PHOTODOCUMENTATION OF TOTAL COLONOSCOPY - HOW SUCCESSFUL ARE ENDOSCOPISTS - DO REVIEWERS AGREE

Background: Documentation of total colonoscopy usually rests on a stat ement in the endoscopy report indicating that cecal landmarks were vis ualized. We sought to determine whether providing photographs of cecal landmarks provided an objective marker of complete colonoscopy. Metho ds: We had 12 outside experienced endoscopists review 120 photographs of cecal landmarks that had been included with colonoscopy reports fro m our center that included 20 consecutive cases of reported total colo noscopy from each of 6 endoscopists. Reviewers graded whether they bel ieved each set of photographs documented that at least the cecal inlet was reached as definite, probable, or uncertain. Results: There was c onsiderable disparity among reviewers as to whether individual photogr aphs documented total colonoscopy. The frequency of combined, definite , and probable scores that they gave for the 120 photographs ranged fr om 97% down to 44% (median 82%). Different endoscopists also seemed to be variably successful in photodocumenting total colonoscopy. Four of the endoscopists received definite and probable scores for their 20 c ases at least 80% of the time (86% for the highest ranked endoscopist) . The lowest ranked endoscopist received such scores just 64% of the t ime. Conclusions: Documenting total colonoscopy with static images of cecal landmarks is only partially successful as an objective measure o f the extent of total colonoscopy.