"Technical competence in performing screening and diagnostic colonoscopies is achieved only after participating in at least 150 cases, according to a report in the April issue of
Gastrointestinal Endoscopy."Qualified colonoscopic examination is important, because there is a chance of missed lesions. This is well known, as 21 per cent of whole polyps, regardless of size, albeit only few significant polyps, are missed," Dr. Dong Soo Han from Hanyang University, Kuri, Korea told Reuters Health. "Therefore, the first colonoscopy in life should be done by a qualified colonoscopic examiner."
Dr. Han and associates sought to determine the adequate level of training in colonoscopy by using various measures for technical competence in screening and diagnostic colonoscopy.
Gastrointestinal fellows reached the requisite standard of competence (performing cecal intubation in less than 20 minutes) after 150 procedures, the authors report, after which there was only a slow improvement.
The time to cecal intubation decreased from 11.16 to 8.39 minutes after 150 procedures and improved continuously thereafter, the report indicates.
The polyp detection rates did not significantly change during the training period, the researchers note.
In a multivariate analysis, elderly patients, female sex, low body-mass index, poor bowel preparation, poor American Society of Anesthesiologists status, abdominal pain, and low case volume were associated with prolonged cecal intubation beyond 20 minutes.
Attendance at a seminar and experience with esophagogastroduodenoscopy and sigmoidoscopy during the early phase of training (but not after 150 procedures) were associated with a lower likelihood of prolonged cecal intubation, the investigators say.
"The quality-assured colonoscopic examination needs to be trained over 150 procedures under supervision," Dr. Han concluded.
"My co-authors and I are going to measure the relationship between withdrawal time, techniques, and patient discomfort scale and other quality index of colonoscopic procedure, especially adenoma detection rate and learning curve after correction of sufficient withdrawal time," Dr. Han added."
