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CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(01): E117-E127
DOI: 10.1055/a-1994-6084
Original article

Colonoscopy quality improvement after initial training: A cross-sectional study of intensive short-term training

Anna Lisa Schult 
 1   Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
 2   Department of Medicine, Vestre Viken Hospital Trust Bærum, Gjettum, Norway
,
Geir Hoff
 1   Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
 3   Institute of Clinical Medicine, University of Oslo, Oslo, Norway
 4   Department of Research and Development, Telemark Hospital Trust, Skien, Norway
,
Øyvind Holme
 1   Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
 5   Institute of Health and Society, University of Oslo, Oslo, Norway
 6   Department of Medicine, Sørlandet Hospital Trust, Kristiansand, Norway
,
Edoardo Botteri
 1   Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
 7   Department of Research, Cancer Registry of Norway, Oslo, Norway
,
Birgitte Seip
 1   Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
 8   Department of Medicine, Vestfold Hospital, Tønsberg, Norway
,
Kristin Ranheim Randel 
 1   Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
,
Ole Darre-Næss
 2   Department of Medicine, Vestre Viken Hospital Trust Bærum, Gjettum, Norway
,
Tanja Owen
 9   Department of Medicine, Østfold Hospital Trust, Grålum, Norway
,
Jens Aksel Nilsen
 2   Department of Medicine, Vestre Viken Hospital Trust Bærum, Gjettum, Norway
,
Dung Hong Nguyen
 9   Department of Medicine, Østfold Hospital Trust, Grålum, Norway
,
Kristin Johansen
 1   Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
,
Thomas de Lange 
10   Department of Medicine and Emergencies Sahlgrenska University Hospital-Mölndal, Region Västra Götaland, Sweden
11   Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
12   Department of Medical Research, Vestre Viken Hospital Trust Bærum, Gjettum, Norway
› Author AffiliationsNorwegian Parliament

TRIAL REGISTRATION: Cross-sectional study NCT01538550 at ClinicalTrials.gov (http://www.clinicaltrials.gov/)
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Abstract

Background and study aims High-quality is crucial for the effectiveness of colonoscopy and can be achieved by high-quality training and verified with assessment of key performance indicators (KPIs) for colonoscopy such as cecum intubation rate (CIR), adenoma detection rate (ADR) and adequate polyp resection. Typically, trainees achieve adequate CIR after 275 procedures, but little is known about learning curves for KPIs after initial training.

Methods This cross-sectional study includes work-up colonoscopies after a positive screening test with fecal occult blood testing (FIT) or sigmoidoscopy, performed by either trainees after 300 training colonoscopies or by consultants. Outcome measures were KPIs. We assessed inter-endoscopist variation in trainees and learning curves for trainees as a group. We also compared KPIs for trainees and consultants as a group. 

Results Data from 6,655 colonoscopies performed by 21 trainees and 921 colonoscopies performed by 17 consultants were included. Most trainees achieved target standards for main KPIs. With time, trainees shortened cecum intubation time and withdrawal time without decreasing their ADR, reduced the proportion of painful colonoscopies, and increased the adequate polyp resection rate (all P < 0.01). Compared to consultants, trainees had higher CIR (97.7 % vs. 96.3 %, P = 0.02), ADR after positive FIT (57.6 % vs. 50.3 %, P < 0.01), and proximal ADR after sigmoidoscopy screening (41.1 % vs. 29.8 %; P < 0.01), higher adequate polyp resection rate (94.9 % vs. 93.1 %, P = 0.01) and fewer serious adverse events (0.65 % vs. 1.41 %, P = 0.02).

Conclusions Trainees performed high-quality colonoscopies and achieved international target standards. Several KPIs continuously improved after initial training. Trainees outperformed consultants on several KPIs.

Supplementary material



Publication History

Received: 24 June 2022

Accepted after revision: 06 December 2022

Accepted Manuscript online:
07 December 2022

Article published online:
26 January 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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