Quality indicators in pediatric colonoscopy in a low-volume center: Implications for training

Table 1 Indications, diagnoses and quality indicators in 121 children who had 177 colonoscopies

	n	%
Sex, males	74	61
Age in yr, median ± SD	7.5 ± 4.5
Concomitant esophagogastroduodenoscopy	81	67
Indications, n = 1211
Suspected of inflammatory bowel disease, new patients	36	30
Per rectal bleeding/investigations of anemia	25	21
Investigation of gastrointestinal symptoms	21	17
Assessment of inflammatory bowel disease, diagnosed elsewhere	16	13
Suspected of colonic polyps	7	6
Exclusion of graft-versus-host disease or colonic malignancies	7	6
Assessment of failure to thrive/malabsorption	4	3.3
Others	10	8
Colonoscopic diagnosis, n = 121
Crohn’s disease	30	25
Ulcerative colitis	20	17
Non-specific colitis or solitary rectal ulcer syndrome	22	18
Infective colitis	9	7
Colonic polyps	8	7
Graft-versus-host disease	5	4
Malabsorption	2	2
Allergic colitis	2	2
Miscellaneous diagnosis	5	4
No diagnosis	18	15
Extent of colonoscopic examination, 177 colonoscopies
Terminal ileum	96	54
Cecum	38	21
Ascending colon	9	5
Transverse colon	13	7
Descending colon	12	7
Sigmoid colon	7	4
Rectum	1	0.6
Reached cecum but no terminal ileum intubation	134	76
Ileal intubation not intended, 177 colonoscopies2	36
Not indicated	18
Distorted anatomy due to previous surgery	1
External stricture	2
Previous colostomy in Crohn’s disease	4
Large polyp at rectum	2
Risk of perforation outweighs benefit of full examination due to	5
Severe colitis
Poor bowel preparation	4
Full colonoscopic examination intended, 177 colonoscopies2	141
Ileal intubation	96	68
Cecum examination	134	95

¹Some patients had more than one indication;

²Not intended include not indicated, not feasible or the risks of full examination outweigh the benefit of full examination.

Table 2 Colonoscopic performance by trainees

	Trainee A	Trainee B	Trainee C	Trainee D	Average
Duration of training in mo	18	18	24	18	19.5
Number of colonoscopies performed during training period	19	17	44	36	29
Number of colonoscopies where intubation of terminal ileum was intended	16	13	39	28	24
Intubation of terminal ileum	12 (75)	10 (77)	34 (87)	18 (64)	77%
Examination of cecum and terminal ileum	16 (100)	13 (100)	38 (97)	26 (93)	97%

Data are presented as n or n (%), unless otherwise indicated. Note: In colonoscopies where trainees encountered technical difficulties during the procedure and were subsequently taken over by the consultant, the procedures were logged as performed by the consultant.