Competence In Colonoscopy Research Articles

Efficacy of ScopeGuide-Assisted Training in Enhancing Colonoscopy Competence and Reducing Patient Discomfort.

In this study, we aimed to evaluate the efficacy of the Magnetic Scope Guide Assist (ScopeGuide) in enhancing the procedural competence of endoscopists and reducing patient discomfort during colonoscopy. This was a retrospective study with 88 trainee participants. The study participants were trained on patients who underwent colonoscopy without anesthesia. Both ScopeGuide-assisted training and conventional training (without ScopeGuide) were utilized for colonoscopy instruction. The outcomes of training were compared, with a particular emphasis on the competency of looping resolution. ScopeGuide-assisted training was superior to conventional training in multiple aspects, including looping resolution ( Z =-3.681, P <0.001), pain scores ( Z =-4.211, P <0.001), time to reach the cecum ( Z =-4.06, P <0.001), willingness to undergo repeat colonoscopy ( Z =-4.748, P <0.001), competence of positional changes ( Z =-4.079, P <0.001), and the effectiveness of assisted compression ( Z =-3.001, P =0.003). Further stratified analysis revealed that the ScopeGuide-assisted training mode was more beneficial for junior endoscopists ( P <0.05 in all parameters) but not for intermediate endoscopists ( P >0.05) and partially beneficial for senior endoscopists ( P <0.05 for all parameters except looping resolution). ScopeGuide-assisted training can significantly facilitate endoscopists in resolving loops and reducing patient pain, thereby enhancing their colonoscopy abilities.

Curriculum for training in endoscopic mucosal resection in the colon: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement.

Endoscopic mucosal resection (EMR) is the standard of care for the complete removal of large (≥ 10 mm) nonpedunculated colorectal polyps (LNPCPs). Increased detection of LNPCPs owing to screening colonoscopy, plus high observed rates of incomplete resection and need for surgery call for a standardized approach to training in EMR. 1 : Trainees in EMR should have achieved basic competence in diagnostic colonoscopy, < 10-mm polypectomy, pedunculated polypectomy, and common methods of gastrointestinal endoscopic hemostasis. The role of formal training courses is emphasized. Training may then commence in vivo under the direct supervision of a trainer. 2 : Endoscopy units training endoscopists in EMR should have specific processes in place to support and facilitate training. 3: A trained EMR practitioner should have mastered theoretical knowledge including how to assess an LNPCP for risk of submucosal invasion, how to interpret the potential difficulty of a particular EMR procedure, how to decide whether to remove a particular LNPCP en bloc or piecemeal, whether the risks of electrosurgical energy can be avoided for a particular LNPCP, the different devices required for EMR, management of adverse events, and interpretation of reports provided by histopathologists. 4: Trained EMR practitioners should be familiar with the patient consent process for EMR. 5: The development of endoscopic non-technical skills (ENTS) and team interaction are important for trainees in EMR. 6: Differences in recommended technique exist between EMR performed with and without electrosurgical energy. Common to both is a standardized technique based upon dynamic injection, controlled and precise snare placement, safety checks prior to the application of tissue transection (cold snare) or electrosurgical energy (hot snare), and interpretation of the post-EMR resection defect. 7: A trained EMR practitioner must be able to manage adverse events associated with EMR including intraprocedural bleeding and perforation, and post-procedural bleeding. Delayed perforation should be avoided by correct interpretation of the post-EMR defect and treatment of deep mural injury. 8: A trained EMR practitioner must be able to communicate EMR procedural findings to patients and provide them with a plan in case of adverse events after discharge and a follow-up plan. 9: A trained EMR practitioner must be able to detect and interrogate a post-endoscopic resection scar for residual or recurrent adenoma and apply treatment if necessary. 10: Prior to independent practice, a minimum of 30 EMR procedures should be performed, culminating in a trainer-guided assessment of competency using a validated assessment tool, taking account of procedural difficulty (e. g. using the SMSA polyp score). 11: Trained practitioners should log their key performance indicators (KPIs) of polypectomy during independent practice. A guide for target KPIs is provided in this document.

Documenting Competence in Colonoscopy: Taking the Next Steps.

aCorresponding Author: Robert E Sedlack, MD, MHPEd, Mayo Clinic, 200 First Street, Rochester MN 55905

Defining the learning curves of colorectal surgical trainees in colonoscopy using the Assessment of Competency in Endoscopy tool

Gastroenterology fellows require on average 250 to 275 colonoscopies to achieve competency. For surgical trainees, 50 colonoscopies is deemed adequate. Two training pathways using different assessment methods make any direct comparison impossible. At the Mayo Clinic colonoscopy training of gastroenterology and colorectal surgery (CRS) fellows were merged in 2017, providing a unique opportunity to define the learning curves of CRS trainees using the Assessment of Competency in Endoscopy (ACE) evaluation tool. In a single-center retrospective descriptive study, ACE scores were collected on colonoscopies performed by CRS fellows over a period of 4 academic years. By calculating the average scores at every 25 procedures of experience, the CRS colonoscopy learning curves were described for each core cognitive and motor skill. Twelve CRS fellows (men, 8; women, 4) had an average prior experience of 123 colonoscopies (range, 50-266) during the general surgical residency. During CRS fellowship, an average of 136 colonoscopies (range, 116-173) were graded per fellow. Although the competency goals for a few metrics were met earlier, most motor and cognitive ACE metrics reached the minimum competency thresholds at 275 to 300 procedures. CRS fellows reached competency in colonoscopy at around 275 to 300 procedures of experience, a trajectory similar to previously reported data for gastroenterology fellows, suggesting little difference in the learning curves between these 2 groups. In addition, no trainee was deemed competent at the onset of training despite an average experience well over the 50 colonoscopies required during residency.

Colonoscopy competence assessment tools: a systematic review of validity evidence.

Assessment tools are essential for endoscopy training, being required to support feedback provision, optimize learner capabilities, and document competence. We aimed to evaluate the strength of validity evidence that supports the available colonoscopy direct observation assessment tools using the unified framework of validity. We systematically searched five databases for studies investigating colonoscopy direct observation assessment tools from inception until 8 April 2020. We extracted data outlining validity evidence (content, response process, internal structure, relations to other variables, and consequences) from the five sources and graded the degree of evidence, with a maximum score of 15. We assessed educational utility using an Accreditation Council for Graduate Medical Education framework and methodological quality using the Medical Education Research Quality Instrument (MERSQI). From 10 841 records, we identified 27 studies representing 13 assessment tools (10 adult, 2 pediatric, 1 both). All tools assessed technical skills, while 10 each assessed cognitive and integrative skills. Validity evidence scores ranged from 1-15. The Assessment of Competency in Endoscopy (ACE) tool, the Direct Observation of Procedural Skills (DOPS) tool, and the Gastrointestinal Endoscopy Competency Assessment Tool (GiECAT) had the strongest validity evidence, with scores of 13, 15, and 14, respectively. Most tools were easy to use and interpret, and required minimal resources. MERSQI scores ranged from 9.5-11.5 (maximum score 14.5). The ACE, DOPS, and GiECAT have strong validity evidence compared with other assessments. Future studies should identify barriers to widespread implementation and report on the use of these tools in credentialing examinations.

A97 TOOLS FOR DIRECT OBSERVATION AND ASSESSMENT OF COLONOSCOPY: A SYSTEMATIC REVIEW OF VALIDITY EVIDENCE

Abstract Background An increasing focus on quality and safety in colonoscopy has led to broader implementation of competency-based educational systems that enable documentation of trainees’ achievement of the knowledge, skills, and attitudes needed for independent practice. The meaningful assessment of competence in colonoscopy is critical to this process. While there are many published tools that assess competence in performing colonoscopy, there is a wide range of underlying validity evidence. Tools with strong evidence of validity are required to support feedback provision, optimize learner capabilities, and document competence. Aims We aimed to evaluate the strength of validity evidence that supports available colonoscopy direct observation assessment tools using the unified framework of validity. Methods We systematically searched five databases for studies investigating colonoscopy direct observation assessment tools from inception until April 8, 2020. We extracted data outlining validity evidence from the five sources (content, response process, internal structure, relations to other variables, and consequences) and graded the degree of evidence, with a maximum score of 15. We assessed educational utility using an Accreditation Council for Graduate Medical Education framework and methodological quality using the Medical Education Research Quality Instrument (MERSQI). Results From 10,841 records, we identified 27 studies representing 13 assessment tools (10 adult, 2 pediatric, 1 both). All tools assessed technical skills, while 10 assessed cognitive and integrative skills. Validity evidence scores ranged from 1–15. The Assessment of Competency in Endoscopy (ACE) tool, the Direct Observation of Procedural Skills (DOPS) tool, and the Gastrointestinal Endoscopy Competency Assessment Tool (GiECAT) had the strongest validity evidence, with scores of 13, 15, and 14, respectively. Most tools were easy to use and interpret and required minimal resources. MERSQI scores ranged from 9.5–11.5 (maximum score 14.5). Conclusions The ACE, DOPS, and GiECAT have strong validity evidence compared to other assessments. Future studies should identify barriers to widespread implementation and report on use of these tools in credentialing purposes. Funding Agencies None

S3103 Learning Curve - Cumulative Sum Analysis (LC-CUSUM) for Assessing Competency in Performing Colonoscopy – A Systematic Review

INTRODUCTION: Learning curves (LC) created with Cumulative summation analysis (CUSUM) is a statistical method to assess the procedural competency attained by trainees in different medical specialties. The aim of this study is to analyze the LC-CUSUM in assessing the number of procedures needed for achieving competency in colonoscopy. METHODS: We searched multiple databases such as PubMed, Embase, Web of science and conference proceedings from inception through May 2020 to identify studies that analyzed the competency of trainees in colonoscopy by utilizing CUSUM analysis. The cecal intubation rate (CIR) of 90% is a key indicator of competency achievement in colonoscopy. Since the number of colonoscopies required to achieve a CIR ≥ 90% is not well established, studies reporting on the LC–CUSUM analysis of number of colonoscopies needed to achieve a CIR ≥ 90% were included. RESULTS: Based on the stringent inclusion criteria used, 3 studies were identified. Overall there were 352 trainees and 76603 colonoscopy procedures included in this analysis of 3 studies. Colonoscopy competency to reach a target CIR ≥90% by CUSUM analysis was attained at variable numbers such as 200,493 and 250 procedures for majority of the included trainees. CONCLUSION: LC-CUSUM analysis identifies early trends, allowing trainers to identify a struggling trainee sooner and alter their curriculum to improve their learning curve during colonoscopy training. Use of CUSUM analysis to track competency could be more effective than fulfilling a preset number of procedures to attain a target competency marker such as a CIR. Wide variations in the number of procedures needed to attain the target CIR ≥90% could be explained by the differences in the study cohorts (Gastroenterology fellows vs General surgery residents) and the quality of training. It is clearly evident that there is a paucity of studies evaluating a dynamic assessment tool such as LC-CUSUM which provides an opportunity for early intervention. Future large cohort studies are warranted to address this need.Figure 1.: Studies using LC-CUSUM in assessing the number of procedures needed for achieving competency in colonoscopy.

Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2020.

The following recommendations should only be applied after a thorough diagnostic evaluation including a contrast-enhanced computed tomography (CT) scan. 1 : ESGE recommends colonic stenting to be reserved for patients with clinical symptoms and radiological signs of malignant large-bowel obstruction, without signs of perforation. ESGE does not recommend prophylactic stent placement.Strong recommendation, low quality evidence. 2 : ESGE recommends stenting as a bridge to surgery to be discussed, within a shared decision-making process, as a treatment option in patients with potentially curable left-sided obstructing colon cancer as an alternative to emergency resection.Strong recommendation, high quality evidence. 3 : ESGE recommends colonic stenting as the preferred treatment for palliation of malignant colonic obstruction.Strong recommendation, high quality evidence. 4 : ESGE suggests consideration of colonic stenting for malignant obstruction of the proximal colon either as a bridge to surgery or in a palliative setting.Weak recommendation, low quality evidence. 5 : ESGE suggests a time interval of approximately 2 weeks until resection when colonic stenting is performed as a bridge to elective surgery in patients with curable left-sided colon cancer.Weak recommendation, low quality evidence. 6 : ESGE recommends that colonic stenting should be performed or directly supervised by an operator who can demonstrate competence in both colonoscopy and fluoroscopic techniques and who performs colonic stenting on a regular basis.Strong recommendation, low quality evidence. 7 : ESGE suggests that a decompressing stoma as a bridge to elective surgery is a valid option if the patient is not a candidate for colonic stenting or when stenting expertise is not available.Weak recommendation, low quality evidence.

Characterizing the Development of Colonoscopy Competence Using Assessment Data.

Assessment of endoscopist competence is an increasingly important component of colonoscopy quality assurance. In this study from the Joint Advisory Group on Gastrointestinal Endoscopy, validity evidence is provided for the use of the Direct Observation of Procedural Skills assessment tool in the formative setting during training. In this national UK dataset, overall colonoscopy competence was typically achieved after 200-249 procedures, although certain complex procedural skills ("proactive problem solving" and "loop management") had not reached the threshold for competence even after 300 procedures. These data will help inform the development and/or refinement of certification policies and practices in jurisdictions around the world.

Effect of individualized feedback on learning curves in EGD and colonoscopy: a cluster randomized controlled trial

Gastroenterology fellowships need to ensure that trainees achieve competence in upper endoscopy (EGD) and colonoscopy. Because the impact of structured feedback remains unknown in endoscopy training, this study compared the effect of structured feedback with standard feedback on trainee learning curves for EGD and colonoscopy. In this multicenter, cluster, randomized controlled trial, trainees received either individualized quarterly learning curves or feedback standard to their fellowship. Assessment was performed in all trainees using the Assessment of Competency in Endoscopy tool on 5 consecutive procedures after every 25 EGDs and colonoscopies. Individual learning curves were created using cumulative sum (CUSUM) analysis. The primary outcome was the mean CUSUM score in overall technical and overall cognitive skills. In all, 13 programs including 132 trainees participated. The intervention arm (6 programs, 51 trainees) contributed 558 EGD and 600 colonoscopy assessments. The control arm (7 programs, 81 trainees) provided 305 EGD and 468 colonoscopy assessments. For EGD, the intervention arm (-.7 [standard deviation {SD}, 1.3]) had a superior mean CUSUM score in overall cognitive skills compared with the control arm (1.6 [SD, .8], P= .03) but not in overall technical skills (intervention, -.26 [SD, 1.4]; control, 1.76 [SD, .7]; P= .06). For colonoscopy, no differences were found between the 2 arms in overall cognitive skills (intervention, -.7 [SD, 1.3]; control, .7 [SD, 1.3]; P= .95) or overall technical skills (intervention, .1 [SD, 1.5]; control, -.1 [SD, 1.5]; P= .77). Quarterly feedback in the form of individualized learning curves did not affect learning curves for EGD and colonoscopy in a clinically meaningful manner. (Clinical trial registration number: NCT02891304.).

Tu1028 – Factors Contributing to Entrustment Decisions in Egd and Colonoscopy Among Gastroenterology (GI) Trainees: Results from a Cluster Randomized Controlled Trial (RCT) on Competence in Egd and Colonoscopy - the Encompas Study

Tu1028 – Factors Contributing to Entrustment Decisions in Egd and Colonoscopy Among Gastroenterology (GI) Trainees: Results from a Cluster Randomized Controlled Trial (RCT) on Competence in Egd and Colonoscopy - the Encompas Study

Colonoscopy education for surgical residents in Korea: a national survey of Korean Surgical Skill Study Group.

PurposeA standardized colonoscopy training program surgical residents is still unestablished. The aim of this study was to assess the current status of colonoscopy training for surgical residents and collect the opinions on the direction for future colonoscopy education.MethodsA questionnaire survey containing 24 items was conducted by sending an email to 310 colorectal surgeons in 84 training hospitals across the country.ResultsOne hundred fifteen staff surgeons (115 of 310, 37%) of 84 institutions returned fully completed questionnaires. Most surgeons were working at tertiary hospitals with more than 5 years of clinical experience. About half of the responding surgeons answered that they perform colonoscopy in clinical practice and the main purpose of colonoscopy was follow-up after colorectal resection. Only 9 of 84 hospitals (10.7%) had a regular program on colonoscopy training for surgical residents. Most of colonoscopy education was conducted irregularly in a form of staff lecture, conferences or hands-on workshops. According to the future directions, 72 of 115 surgeons (62.6%) answered judging competency in colonoscopy should be needed for professional qualification of the surgeon. About 50 cases of colonoscopy seem appropriate during the 4-year-training of surgical residency, especially during the third- and fourth-year.ConclusionThis survey shows colonoscopy education for surgical residents is still insufficient in Korea and that most surgeons feel that regular colonoscopy training is needed during the surgical residency period. There needs to be efforts to standardize the education program as well as various institutional and academic societal supports to achieve this goal.

Colonoscopy learning curves for colorectal surgery fellow trainees: experiences with the 15-year colonoscopy training program.

PurposeThis study aimed to analyze the learning curves for colorectal surgery fellows in a colonoscopy training program.MethodsBetween May 2003 and February 2017, 60 surgical fellows joined our 1-year colonoscopy training program as trainees and performed 43,784 cases of colonoscopy. All trainees recorded their colonoscopy experiences prospectively into the database. After excluding 6 trainees, who had experience with performing more than 50 colonoscopies before participating in our training program or who discontinued our training program with experience performing less than 300 colonoscopies, this study included 54 trainees who had performed 39,539 colonoscopy cases. We analyzed the cecal intubation rate (CIR) and cecal intubation time (CIT) using the cumulative sum (Cusum) technique and moving average method to assess the technical colonoscopy competence.ResultsOverall, the CIR by the trainees was 80.7%. The median number of cases of colonoscopy performed during the training period for each trainee was 696 (range, 322–1,669). The trainees were able to achieve a 90% CIR with 412 and 493 procedures when analyzed using the moving average and the Cusum, respectively. Using the moving average method, CIRs after 150, 300, and 400 procedures were 67.0%, 84.1%, and 89.2%, respectively. The CIT of trainees continuously decreased until 400 successful cases. Median CITs were 9.4, 8.3, and 7.4 minutes at 150, 300, and 400 successful cases, respectively.ConclusionWe found that more than 400 cases of experience were needed for technical competence in colonoscopy. Continuous teaching and monitoring is required until trainees become sufficiently competent.

Impact of experience on self-assessment accuracy of clinical colonoscopy competence

Self-assessment is important for life-long learning and a recommended assessment method for endoscopy skills. Prior literature has not investigated self-assessment accuracy of colonoscopic competence in the clinical setting. This study aimed to determine the self-assessment accuracy of novice, intermediate, and experienced endoscopists. Novice (performed<50 previous colonoscopies), intermediate (50-500), and experienced (>1000) endoscopists from 5 hospitals each performed a clinical colonoscopy. Video recordings of procedures were independently assessed by 2 blinded expert endoscopists by using the Gastrointestinal Endoscopy Competency Assessment Tool (GiECAT). Externally assessed and self-assessed GiECAT scores were defined as the mean of the 2 video-based ratings and as participants' own assigned ratings, respectively. Self-assessment accuracy between the externally assessed and self-assessed scores was evaluated by using absolute difference scores, intraclass correlation coefficients, and the Bland-Altman analysis. Twenty novice, 10 intermediate, and 10 experienced endoscopists participated. There was moderate agreement of externally assessed and self-assessed GiECAT scores, with an intraclass correlation coefficient of 0.65 (95% confidence interval, 0.44-0.80). The absolute difference scores among the 3 groups were significantly different (P= .002), with experienced endoscopists demonstrating a more accurate self-assessment ability compared with novices (P=.002). Bland-Altman plots suggest that novice and experienced endoscopists tend to overrate and underrate their clinical competence, respectively; no specific trends were associated with intermediates. Participants demonstrated moderate self-assessment accuracy of clinical competence. Endoscopist experience was positively associated with self-assessment accuracy; novices demonstrated lower self-assessment accuracy compared with experienced endoscopists. Moreover, novices tended to overestimate their performances. Novice endoscopists may benefit from targeted interventions to improve self-assessment accuracy.

Training in Endoscopy: Colonoscopy.

Colonoscopy is effective in reducing the morbidity and mortality associated with colorectal cancer (CRC). Interval cancers or post-colonoscopy CRCs, are cancers detected within the surveillance interval, or between 6–36 months after a clearing colonoscopy. The incidence of interval cancers is 3.4%–9.2% of all detected CRCs, as reported in population-based studies. Colonoscopy is a technically difficult procedure that is challenging to learn, and needs time and effort to gain competency. Therefore, trainee competence is a critical component of CRC screening and surveillance. Herein, we review the colonoscopy training methods and quality assessment metrics for colonoscopy competency.

Impact of cap-assisted colonoscopy on the learning curve and quality in colonoscopy: a randomized controlled trial

Colonoscopy competency assessment in trainees traditionally has been informal. Comprehensive metrics such as the Assessment of Competency in Endoscopy (ACE) tool suggest that competency thresholds are higher than assumed. Cap-assisted colonoscopy (CAC) may improve competency, but data regarding novice trainees are lacking. We compared CAC versus standard colonoscopy (SC) performed by novice trainees in a randomized controlled trial. All colonoscopies performed by 3 gastroenterology fellows without prior experience were eligible for the study. Exclusion criteria included patient age<18 or >90 years, pregnancy, prior colon resection, diverticulitis, colon obstruction, severe hematochezia, referral for EMR, or a procedure done without patient sedation. Patients were randomized to either CAC or SC in a 1:1 fashion. The primary outcome was the independent cecal intubation rate (ICIR). Secondary outcomes were cecal intubation time, polyp detection rate, polyp miss rate, adenoma detection rate, ACE tool scores, and cumulative summation learning curves. A total of 203 colonoscopies were analyzed, 101 in CAC and 102 in SC. CAC resulted in a significantly higher cecal intubation rate, at 79.2% in CAC compared with 66.7% in SC (P= .04). Overall cecal intubation time was significantly shorter at 13.7 minutes for CAC versus 16.5 minutes for SC (P=.02). Cecal intubation time in the case of successful independent fellow intubation was not significantly different between CAC and SC (11.6 minutes vs 12.7 minutes; P= .29). Overall ACE tool motor and cognitive scores were higher with CAC. Learning curves for ICIR approached the competency threshold earlier with cap use but reached competency for only 1 fellow. The polyp detection rate, polyp miss rate, and adenoma detection rate were not significantly different between groups. CAC resulted in significant improvement in ICIR, overall ACE tool scores, and trend toward competency on learning curves when compared with SC in colonoscopy trainees without prior colonoscopy experience. (Clinical trial registration number: NCT02472730.).

Combining different methods improves assessment of competence in colonoscopy

Objectives: To develop a reliable method of assessing competence in colonoscopy based on multiple sources.Materials and methods: Physicians with varying degrees of experience in colonoscopy performed two colonoscopies each in a standardized simulated environment. Their performances were assessed under direct observation by an expert rater and by automatic computerized analysis of operator movements and scope movements, respectively. Reliability (Cronbach’s alpha) for subjective assessment, time to cecum, analysis of operator movement and analysis of scope movements were calculated. Composite score calculations were used to explore different combinations of the measures.Results: Twenty physicians were included in the study. The reliability (Cronbach’s alpha) were 0.92, 0.57, 0.87 and 0.55 for the subjective score assessed under direct observation, time to cecum, distance between operator’s hands and colonoscopy progression score, respectively. Equal weight (=25%) to all four methods resulted in a reliability of 0.91 and optimal weighting of the methods (55%, 10%, 25% and 10%, respectively) resulted in a maximum reliability of 0.95.Conclusion: Combining subjective expert ratings with automated objective assessments results in a less biased and more reliable assessment of competence in colonoscopy.

Automatic and unbiased assessment of competence in colonoscopy: exploring validity of the Colonoscopy Progression Score (CoPS).

Background and aims: Colonoscopy is a difficult procedure to master. Increasing demands for colonoscopy, due to screening and surveillance programs, have highlighted the need for competent performers. Valid methods for assessing technical skills are pivotal for training and assessment. This study is the first clinical descriptive report of a novel colonoscopy assessment tool based on Magnetic Endoscopic Imaging (MEI) data and the aim was to gather validity evidence based on the data collected using the “Colonoscopy Progression Score” (CoPS). Methods: We recorded 137 colonoscopy procedures performed by 31 endoscopists at three university hospitals. The participants performed more than two procedures each (range 2 – 12) and had an experience of 0 – 10 000 colonoscopies. The CoPS was calculated for each recording and validity was explored using a widely accepted contemporary framework. The following sources of validity evidence were explored: response process (data collection), internal structure (reliability), relationship to other variables (i. e. operator experience), and consequences of testing (pass/fail). Results: Identical set-ups at all three locations ensured uniform data collection. The Generalizability coefficient (G-coefficient) was 0.80, and a Decision-study (D-study) revealed that four recordings were sufficient to ensure a G-coefficient above 0.80. We showed a positive correlation between CoPS and experience with Pearson’s r of 0.61 (P < 0.001). A pass/fail standard of 107 points was established using the contrasting group method to explore the consequences of testing. Conclusion: This study provides evidence supporting the validity of the CoPS for use in assessing technical colonoscopy performance in the clinical setting.Study registration: NCT01997177.

The effect of linker type and recognition peptide conjugation chemistry on tissue affinity and cytotoxicity of charged polyacrylamide

To increase colonoscopy competence in ambiguous situations (e.g. the existence of flat polyps), an explicit in situ (at real time) diagnosis at the molecular level is required. We have previously shown that the affinity of fluorescent cationic polyacrylamide (Flu-CPAA) to malignant regions in the colon mucosa can be improved by conjugating the recognition peptide EPPT1 to the polymer backbone (to form Flu-CPAA-Pep). Using another recognition peptide, namely VRPMPLQ, we elucidated in the present study the effect of linker type and conjugating methods on Flu-CPAA-VRPMPLQ cytotoxicity and on its affinity to cell lines as well as human colorectal cancer (CRC) biopsies.In order to derive the relationship between the response variable and the experimental factors in a minimal set of experiments, a computerized statistical design of experiment (DoE) strategy was implemented. Data were collected in a six-factor factorial design to study the effect of experimental factors (independent variables) on the ability of the Flu-CPAA polymers to bind specifically to the colon cancer cell lines or the human biopsies (the response).It was found that the presence of VRPMPLQ on the Flu-CPAA improved the polymer's affinity to the human CRC biopsies and to the colon cancer cell lines representing stage B in the Duke severity staging system. The cytotoxicity of Flu-CPAA with high charge density was reduced after conjugated with VRPMPLQ. The replacement of Ahx linker by PEG linker of similar length did not affect the affinity to the human biopsies, nor did it affect cytotoxicity. However, elongating the PEG linker reduced the in vitro affinity to the colon cancer cell lines and to human CRC biopsies. Changing the conjugation method from condensation (amide bond formation) to the click conjugation method did not affect the affinity properties of the polymers. It did reduce, however, the polymer cytotoxicity. We suggest that Flu-CPAA-Pep, with the VRPMPLQ peptide as a recognition moiety, could serve for early diagnosis and screening of CRC patients during endoscopic procedures.

Sa1224 CAP Assisted Colonoscopy Enhances Quality Based Competency in Colonoscopy Among Trainees: A Randomized Controlled Trial

Sa1224 CAP Assisted Colonoscopy Enhances Quality Based Competency in Colonoscopy Among Trainees: A Randomized Controlled Trial