Limited Formal Training in Optically-enhanced Endoscopy: A Single Center Survey Analysis

Abstract

Purpose: Colonoscopy is the gold standard screening modality for colorectal cancer but miss rates up to 25% have been reported. Novel technologies assist real-time polyp histology evaluation such as confocal endomicroscopy and endocytoscopy along with the contemporary NBI, I-Scan and FICE functions. The aim of this survey was to investigate trainee fellow exposure and demand of novel optically-enhanced endoscopy (OEE) techniques. Methods: A 10-question web-based survey was distributed to 34 gastroenterologists (17 fellows and 17 attendings) at a university-based gastroenterology program. Each of the survey participants have experience in performing screening colonoscopy and polyp evaluation but variable experiences with OEE. Results: We received a 74% overall response rate which included 15 fellows and 9 attending physicians. The GI trainee response rate was 94% and the attending response rate was 53%. The trainees comprised six physicians in their first year, four in their second year, and six in their third year. Overall, 68% of the survey participants reported a cecal intubation rate >90%, and in 88% an estimated cecal withdrawal times greater than 6 minutes. Forty percent of the survey reported high confidence in classifying polyps as hyperplastic or adenomatous. A total of 68% reported limited formal training with OEE either during GI training or as part of continued medical education. An overall 80% of respondents felt formal training in these modalities would be useful; since only 40% currently utilize these techniques in polyp evaluation. Predictably, attendings characterized polyp histology with a higher confidence than fellows (78% vs. 19%). Only 31% of the trainee fellows reported significant formal exposure to OEE but 63% use these technologies to assist polyp evaluation. These values were similar for attending physicians with one-third reporting formal training in OEE and nearly two-thirds utilizing these technologies in polyp evaluation. Overall, 75% of fellows reported formal training in these technologies would be useful in their training and 89% of the experienced attending physicians stated that formal training in these technologies would be useful. Conclusion: A majority of GI trainees and GI attendings surveyed reported limited formal training in OEE techniques and believe that formal training in these technologies would be useful during GI fellowship. The limitations of this study include its single institution, survey-based format, and lack of correlation between self-reported polyp characterization confidence and technology utilization rates with actual clinical encounters. Further studies are needed to explore the learning curve for novel endoscopic technologies and the role of these technologies in GI fellowship training.Table: Table. Survey demographics and response rate