What are the sensitivity and specificity of endoscopic photographs in determining completion of colonoscopy? Results from an online questionnaire.

OBJECTIVES: There is no consensus as to the optimal method for documenting colonoscopy completion. For endoscopic photographs to be useful for documentation, reviewers must be able to distinguish between photographs taken from incomplete and complete colonoscopy. The primary aim of this study was to calculate the diagnostic specificity and sensitivity of a pair of photographs in confirming complete colonoscopy. The secondary aim was to assess current methods of documenting colonoscopy completion.
METHODS: Eighty pairs of photographs were taken from completed colonoscopies. Two photographs, including at least one view of the ileo-caecal valve, were taken of caecal landmarks and/or the terminal ileum. Colonoscopy completion was independently validated using video clips. Twenty pairs of photographs were also taken from another colonic site that could potentially be misinterpreted as the caecum, for example, hepatic flexure. Using an online questionnaire 34 experienced endoscopists were asked about their own methods of colonoscopy documentation. Thirty-two of these reviewers then assessed the 100 photographic pairs, blinded to their origin, and were asked 'Taking both photographs into account, are you convinced that complete colonoscopy has been performed?'
RESULTS: Fifty-six percent of endoscopists did not routinely use any objective method of documentation although 38% frequently used some photographs for documentation. Using a pair of endoscopic photographs to document colonoscopy completion has a sensitivity of 51.4% (confidence intervals: 49.5-53.3%) and a specificity of 89.2% (confidence intervals: 86.8-91.6%).
CONCLUSION: Both the sensitivity and the specificity of a pair of endoscopic photographs are too low to be used for reliably documenting colonoscopy completion.