator background rather than sedation practice. While completion rates were high overall, modest variation was observed between operator groups, with nurse endoscopists achieving slightly lower caecal intubation rates. Sedation dose did not independently improve caecal intubation, whereas older age was associated with lower completion rates. These findings highlight operator experience and patient factors as key determinants of colonoscopy success and identify potential areas for targeted quality improvement.",
  "authors": [
    {
      "affiliations": [
        "Sheffield Teaching Hospital, Sheffield, United Kingdom"
      ],
      "name": "Kennedy Edwards"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Doncaster Royal Infirmary, Doncaster, UK"
      ],
      "name": "Niamh Louwman"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Doncaster Royal Infirmary, Doncaster, UK",
        "Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK"
      ],
      "name": "Suneil A Raju"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Doncaster Royal Infirmary, Doncaster, UK"
      ],
      "name": "Sampath Kumar"
    }
  ],
  "title": "P357 Factors influencing caecal intubation during diagnostic colonoscopy: a multicentre UK study",
  "uid": "718da056-ebcd-55b9-b09f-11a8031cf35f"
}