Background: The primary aim of our study was to determine provider variation in diagnostic yield in a pediatric endoscopy center. Secondary aims were to examine ileal intubation rates as well as procedural complications at the provider level.
Methods: A retrospective review of sequential pediatric patients who underwent a colonoscopy, completed by June 2018, determined the rates of endoscopically abnormal (EA) and isolated histologically abnormal (IHA) colonoscopies; the overall diagnostic yield was the combination of EA and IHA.
Results: In total, 374 charts were reviewed. This study found high variability in diagnostic yield among the 16 clinicians ranging from as low as 22% to as high as 86% (p = 0.11) with an overall diagnostic yield of 48% for colonoscopy; excluding follow-up colonoscopies, the diagnostic yield was 42%. Abnormal calprotectin and abnormal blood tests were associated with higher diagnostic yields of 83 and 65%, respectively, compared with symptoms such as abdominal pain, diarrhea, and rectal bleeding which had yields of 39, 43, and 61%. Ileal intubation rates averaged 90% (range -63-100%, p = 0.06). In patients with a normal colon, there were 21 (6%) patients with an EA ileum and an additional 16 (4%) with an IHA ileum. Prep quality was rated excellent, good, or average in 97%. In addition, there was a low rate of serious complications (1 of 374).
Conclusions: This study highlights the individual variability in diagnostic yield and ileal intubation rates in a pediatric gastroenterology practice. Goals for pediatric endoscopy could include ileal intubation rates of >90% and provider diagnostic yields of >40%.
Keywords: Colonoscopy; Diagnostic yield; Ileal intubation; Provider variation.
© 2019 S. Karger AG, Basel.