Endoscopic Training Research Articles

Use of konjac in a novel colonic endoscopic submucosal dissection training model that is inexpensive and hygienic.

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Novel image enhancement technology that helps find bleeding points during endoscopic submucosal dissection of gastric neoplasms.

The management of bleeding during endoscopic submucosal dissection (ESD) is critical and related to the procedure time. We collaborated on a new image enhancement algorithm with parameter optimization for clinical use being developed by FUJIFILM Co. and processed white light image data offline to evaluate the effectiveness of this technology. This study aims to evaluate the clinical usefulness of this technology. Eighteen video scenes of bleeding points from five gastric ESDs were selected and processed by the new image enhancement algorithm. The time until a bleeding point was found, visibility of a bleeding point, and color abnormality of the submucosal layer were evaluated by ESD experts, ESD trainees, and endoscopy trainees. The color differences between the bleeding point and the surroundings in CIE-L*a*b* color space were calculated in the original and enhanced images. The time until a bleeding point was found in the enhanced videos was significantly shorter than that in the original videos (11.10s vs 13.85s) (P=0.017). On a 5-point (-2 to +2) Likert scale of visibility, the enhanced image was slightly superior to the original (+0.45), and the appearance of the submucosa was comparable between images (+0.14). The color difference among the bleeding areas on the enhanced images was significantly larger than that on the original images (10.93 vs 8.36). This novel image enhancement algorithm emphasizes the color difference between a bleeding point and the surrounding area, which would help find bleeding points faster during ESD for the less experienced endoscopists.

Tips And Tricks in Training Endoscopists

The relevance of training an endoscopist using safe simulation technologies is considered.

Endoscopic Ultrasound-Directed Transgastric ERCP (EDGE) Utilization of Trends Among Interventional Endoscopists.

Endoscopic ultrasound-directed transgastric ERCP (EDGE) has become standard-of-care therapy at many centers for pancreaticobiliary disease in patients with Roux-en-Y Gastric Bypass. In this study, we aimed to evaluate the opinions and practices of endoscopists who perform EDGE. A 22-question utilization of EDGE survey was sent to 36 advanced endoscopists at tertiary care centers in the United States. The two-section survey included questions regarding advanced endoscopy volume and training at the respective facilities, and questions on specific details of EDGE utilization. Among 36 interventional endoscopists (IE) surveyed, 14 (39%) reported performing > 1000 ERCPs annually. Thirty (83%) offered EDGE as an option for Roux-en-Y gastric bypass patients with previous cholecystectomy. Other options offered included: 19 (53%) offered Laparoscopy-assisted ERCP (LA-ERCP), 7 (19%) offered Single-Balloon ERCP (SBE), and 10 (28%) offered percutaneous drainage (PTC). Twenty (56%) IE performed 10 or less EDGE procedures, while 16 (44%) performed 11 or more. Single-session EDGE was performed by 7 (19%) IE, while 15 (42%) performed dual session, and 13 (36%) performed both. 19 (53%) actively closed fistulas while 17 (47%) let them close spontaneously. Thirty one (86%) reported a technical success rate of 91% to 100%. The most frequently reported immediate adverse event post-procedurally was abdominal pain, reported by 17IE (47%). Weight gain was reported by 2IE (6%). EDGE continues to gain in popularity as an option for Roux-en-Y gastric bypass patients requiring pancreaticobiliary interventions, with 24/36IE (67%) believing that it should be the new standard. In addition, most report a low frequency of post-procedural weight gain. ClinicalTrials.gov Identifier NCT05041608.

TU6.7 How to solve the problem of endoscopy training for General Surgery trainees

Abstract Introduction COVID-19 has negatively impacted on all aspects of surgical training, compounding longstanding issues with surgical trainees achieving required endoscopy training standards. Innovative approaches are required to ensure trainees progress appropriately. Aims We aim to present an ideal immersive training pathway for endoscopy training for general surgery trainees. Results JAG certification has strict criteria which are achievable during a six month “immersive” training period with six, half day, sessions per week. JAG basic skills courses should be booked in advance and ideally complete in the 2nd to 3rd month of training. Weeks 1–2: Supervised simulator training to introduce basic scope handling and manipulation. Observation of “upper” and “lower” lists to grasp understanding of patient journey. Weeks 3–4: Attend at least 3 dedicated training sessions per week with DOPS discussion and completion. Ongoing simulator practice (1–2 sessions per week). Attendance at service lists with recognised trainers (1–2 sessions per week); likely to be opportunities for trainees to participate on ad Hoc basis. Weeks 4–20: As per weeks 3–4 with an increased attendance of ad Hoc lists and reduction of simulation to one session per week. Weeks 20–24: Consolidation of learning, endoscopies undertaken with minimal assistance from trainer. Weeks 24–26: Reduced capacity lists with trainer in the department but out-with scope room in preparation of independent lists after JAG certification. Conclusions We have described the ideal immersive endoscopy training pathway. Consideration should be given to incorporating this into the general surgical curriculum around on-call commitments, elective operating and clinics.

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.

GIE Editorial Board Top 10: advances in GI endoscopy in 2021

The 9-member Editorial Board of the American Society for Gastrointestinal Endoscopy performed a systematic literature search of original articles published during 2021 in Gastrointestinal Endoscopy and 10 other high-impact medical and gastroenterology journals on endoscopy-related topics. Votes from each editorial board member were tallied to identify a consensus list of the 10 most significant topic areas in GI endoscopy over the calendar year of study, with a focus on 3 criteria: significance, novelty, and global impact on clinical practice. The 10 areas identified collectively represent advances in the following endoscopic topics: colonoscopy optimization, bariatric endoscopy, endoscopic needle sampling and drainage, peroral endoscopic myotomy, endoscopic defect closure, meeting systemic challenges in endoscopic training and practice, endohepatology, FNA versus fine-needle biopsy sampling, endoscopic mucosal and submucosal procedures, and cold snare polypectomy. Each board member contributed a summary of important articles relevant to 1 to 2 of the consensus topic areas, leading to a collective summary that is presented in this document of the "top 10" endoscopic advances of2021.

Advanced Endoscopy Training in UK –what's in there for Pakistan?

Gastrointestinal endoscopy revolutionized the diagnostic as well as therapeutic paradigms of many gastrointestinal diseases. Advanced endoscopy procedures like ERCP and EUS have gained paramount importance in recent times. Structured training in basic as well as advanced endoscopy techniques is essential to boost the confidence of the trainee and ensure positive patient outcomes. This review article used the databases, published literature, and a large number of research journals to find out the latest data on the standards of advanced endoscopy training to improve patient care. To excel in the field of endoscopy, studies have established that an endoscopy trainee should be assessed based on his skill and expertise; not based on a particular number of procedures. The endoscopists must benchmark their performance against their peers to assess their competency. The training of endoscopists should be on real patients, in addition to practice on simulators. Also, training programs and curricula should be well structured. With advanced endoscopy being established across the world in patient-care, it is the need of the hour to establish standards and mechanisms for endoscopy training in Pakistan. The UK systems can offer a roadmap to achieve this goal.

The diagnostic upper GI endoscopy camp: a pilot for enhancing service provision and training in eastern Uganda.

Upper gastrointestinal (UGI) symptoms are common in East Africa but there is limited diagnostic endoscopy availability. Surgical camps are a recognised method of providing intensive service provision and training. We describe a novel application of the camp model for diagnostic UGI endoscopy in eastern Uganda. A 7-day camp took place in an existing endoscopy department of Mbale Regional Referral Hospital. Patients with symptoms warranting investigation were invited for free diagnostic UGI endoscopy, biopsy and H.pylori testing. 148 patients underwent endoscopy. 47 were deemed to have significant pathology, 7 with malignancy. 61% had H.Pylori. A resident surgeon was trained and performed 55 supervised unassisted procedures. Our pilot has illustrated that camps are a safe and efficient way of providing intense endoscopy service and training in an established department. Camps can be utilised for scaling up much needed endoscopy services and training in low- and middle-income countries.

Endoscopy for upper gastrointestinal bleeding in a tertiary hospital in Kaduna, North-West Nigeria: Experience and findings.

Upper gastrointestinal bleeding (UGIB) is a common medical emergency and upper gastrointestinal endoscopy (UGIE) makes diagnosis and treatment possible; performing this procedure within 24 h of bleeding is considered the standard of care for managing this condition. Access to upper endoscopy improves the prognosis of the disease. We present our experience and findings of performing UGIE in patients referred for UGIB to a new endoscopy unit in a tertiary center in North-West Nigeria. The age, gender, reasons for referral, interval between endoscopy, and last known episode of bleeding and endoscopic findings were obtained from endoscopy records. We performed UGIE in 204 patients for UGIB over a 7-year period: Mean age 45.5 years (range 10-88 years), 61.8% male, 54.8% <50 years. Most patients (81.3%) had endoscopy seven or more days after the last known episode of bleeding and none had endoscopy within 24 h. Esophageal and gastric varices were found in almost 30% of patients while peptic ulcer disease was found in 23%. Portal hypertensive gastropathy was found in 12.7% of patients all of whom also had esophageal or gastric varices. Gastric mucosal erosions (7.4%) and gastric malignancy (6.4%) were other notable findings. No significant abnormalities were detected in 11.8% of patients. Bleeding from esophageal/gastric varices and peptic ulcer disease were the most common finding in our patients. There was delay in performing endoscopy and improving access and training for endoscopy will go a long way in addressing some of the challenges we identified.

Endoscopy training through the COVID-19 pandemic: maintaining procedural volumes and key performance standards

ObjectiveEndoscopy departments have experienced considerable challenges in the provision of endoscopy services since the start of the COVID-19 pandemic. Several studies have reported a reduction of procedures performed by trainee...

Geographic distribution of colonoscopy providers in the United States: An analysis of medicare claims data.

Screening colonoscopy is one of the few procedures that can prevent cancer. While the majority of colonoscopies in the USA are performed by gastroenterologists, general surgeons play a key role in at-risk, rural populations. The aim of this study was to examine geographic practice patterns in colonoscopy using a nationwide Medicare claims database. The 2017 Medicare Provider Utilization and Payment database was used to identify physicians performing colonoscopy. Providers were classified as gastroenterologists, surgeons, ambulatory surgical centers (ASCs), or other. Rural-Urban Commuting Area classification at the zip code level was used to determine whether the practice location for an individual provider was in a rural area/small town (&lt; 10,000 people), micropolitan area (10-50,000 people), or metropolitan area (&gt; 50,000 people). Claims data from 3,861,187 colonoscopy procedures on Medicare patients were included. The majority of procedures were performed by gastroenterologists (57.2%) and ASCs (32.1%). Surgeons performed 6.8% of cases overall. When examined at a zip code level, surgeons performed 51.6% of procedures in small towns/rural areas and 21.7% of procedures in micropolitan areas. Individual surgeons performed fewer annual procedures as compared to gastroenterologists (median 51 vs. 187, p &lt; 0.001). Surgeons perform the majority of colonoscopies in rural zip codes on Medicare patients. High-quality, surgical training in endoscopy is essential to ensure access to colonoscopy for patients outside of major metropolitan areas.

Peroral Endoscopic Myotomy; Novice Surgeon Learning Curve.

Peroral endoscopic myotomy (POEM) is a novel endoscopic procedure used to treat achalasia and other spastic esophageal disorders that is an alternative to Heller myotomy. We seek to define the learning curve of POEM for a foregut surgeon with no formal endoscopic or POEM training by analyzing different intraoperative factors in a single series. The first 38 consecutive patients undergoing POEM by a single foregut surgeon were included in this retrospective study. Inverse curve regression models were used to analyze total operative time (TOT) and total operative time per centimeter of myotomy (TOT-CM), in addition to other intraoperative variables. Clinical outcomes were reported as pre- and post-operative Eckardt Scores. All patients had type II achalasia with no post-operative complications observed. Eckardt scores improved postoperatively (median (range): 1 (0-4)) compared with the preoperative scores (10 (8-12)) (P < .001). The total operative time (median 76minutes, range 51-129) decreased significantly over the course of the series (R2 = .38, P < .001), with a learning plateau at 70minutes and a learning rate of 12 cases. Total operative time per centimeter of myotomy (median 7.08min/cm, range 4.25 to 15.38) decreased over time (R2 = .45, P < .001), with a learning plateau at 7minutes/cm and a learning rate of 12 cases. The number of cases for a foregut surgeon to become proficient in a POEM procedure was found to be 12-14 cases. The learning curve for a POEM in a formally trained foregut surgeon may be comparable to an endoscopically trained interventionist.

Diagnostic value of endoscopic ultrasound-guided fine needle aspiration with rapid on-site evaluation performed by endoscopists in solid pancreatic lesions: A prospective, randomized controlled trial.

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the most established diagnostic method for pancreatic tissue. Rapid on-site evaluation by a trained endoscopist (self-ROSE) can improve the diagnostic accuracy. This research is aimed to analyze the application value of self-ROSE for EUS-FNA in solid pancreatic lesions. A total of 194 consecutive patients with solid pancreatic lesions in Nanjing Drum Tower Hospital were randomized in a 1:1 ratio to EUS-FNA with or without self-ROSE in this single-center randomized controlled trial. Before initiating self-ROSE, the endoscopist underwent training for pancreatic cytologic sample adequacy assessment and cytopathological diagnosis of EUS-FNA in pathology department for 1month. Some parts of the slides of EUS-FNA were air dried, stained on-site with BASO Liu's reagent, and on-site evaluated in self-ROSE group. Between the two groups, the diagnostic performance of EUS-FNA was analyzed, including sensitivity, specificity, positive predictive value, negative predictive value, and accuracy, with a comparison of the number of needle passes and the complication rates. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 94.8%, 94.4%, 100%, 100%, and 58.3% in the self-ROSE group, respectively, and 70.1%, 65.1%, 100%, 100%, and 32.6% in the non-self-ROSE group. The diagnostic accuracy (P<0.001) and sensitivity (P<0.001) were both significantly increased during EUS-FNA in the self-ROSE group compared to the non-self-ROSE group. The rate of cytologic sample adequacy was 100% in self-ROSE group and 80.4% in non-self-ROSE group. The number of passes were 3.38±1.00 in self-ROSE group and 3.22±0.89 in non-self-ROSE group (P=0.228). No complications were found in both. There was acceptable consistency between endoscopist and pathologist in the cytopathological diagnosis (kappa=0.666, P<0.05) and in the sample adequacy rate (kappa=1.000, P<0.001). Our results demonstrated that self-ROSE is valuable for EUS-FNA in the diagnosis of solid pancreatic lesions and is an important choice to routinely increase the accuracy of EUS-FNA in centers without ROSE assessment.

A nursing perspective on the ACPGBI Colonoscopy Clinical Sub-Committee

Gastrointestinal NursingVol. 20, No. 5 ACPN UpdateA nursing perspective on the ACPGBI Colonoscopy Clinical Sub-CommitteeMaria PettmanMaria PettmanE-mail Address: [email protected]Lower Endoscopy Nurse Consultant & Nurse Representative on the ACPGBI Colonoscopy Clinical Sub-CommitteeSearch for more papers by this authorMaria PettmanPublished Online:15 Jun 2022https://doi.org/10.12968/gasn.2022.20.5.6AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Cripps N, Mills S, Docherty J, Baragwanath P. Colonoscopy at a crossroads: which direction to take in the UK after the coronavirus pandemic? Colorectal Dis. 2021; 23(3):576–579. https://doi.org/10.1111/codi.15437 Crossref, Google ScholarD'Souza N, Georgiou Delisle T, Chen M, Benton SSCC, Abulafi M. Faecal immunochemical testing in symptomatic patients to prioritize investigation: diagnostic accuracy from NICE FIT Study. Br J Surg. 2021; 108(7):804–810. https://doi.org/10.1093/bjs/znaa132 Crossref, Google ScholarHealth Education England. Training academies. 2022. https://tinyurl.com/tzvvhfym (accessed 30 May 2022) Google ScholarRatcliffe E, Subramaniam S, Ngu WSWS et al. Endoscopy training in the UK pre-COVID-19 environment: a multidisciplinary survery of endoscopy training and the experience of reciprocal feedback. Frontline Gastroenterol. 2022; 13(1):39–44. https://doi.org/10.1136/flgastro-2020-101734 Crossref, Google ScholarVaughan-Shaw P, D'Souza N, Ngu L et al. Joint ACPGBI and the Dukes' Club statement on colonoscopy training. Colorectal Dis. 2021; 23(3):580-–581. https://doi.org/10.1111/codi.15584 Crossref, Google Scholar FiguresReferencesRelatedDetails 2 June 2022Volume 20Issue 5ISSN (print): 1479-5248ISSN (online): 2052-2835 Metrics History Published online 15 June 2022 Published in print 2 June 2022 Information© MA Healthcare LimitedPDF download

COLONOSCOPIC ULTRASOUND (C-US)-GUIDED FINE NEEDLE ASPIRATION (FNA) USING A CURVILINEAR ARRAY TRANSDUCER AND A STANDARDIZED INSERTION PROTOCOL: A SINGLE-CENTER RETROSPECTIVE COHORT STUDY

Spencer Cheng: YES financial relationship with a commercial interest;Boston Scientific :Consulting | Sérgio Matuguma: NO financial relationship with a commercial interest | Guilherme Henrique Peixoto de Oliveira: NO financial relationship with a commercial interest | Gustavo Silva: NO financial relationship with a commercial interest | Henrique Cheng: NO financial relationship with a commercial interest | Mauricio Minata: NO financial relationship with a commercial interest | Sergio A. Sánchez-Luna: YES financial relationship with a commercial interest;2021 American Society for Gastrointestinal Endoscopy (ASGE) Endoscopic Training Award by the ASGE and Fujifilm:Grant/Research Support

A single centre audit: repeat pre-operative colonoscopy.

Repeat colonoscopy may be required for tumour localisation. The aim of the study is to explore the clinical settings it was used and benchmark the quality of initial colonoscopy against standardized guidelines for tumour localisation, tattooing and colonoscopy reporting amongst clinicians. A retrospective study from 2016 to 2021 has been performed on patients who underwent elective colorectal cancer resections at the Northern Hospital. Patient demographics, colonoscopic and operative details were retrieved from the Bi-National Colorectal Cancer Audit (BCCA) Registry database and hospital medical records. changes in operative approach and delays to operation. reasons for a repeat colonoscopy and complications from repeat colonoscopy. A total of 339 patients were included in this study. 94 (28.6%) underwent a repeat colonoscopy. Re-scoping rate was 29.6% for surgeons, and 26.2% for non-operating endoscopists. Surgeons had a 5.9% localisation error rate, and non-operating endoscopist 6.95% (p= 0.673). Surgeons did not have a lower rate of repeat colonoscopy (p= 0.462). Repeat endoscopy was associated with a longer time to definitive operation (p < 0.001). No complications were associated with a repeat colonoscopy. There was no difference in localisation error rates or repeat colonoscopy amongst surgeons (29.6%) and non-operating endoscopists (26.2%) (p= 0.462). This could be explained by the standardized endoscopy training in Australia governed by a common training board. Lack of tattooing at index colonoscopy and inadequate documentation often led to a repeat endoscopy, which was associated with a longer time to definitive operation. Standardized guidelines in tattooing of lesions and colonoscopy reporting should be implemented.

Distinguishing the papilla of Vater during biliary cannulation using texture and color enhancement imaging: A pilot study.

ObjectivesUnderstanding the exact morphology of the bile duct opening is important for determining the success of bile duct cannulation. Texture and color enhancement imaging (TXI) has been reported to enhance slight changes in color tone and structure that are difficult to see with white light imaging. This study investigated whether TXI mode1 could improve papillary recognition by trainees inexperienced in endoscopic retrograde cholangiopancreatography.MethodsWe included 31 patients with naive papilla of Vater at a single institution in the study. Trainee endoscopists (n = 4) evaluated and identified the papilla according to the Inomata classification using white light imaging and TXI. The degree of agreement with the evaluation of supervising physicians (n = 4) was examined using the McNemar test.ResultsIn the trainee group, the kappa coefficient agreements were κ = 0.346 and κ = 0.754 for white light imaging and TXI, respectively. When further evaluated, the separate and septal types of papilla groups showed an increased concordance rate in one of the four trainees (76.67%–96.67%, p = 0.031, respectively). Moreover, comparison for two‐group evaluation showed an increased kappa coefficient in two of four trainees (0.34–0.92, p = 0.010, 0.45–0.92, p = 0.024).ConclusionsObservation of the duodenal papilla using TXI improved papillary differentiation and suggested the potential of TXI as a clinical tool. Further study of this method is necessary; it is expected to help reduce cannulation time and the incidence of pancreatitis.

A deep learning-based segmentation system for rapid onsite cytologic pathology evaluation of pancreatic masses: A retrospective, multicenter, diagnostic study.

SummaryBackgroundWe aimed to develop a deep learning-based segmentation system for rapid on-site cytopathology evaluation (ROSE) to improve the diagnostic efficiency of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) biopsy.MethodsA retrospective, multicenter, diagnostic study was conducted using 5345 cytopathological slide images from 194 patients who underwent EUS-FNA. These patients were from Nanjing Drum Tower Hospital (109 patients), Wuxi People's Hospital (30 patients), Wuxi Second People's Hospital (25 patients), and The Second Affiliated Hospital of Soochow University (30 patients). A deep convolutional neural network (DCNN) system was developed to segment cell clusters and identify cancer cell clusters with cytopathological slide images. Internal testing, external testing, subgroup analysis, and human–machine competition were used to evaluate the performance of the system.FindingsThe DCNN system segmented stained cells from the background in cytopathological slides with an F1-score of 0·929 and 0·899–0·938 in internal and external testing, respectively. For cancer identification, the DCNN system identified images containing cancer clusters with AUCs of 0·958 and 0·948–0·976 in internal and external testing, respectively. The generalizable and robust performance of the DCNN system was validated in sensitivity analysis (AUC > 0·900) and was superior to that of trained endoscopists and comparable to cytopathologists on our testing datasets.InterpretationThe DCNN system is feasible and robust for identifying sample adequacy and pancreatic cancer cell clusters. Prospective studies are warranted to evaluate the clinical significance of the system.FundingJiangsu Natural Science Foundation; Nanjing Medical Science and Technology Development Funding; National Natural Science Foundation of China.

Real-time, computer-aided, detection-assisted colonoscopy eliminates differences in adenoma detection rate between trainee and experienced endoscopists

Background and study aims Adenoma detection rate (ADR) is a well-accepted quality indicator of screening colonoscopy. In recent years, the added value of artificial intelligence (AI) has been demonstrated in terms of ADR and adenoma miss rate (AMR). To date, there are no studies evaluating the impact of AI on the performance of trainee endoscopists (TEs). This study aimed to assess whether AI might eliminate any difference in ADR or AMR between TEs and experienced endoscopists (EEs). Patients and methods We performed a prospective observational study in 45 subjects referred for screening colonoscopy. A same-day tandem examination was carried out for each patient by a TE with the AI assistance and subsequently by an EE unaware of the lesions detected by the TE. Besides ADR and AMR, we also calculated for each subgroup of endoscopists the adenoma per colonoscopy (APC), polyp detection rate (PDR), polyp per colonoscopy (PPC) and polyp miss rate (PMR). Subgroup analyses according to size, morphology, and site were also performed. Results ADR, APC, PDR, and PPC of AI-supported TEs were 38 %, 0.93, 62 %, 1.93, respectively. The corresponding parameters for EEs were 40 %, 1.07, 58 %, 2.22. No significant difference was found for each analysis between the two groups ( P > 0.05). AMR and PMR for AI-assisted TEs were 12.5 % and 13 %, respectively. Sub-analyses did not show any significant difference ( P > 0.05) between the two categories of operators. Conclusions In this single-center prospective study, the possible impact of AI on endoscopist quality training was demonstrated. In the future, this could result in better efficacy of screening colonoscopy by reducing the incidence of interval or missed cancers.