Terminal ileum intubation is not associated with colonoscopy quality measures.

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BACKGROUND AND AIM:Intubation of the terminal ileum (TI) demonstrates a complete colonoscopy, but its clinical value during screening exams is unknown. We aimed to determine whether TI intubation during screening colonoscopy is associated with colonoscopy quality measures or identifies subclinical pathology. METHODS:We performed a retrospective cohort study examining average-risk screening colonoscopies performed at an academic health system between July 2016 and October 2017. Data were extracted from an internal colonoscopy quality registry and the electronic health record. Appropriate statistical tests were used for group comparisons, to correlate TI intubation rate (TIIR) with measures of colonoscopy quality and to examine factors associated with the likelihood of TI intubation. RESULTS:There were 7799 colonoscopies performed with adequate prep quality by 28 gastroenterologists. Most patients were female (56.4%) with a median age of 58. The median TIIR was 37.0%, with significant variability among physicians (2-93%). The detection rates for all polyps, adenomas, and sessile serrated polyps were 62.1%, 45.5%, and 7.2%, respectively, and none correlated with TIIR. Intubation of the TI was associated with significantly longer withdrawal times. In a random 10% sample of cases with TI intubation, no clinically significant pathology was found. CONCLUSIONS:There is wide variability in TIIR among endoscopists. Except to provide photodocumentation of exam extent when other images may be difficult to obtain, the lack of correlation between TI intubation and meaningful clinical outcomes together with the associated time costs suggest routine TI intubation during screening colonoscopy may not be warranted.





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Leiman, David A, Nicole G Jawitz, Li Lin, Richard K Wood and Ziad F Gellad (2020). Terminal ileum intubation is not associated with colonoscopy quality measures. Journal of gastroenterology and hepatology, 35(9). pp. 1503–1508. 10.1111/jgh.14997 Retrieved from https://hdl.handle.net/10161/21591.

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David Asher Leiman

Associate Professor of Medicine

Dr. Leiman is an Associate Professor of Medicine and gastroenterologist specializing in esophageal diseases and swallowing disorders, such as eosinophilic esophagitis (EoE), motility disorders such as achalasia, and gastroesophageal reflux disease (GERD) as well as its associated complications including Barrett’s esophagus (BE). His busy clinical practice dovetails with his academic focus on health services research, including patient outcomes and clinical quality measurement. He is also a PI for several ongoing multicenter clinical trials investigating novel therapies for EoE and GERD.

Dr. Leiman has mentored numerous medical students, residents, and GI fellows on research and quality improvement projects resulting in research awards, presentations at national meetings, and peer-reviewed publications.


Nicole Gong Jawitz

Assistant Professor of Medicine

Richard Kevin Wood

Associate Professor of Medicine

I am an academic esophagologist and medical educator.

I am the program director for the Gastroenterology and Hepatology Training Program at Duke.

My clinical area of specialty is in esophageal disorders.  I see patients with a wide range of esophageal problems including: gastroesophageal reflux diseaase (GERD); swallowing disorders; primary esophageal motility disorders including achalasia, esophageal spasm, and jackhammer esophagus; Barrett's esophagus; and Esophageal cancer.

I also practice as a general gastroenterologist and see patients for routine screening colonoscopies.


Ziad F. Gellad

Professor of Medicine

Dr. Gellad is an associate professor of medicine in the Division of Gastroenterology at Duke University Medical Center and the Chief of Gastroenterology at the Durham VA Health Care System.  His research focuses on quality of care in gastroenterology, with a particular focus on colorectal cancer screening. Dr. Gellad has also received several innovation grants to develop and implement novel information technology platforms to improve the patient and clinician experience.  He is also an active contributor to the innovation and entrepreneurship activities within Duke University and co-founder of a health technology startup in Durham, NC.

Dr. Gellad received his MD and MPH degrees from Johns Hopkins University.  He completed a residency in internal medicine and a fellowship in gastroenterology at Duke University Medical Center.   Dr. Gellad is past-chair of the Quality Measures Committee of the American Gastroenterological Association, associate editor for GI & Hepatology News and is on the Board of Editors for Clinical Gastroenterology and Hepatology.

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