TEACHING IN COLONOSCOPY: AN EVALUATION OF PROCEDURES PERFORMED BY RESIDENT PHYSICIANS IN THE COLOPROCTOLOGY SERVICE FROM 2021 TO 2023 AND POSSIBLE STRATEGIES FOR INTERVENTIONS

Colorectal cancer ranks among the cancers most benefited by secondary prevention interventions. Colonoscopy, selected as the gold standard method, plays a key role in prevention and screening. Despite its complexity and dependence on the examiner, the absence of a standardized teaching system and the lack of measures to assess competency are evident. Insufficient training in the procedure leads to diagnostic and therapeutic errors. This study analyzed colonoscopies performed in a coloproctology service by six resident physicians from December 2021 to June 2023. The goal was to identify potential areas for improvement and propose interventions to enhance learning within the service. A total of 5,855 colonoscopies were analyzed. Female patients accounted for 59.6%, and male patients for 40.4%, with an average age of 61.4 years. The quality of bowel preparation was classified as good (Boston scores 7, 8, and 9) in 55.6%, fair (Boston score 6) in 24.4%,dd and inadequate (Boston scores 0-5) in 20%. The cecal intubation rate was 85.3%, and the ileal intubation rate was 69.6%. However, when only the exams with good preparation quality were considered, the rates reached 94% and 80.8%, respectively. Incomplete colonoscopies accounted for 14.2%, with inadequate preparation (81%) and technical difficulties (19%) as the main reasons. Indications for the procedure included screening (16%), cancer follow-up (16%), lower gastrointestinal bleeding (14%), and positive fecal occult blood test (12.6%). Polypectomies were performed in 2,312 exams, with adenomas detected in 33%. Three colon perforations occurred (1/1,951). The main findings in the reports were diverticulosis (13.8%), endoscopically suspected neoplastic lesions (4.4%), and inflammatory diseases (1.8%). In the obtained results, bowel preparation effectiveness emerged as a critical factor impacting colonoscopy quality. One of the determinants for poor preparation quality was identified as the low socioeconomic status of the population served, combined with insufficient guidance on diet and laxative management during the appointment scheduling. It was inferred that adequate patient understanding of proper preparation is not always guaranteed. During the pre-examination phase, improving patient access to information is essential to ensure proper bowel preparation. It is important to encourage continuous improvement in colonoscopy teaching.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025