Photodocumentation of total colonoscopy: How successful are endoscopists? Do reviewers agree?

Background: Documentation of total colonoscopy usually rests on a statement in the endoscopy report indicating that cecal landmarks were visualized. We sought to determine whether providing photographs of cecal landmarks provided an objective marker of complete colonoscopy. Methods: We had 12 outside experienced endoscopists review 120 photographs of cecal landmarks that had been included with colonoscopy reports from our center that included 20 consecutive cases of reported total colonoscopy from each of 6 endoscopists. Reviewers graded whether they believed each set of photographs documented that at least the cecal inlet was reached as definite, probable, or uncertain. Results: There was considerable disparity among reviewers as to whether individual photographs documented total colonoscopy. The frequency of combined, definite, and probable scores that they gave for the 120 photographs ranged from 97% down to 44% (median 82%). Different endoscopists also seemed to be variably successful in photodocumenting total colonoscopy. Four of the endoscopists received definite and probable scores for their 20 cases at least 80% of the time (86% for the highest ranked endoscopist). The lowest ranked endoscopist received such scores just 64% of the time. Conclusions: Documenting total colonoscopy with static images of cecal landmarks is only partially successful as an objective measure of the extent of total colonoscopy.