Impact of sedation on the Performance Indicator of Colonic Intubation (PICI)

<jats:p>Background: Performance Indicator of Colonic Intubation (PICI) has been introduced as new measure of high-quality colonic intubation. Adequate PICI was defined as cecal intubation without significant discomfort and use of minimal sedation. In a UK national audit, adequate PICI was achieved in 54.1% of colonoscopies and associated with higher polyp detection rates. In this study, achievement of PICI was assessed within the Dutch colorectal cancer (CRC) screening program and the association between PICI and the adenoma detection rate (ADR) was determined. Furthermore, we assessed the achievement of the performance indicator using the Dutch median midazolam dose. Methods: This retrospective study was conducted within the Dutch FIT-based CRC screening program. Colonoscopy and pathology data were prospectively collected in a national database. Data between 01-01-2016 and 01-01-2018 were analyzed. Adequate PICI was defined as successful cecal intubation, Gloucester Comfort Scale (GCS) between 1 - 3 and use of ≤ 2.5 mg midazolam. Results: During the study period, 107.328 colonoscopies were performed. Adequate PICI was achieved in 49.500 (46.1%) colonoscopies. In the colonoscopies with inadequate PICI, this was due to higher sedation dosages in 87.8%. Adequate PICI was associated with higher ADR (OR: 1.16; 95%CI: 1.12-1.20). When using a cut-off of 5 mg midazolam, median dose in this Dutch population, adequate PICI was achieved in 95.410 colonoscopies (88.9%). Conclusion: PICI appears to be an indicator that is heavily dependent on sedation practice. Because of wide variation in sedation practice between individual endoscopists and countries, the benefit of PICI as quality indicator is limited. </jats:p>