Still photography versus videotaping for documentation of cecal intubation: a prospective study

Background: Documentation of cecal intubation is important for credentialin g and continuous quality improvement. However, convincing cecal photographs can be difficult to obtain. The aims of the study were to determine (1) th e anatomic variations and photographic factors associated with convincing c ecal photographs; (2) whether a prospective attempt to capture specific fea tures resulted in more convincing photographs; and (3) how a prospective at tempt at capturing convincing cecal features during still photography compa res with videotaping as a method of documenting cecal intubation. Methods: A single examiner evaluating 165 consecutive patients photographed the entire cecum from just distal to the ileocecal valve, the appendiceal orifice, the ileocecal valve orifice, and in the last 110 consecutive cases , the terminal ileum, if it could be intubated. The photographs were then s cored by 8 experts according to how convinced they were that cecal intubati on had occurred. Features associated with high and low scores were determin ed, and 50 additional consecutive patients were photographed with a specifi c effort to capture these features, along with videotaping of the cecum. Th ese photographs and videotapes were then scored by 7 of the 8 experts on a scale of 1 to 5, with 5 representing "definitely the cecum:" Results: There was marked variation in scores of still photographs among re viewers. A combination of photographs produced the highest mean score and t he highest percentage of scores that were either "probably" or "definitely" of the cecum. The photograph of the cecum from just distal to the ileoceca l valve was most convincing and the terminal ileum photograph was least con vincing. In the 50 cases in which an attempt was made to capture specific f eatures, mean scores improved for the overall cecal photograph by 0.10, the appendiceal orifice by 0.23, the ileocecal valve lips by 0.20, and the ter minal ileum by 0.19. The cecum, appendiceal orifice, valve lips, and termin al ileum photographs for the last 50 patients were scored higher than those from the first 165 patients by 4, 4, 4, and 5 reviewers, respectively. Vid eotapes were consistently convincing (overall mean score 4.78 out of 5) and were scored more convincing than the combination of still photos from the final 50 cases by 6 of 7 reviewers. Conclusions: Still photography of the cecum can be improved somewhat by att empting to capture specific cecal features. However, because of anatomic va riation among normal individuals, still photography remains inconsistently convincing. A combination of photographs is most convincing. Videotaping of the cecum is consistently convincing and would appear to serve effectively as a means of documenting cecal intubation rates for the purposes of conti nuous quality improvement and credentialing.