Various training programs in colonoscopy recommend that trainees should perform at least 100 to 200 procedures to be considered technically competent at diagnostic colonoscopy.
Dr Suck-Ho Lee and colleagues from Korea established what the adequate level of training for technical competence in screening and diagnostic colonoscopy is.
|The success rate improved and reached the requisite standard of competence after 150 procedures|
The team evaluated the procedures of 24 first-year gastroenterology fellows in 15 tertiary care academic medical centers over 8 months.
A total of 4,351 colonoscopies were assessed prospectively with variable clinical factors.
Cecal intubation was documented by photographing the identified cecal landmarks, including the appendiceal orifice and the ileocecal valve.
The team evaluated acquisition of competence for colonoscopic training on the basis of 2 objective criteria.
These included adjusted completion rate of over 90%, and cecal intubation time less than 20 minutes.
The researchers found that the overall success rate was 84%.
The mean cecal intubation time was 9 minutes.The team noted that the success rate significantly improved and reached the requisite standard of competence after 150 procedures.
The polyp detection rate did not improve significantly during the 8 months, and was not correlated with the learning curve.
In addition, mean time to cecal intubation decreased significantly, from 11 to 8 minutes, after 150 procedures.
Logistic regression analysis found that prolonged cecal intubation was caused by factors including elderly patients, female sex, and low body mass index.
Poor bowel preparation, poor American Society of Anesthesiologists status, abdominal pain as an indication, instructor's supervision, and low case volume also predicted prolonged cecal intubation.
The team did not record final pathologic reports of detected polyps and withdrawal time.
Dr Lee's team concluded, "Competence in technically efficient screening and diagnostic colonoscopy generally requires experience with more than 150 cases.
"Also, factors associated with prolonged cecal intubation for typical trainees did not differ from those for experienced colonoscopists."