A colonoscopy report that says "caecum reached, no polyps" records the outcome and none of the information the next endoscopist needs. What determines whether that finding can be trusted is the quality of the examination, and three things capture almost all of it.
Withdrawal time, measured from caecum to anus excluding polypectomy. Bowel preparation, scored segment by segment rather than called good or adequate overall - a right colon that was poorly prepared is where the flat serrated lesions are, and an overall score hides it. And an explicit note of any segment not adequately visualised, with what you propose to do about it.
This matters most for exactly the lesions that are hardest to see. Sessile serrated lesions are flat, pale, right-sided, and covered by a mucus cap that looks like residue. An interval cancer arising after a negative colonoscopy is far more often a missed lesion than a fast-growing new one, and the report is the only record of whether it could have been seen.
- Record withdrawal time from caecum, excluding time spent on polypectomy.
- Score bowel preparation by segment, not as a single overall judgement.
- State explicitly any segment not adequately seen, and the plan for it.
- Look for the mucus cap in the right colon - it is often the only sign of a serrated lesion.
- Photodocument the caecum and the rectum on retroflexion as a matter of routine.
Why it matters
Interval cancers are usually lesions that were there and not seen, and the report is the only evidence of whether seeing them was possible.
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