ASGE-ESGEQuality Indicators for Colonoscopy
Quality Processor
Provide total counts to determine Caecal Intubation Performance Metrics.
Guidelines & Evidence
Verified
Last Review: 2026-07-17
When to Use
When to Use
Endoscopy quality assurance for colorectal cancer screening programs
To benchmark individual endoscopist technical skill and completeness
To ensure the entirety of the colon has been inspected for precancerous lesions
Used as a threshold requirement for credentialing and "Global Rating Scale" (GRS) assessment
Definition of Success
Caecal intubation is defined as the passage of the colonoscope tip to a point proximal to the ileocaecal valve, such that the entire caecal caput (including the medial wall and the appendiceal orifice) is visualized.
How it Works
Standard Benchmarks (ASGE/ACG)
| Screening Colonoscopy | ≥ 95% |
| All Colonoscopies (Overall) | ≥ 90% |
Proof of Intubation
01
Photographic Documentation: Most quality guidelines require photos of the appendiceal orifice AND the ileocaecal valve.
02
Terminal Ileum Intubation: While not mandatory for CIR, intubation of the terminal ileum (TI) is the "definitive" proof of caecal intubation and should be performed if diagnostic (e.g., suspicious for IBD).
Excludable Failures
Inadequate bowel preparation hindering visualization
Severe obstructing lesions (e.g., cancer, severe stricture)
Technical defect (scope failure)
Clinical Pearls
The Risk of Incompleteness
The colonoscopist's CIR is inversely correlated with the risk of "Interval" Right-Sided Colorectal Cancer. A CIR < 90% is typically associated with a significantly higher rate of missed adenomas in the caecum and ascending colon due to poor technique or premature termination of the exam.
Factors Affecting CIR
Poor Bowel Prep — the leading modifiable reason for failure
Patient Anatomical Factors — redundant colon (extra loops), prior pelvic surgery (adhesions)
Sedation Policy — adequate conscious sedation or propofol improves success in "difficult" anatomy
Advanced Techniques — use of water immersion/exchange, paediatric colonoscopes, or magnetic scope trackers
Next Steps
Management of Incomplete Exam
01
Reason: Poor Prep. Action: Repeat after aggressive 2-day prep clearing.
02
Reason: Anatomical Complexity. Action: Repeat with propofol, use a thin scope, or refer to an expert in difficult intubation. Consider Computed Tomography Colonography (CTC).
03
Reason: Obstructing Lesion. Action: Immediate staging and surgical/oncology referral.
Complementary Performance Metrics
Adenoma Detection Rate (ADR) Benchmark
Boston Bowel Prep Scale (BBPS)
Withdrawal Time (WT) Benchmark
The Evidence
Primary Quality Standard
Quality indicators for colonoscopy.
Rex DK et al. • Gastrointestinal Endoscopy. 2015;81(1):31-53. ACG-ASGE Task Force establishing the 95% target.
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Origins & History
The Shift to Quality Analytics
Caecal intubation was once considered a "personal" skill badge, but was transformed into a regulated quality benchmark in the late 1990s as colorectal cancer screening became a public health priority. It is now a core requirement for any accredited endoscopy center.
Last Comprehensive Review: 2026-07-17