Course Of Colonoscopy Research Articles

Acute colonic flexures: the basis for developing an artificial intelligence-based tool for predicting the course of colonoscopy

Tortuosity of the colon is an important parameter for predicting the course of colonoscopy. Computed tomography scans of the abdominal cavity were performed in 224 (94 female, 130 male) adult subjects. The number of acute (angle not exceeding 90°) bends between adjacent colonic segments was noted and analyzed. Data were analyzed for correlation with gender, age, height and weight. An artificial intelligence algorithm was proposed to predict the course of colonoscopy. We determined the number of acute flexions in females to be 9.74 ± 2.5 (min–max: 4–15) and in males to be 8.7 ± 2.75 (min–max: 4–20). In addition, more acute flexions were found in women than in men and in older women (after 60 years) and men (after 80 years) than in younger ones. We found the greatest variability in the number of acute flexures in the sigmoid colon (0–9), but no correlation was found between the number of acute flexures and age, gender, height or BMI. In the transverse colon, older and female subjects had more flexures than younger and male subjects, respectively. Older subjects had more acute flexures in the descending colon than younger subjects. There are opportunities to use the number of acute flexures (4–7, 8–12, more than 12 flexures) to classify patients into appropriate risk categories for future incomplete colonoscopy. On this basis, we predicted troublesome colonoscopies in 14.9% female and in 6.1% male subjects.

TU6.6 The value of immersive endoscopy training for the surgical trainee

Abstract Aims Achieving endoscopic targets for CCT is problematic for General Surgery trainees. COVID-19 has negatively impacted all aspects of surgical training. Nationally, only 19% of colorectal trainees report completing 300 colonoscopies by CCT. We report on an immersive endoscopy training programme to achieve CCT targets. Methods To confirm reduced access to endoscopy, local General Surgery trainees (n=95) were invited to complete our survey assessing their endoscopic experience during their training to date. We compared the results to outcomes from a new 6-month immersive endoscopy programme. 2 out-of-programme (OOP) trainees; one had no endoscopy experience (completed core training; OOP 1); one had attempted 70 colonoscopies and 130 UGI endoscopies (ST4; OOP2). Results 42 trainees completed the survey (44% response rate), ranging from ST2-ST8 (74% ST2-ST6, 14% ST7/ST8, 12% OOP). UGI endoscopies attempted by all trainees: mean 119 (range 10–306). 55% had attended or secured a place on the JAG UGI endoscopy course. Colonoscopies attempted by all trainees: mean 67 (range 2–233). 45% having attended or secured a place on the JAG colonoscopy course. 29% of trainees anticipated not reaching target CCT endoscopy numbers. In comparison, in 6 months; OOP1 attempted 49 OGD, 199 colonoscopies with a place secured on colonoscopy course. OOP2 attempted 109 OGD and 216 colonoscopies with both courses completed. Conclusion Shortcomings in endoscopic training and courses, particularly for colonoscopy, have been confirmed. Implementation of immersion endoscopy training can achieve CCT target numbers and competency within a short time, irrespective of previous experience.

Impact of a national basic skills in colonoscopy course on trainee performance: An interrupted time series analysis.

BACKGROUNDThe Joint Advisory Group on Gastrointestinal Endoscopy basic skills in colonoscopy (BSC) course was introduced in 2009 to improve colonoscopy training within the United Kingdom, but its impact on trainee performance is unknown.AIMTo assess whether attendance of the BSC could improve colonoscopy performance.METHODSTrainees awarded colonoscopy certification between 2011-2016 were stratified into 3 groups according to pre-course procedure count (< 70, 70-140 and > 140). Study outcomes, comprising the unassisted caecal intubation rate (CIR) and the performance indicator of colonic intubation (PICI), were studied over the 50 procedures pre and post- course. Interrupted time series analyses were performed to detect step-change changes attributable to the course.RESULTSA total of 369 trainees with pre-course procedure counts of < 70 (n = 118), 70-140 (n = 121) and > 140 (n = 130) were included. Over the 50 pre-course procedures, significant linear improvements in CIR were found, with average increases of 4.2, 3.6 and 1.7 percentage points (pp) per 10 procedures performed in the < 70, 70-140 and > 140 groups respectively (all P < 0.001). The < 70 procedures group saw a significant step-change improvement in CIR, increasing from 46% in the last pre-course procedure, to 51% in the first procedure post-course (P = 0.005). The CIR step-change was not significant in the 70-140 (68% to 71%; P = 0.239) or > 140 (86% to 87%; P = 0.354) groups. For PICI, significant step-change improvements were seen in all three groups, with average increases of 5.6 pp (P < 0.001), 5.4 pp (P = 0.003) and 3.9 pp (P = 0.014) respectively.CONCLUSIONAttendance of the BSC was associated with a significant step-change improvement in PICI, regardless of prior procedural experience. However, CIR data suggest that the optimal timing of course attendance appears to be at earlier stages of training (< 70 procedures).

Anatomy-related ratios predict colonoscopy incompleteness in similar examination conditions.

Screening colonoscopy is one of the most popular modalities for screening and surveillance of colorectal cancer and other colon disorders. To introduce new ratios to predict the colonoscopy course in patients with similar characteristics. Five hundred screening colonoscopies (252 females and 248 males) were performed by an experienced endoscopist. Incomplete colonoscopies (without pathologic findings, i.e., disease-unrelated) were included in the study. Collected data was used to determine new ratios. An examination was completed in 231 (91.7%) females (F) and 239 (96.4%) males (M). The majority of incomplete colonoscopies were discontinued in the sigmoid colon: 8 F (38.1%) and 4 M (44.4%) or in the descendosigmoid flexure: 4 F (19%) and 2 M (22.2%). We found statistically significant higher risk of incompleteness in females (p = 0.03), patients after 2 or more surgical treatments (p = 0.007) and in males with lower body mass index (BMI) (p = 0.01) (χ2 tests). Moreover, we discovered a statistically significant correlation with 2 or more previous surgical treatments in the female group (p = 0.02) (χ2 test). We calculated the incomplete colonoscopy anatomy-related (ICAR) and modified ICAR (MICAR) ratios. The range of ICAR and MICAR was 0-0.17; the number of incomplete examinations ranged from 0 to 1 failed out of 6 attempts (calculation: 100:17 = 5.88). The ICAR and MICAR ratios reflect the various risk of colonoscopy incompleteness (i.e., disease-unrelated) and highlight the differences between patients in similar examination condition.

New colon anatomy-related ratios used to predict the course of colonoscopy in children.

In children, colonoscopy is a safe procedure, although it is more difficult to perform in patients whose body mass index (BMI) is under 25. The aim of the study was to establish the relationship between children's age, body mass and height and incomplete colonoscopies due to colon anatomy. A retrospective evaluation of diagnostic endoscopies in 403 children aged 3-18 years (192 girls and 211 boys) was performed. New ratios were introduced: the incomplete colonoscopy anatomy-related ratio (ICAR) and the modified incomplete colonoscopy anatomy-related ratio (MICAR). The terminal ilium was not reached in 59 children: 27 girls and 32 boys (14.6% of patients). In 13 girls and 18 boys (comprising 7.69% of the study population) no pathological causes were found for the incomplete colonoscopy. There were statistically significant differences concerning colon anatomy-related incomplete colonoscopies in relation to the children's weight. No significance was found in relation to height or age. Incomplete examinations were more frequent in patients weighing less than 30 kg (p = 0.0006), both in boys (p = 0.0090) and girls (p = 0.048). The risk of incomplete colonoscopy (odds ratio - OR) in boys and girls weighing less than 30 kg was 3.995 (95% CI = 1.489-10.720) and 3.373 (95% CI = 1.078-10.560), respectively. For this group of patients, the ICAR ranged between 0.0309 and 0.1889, while the MICAR range was 0.0-0.1889. Body mass is a statistically significant factor for evaluating the risk of incomplete colonoscopies in children. The lower the ICAR and MICAR values, the lower the risk of non-completion of a colonoscopy due to anatomical (i.e., disease-unrelated) causes.

The large intestine from fetal period to adulthood and its impact on the course of colonoscopy

The human large intestine in the living adult has a total length of about 1300 mm, ranging from 1100 to 2108 mm. The development of the gut continues after birth, up to the age 4–5. The large intestine ascends at the beginning in the right abdominal quadrant, then it traverses the abdominal cavity, and finally it descends to the anus. The left and right colic flexures are the basic flexions between the transverse, ascending and descending colon, respectively. Additionally, there are secondary bendings between intestinal segments. The angles between the neighbouring parts can vary between examined subjects. Most of the angulations can be found in the transverse (range 2–9) and sigmoid colon (range 1–9), making them the most troublesome parts to pass with a colonoscope.Colonoscopy (usually performed in the left lateral or supine position) is one of the most important examination of the large intestine mucus membrane. During this procedure the endoscope is passed through the colon into the cecum or terminal ilium. The individual anatomical features (tortuosity, supernumerary loops and elongation) may slow down or interfere with the progress of the scope.We summarize current knowledge on the human large intestine from the fetal period to adulthood and carve out some aspects that are currently less known to colonoscopists.

Rupture of the spleen after colonoscopy: A life-threatening complication

During colonoscopy, the risk of injuring the spleen or other viscera except the colon is negligible. We report here a patient in whom spleen rupture did complicate the very early course of colonoscopy, but this remains an extremely rare complication with no more than 50 cases so far described. Diagnosis may be difficult, and the risk of spleen rupture seems to be greatest within 24 hours of colonoscopy. Mechanisms leading to spleen injury in the setting of colonoscopy are unclear; however, direct trauma, colon distension by insufflated air, and the excessive traction on the splenocolic ligament may be involved. Patients with splenomegaly and those with preexisting adhesions are at greater risk for this complication. Patients complaining of persistent abdominal pain after colonoscopy should be closely monitored and aggressively investigated for the suspect of spleen injury and rupture.

Intensive training over 5 days improves colonoscopy skills long-term

Poor standards in colonoscopy services and the introduction of a colorectal cancer screening program in the United Kingdom have highlighted the need to establish high-quality training and competency assessments in colonoscopy. The aims of this study were to evaluate the effectiveness of a 1-week hands-on colonoscopy course utilizing novel assessment tools. Twenty-one doctors with varying colonoscopy experience who attended an accelerated colonoscopy training week (ACTW) were prospectively studied. They were trained and assessed in key aspects of colonoscopy. Knowledge was assessed with a multiple choice question (MCQ) paper. Practical hand skills were taught and evaluated using a computer simulator and live case teaching. Actual colonoscopy performance was assessed using Direct Observation of Procedural Skills scores (DOPS) and an objective tri-split video score of insertion technique. Two independent trainers taught and assessed the trainees at the start and end of the ACTW and at a median of 9 months' follow-up. Following training there were significant improvements in the MCQ score (P < 0.001), the simulator test case times (P = 0.02, P = 0.003), and the global DOPS score (P < or = 0.02). All improvements following the accelerated training were sustained at a median follow-up of 9 months. This study is the first in the literature to describe the positive, sustained impact of an intensive hands-on colonoscopy training course. Measurements of performance in key areas of skill acquisition improved following training.