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Study finds that competency in colonoscopy requires experience with 150 cases or more
Date:4/23/2008

ved significantly after performing 150 procedures.

Patients and Methods

A prospective study was conducted at 15 tertiary care academic medical centers over eight months from June 2006 to January 2007. The study included 4,351 colonoscopies. There were 2,500 male patients and 1,851 female patients with a mean age of 51 years. A total of 24 first-year gastrointestinal (GI) fellows (trainees) participated in the study. The starting level of training was based on the observation of colonoscopies performed by seniors (at least 50 cases); training included an understanding of indications, performance of procedures, patient monitoring, use of sedatives and analgesics, interpretation of findings and avoidance of complications.

Colonoscopies were carried out by using the single-handed technique, unaided by radiographic screening or a variable-stiffening colonoscope. The instructor allowed trainees 30 minutes to reach the cecum, if the procedure was being performed safely and the patient was comfortable. Cecal intubation was documented by photographing the identified cecal landmarks, including the appendiceal orifice and the ileocecal valve. Success rates were based on adjusted completion rate greater than 90 percent and cecal intubation time, less than 20 minutes. Polyps greater than 5 mm were recorded. The trainees learning curve was calculated in consecutive blocks of 50 procedures.

During a colonoscopy, the ability to reach and examine the cecum is an obligatory measure of competence. Trainees, however, may confuse the flexure (or bend of the colon) with the cecum. This study considered the cecum reached only if cecal landmarks (appendiceal orifice and ileocecal valve) were clearly identified with electronic photography.

Cecal intubation rates above 90 percent are a goal of training. Mean cecal intubation time by experienced endoscopists has been reported at between 10 and 20 minutes. Another measure that could b
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Contact: Anne Brownsey
abrownsey@asge.org
630-570-5635
American Society for Gastrointestinal Endoscopy
Source:Eurekalert

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