Quality of Colonoscopy Performance Among Gastroenterology and Surgical Trainees: Is There a Need to Standardise Endoscopic Training?

Abstract

Introduction: Caecal intubation and polyp detection rates are objective measures of colonoscopy performance. Minimum caecal intubation rates greater than 90% have been endorsed by the ASGE/ACG. Methods: Colonoscopies performed by unsupervised Gastroenterology and Surgical Fellows between 7/2006 and 6/2007 were identified; completion rates and polyp detection rates for endoscopists performing more than fifty procedures were audited. Insertion and withdrawal times were prospectively recorded in a representative subset of 140 patients. Results: 1889 unsupervised colonoscopies were performed by Fellows over this period; 1178 (67%) by four Gastroenterology Fellows [GF] and 711 (33%) by four Surgical Fellows [SF]. Completion rate was 80% overall; 75% for SR and 83% for GF (p < 0.001 vs SF). Completion rate for outpatient procedures only was 86%; 89% for GF and 81% for SF. Polyp detection rate was 17% for SR, 23% for GF (p = 0.029 GF vs SF). Completion rates and polyp detection rates in the subset of 115 procedures (GF 63, SR 52) were similar to those observed in the larger cohort. Median insertion (9 and 8 min respectively) and withdrawal (2.5 and 5 min respectively) varied among SR and GF. The difference in withdrawal times between SR and GF was statistically significant (p = 0.003). Polyp detection closely correlated with withdrawal times (r = 0.99) Discussion: The observed disparity in endoscopic performance among Gastroenterology and Surgical Fellows illustrates the need for greater uniformity in endoscopic training. Recommended international minimum caecal intubation rates were not met. These findings have important implications for provision of services for colon cancer screening and surveillance.