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DOI: 10.1055/s-0040-1704222
COLONOSCOPY QUALITY AFTER INTENSIVE TRAINING OF INEXPERIENCED ENDOSCOPISTS IN A NORWEGIAN SCREENING TRIAL FOR COLORECTAL CANCER
Publication History
Publication Date:
23 April 2020 (online)
Aims High-quality colonoscopies are essential to achieve an effective colorectal cancer (CRC) screening program. Limited colonoscopy capacity is a bottleneck for CRC screening. To inform the Norwegian health authorities of the feasibility of CRC screening, a screening pilot project was launched. Most of the endoscopists who performed the screening colonoscopies had little endoscopy experience and were given intensive training (one-to-one supervision by an experienced endoscopist) for three to six months before performing endoscopies. The aim of this work is to show colonoscopy performance of inexperienced endoscopists.
Methods The project was introduced as a randomised effectiveness trial comparing once-only sigmoidoscopy and biennial fecal immunochemical testing (FIT). A positive screening test was followed by a colonoscopy. Colonoscopies were performed between 2012 and 2019. We measured well-established quality performance indicators: cecum intubation rate (CIR), mean withdrawal time for diagnostic colonoscopies, adenoma detection rate (ADR). We calculated these measures for the first colonoscopy per participant, performed by an inexperienced endoscopist who had performed ≥100 colonoscopies in the course of the trial. We state the patient reported outcomes abdominal pain and satisfaction in colonoscopies performed between 2012-2018.
Results Between 2012 and 2019, 8,857 colonoscopies were performed. The CIR was 97.2% (95% confidence interval [CI] 96.8%-97.5%). The mean withdrawal time was 13.6 minutes (95% CI 13.3-14.0 minutes). ADR after positive FIT was 57.7% (95% CI 56.4-59.0); 51.3% (95% CI 49.3%-53.2%) for women and 62.8% (95% CI 61.1%-64.4%) for men. The feed-back questionnaire was completed by 85.6% regarding pain and 72.4 % of participants regarding satisfaction. 9.5% of colonoscopy participants who submitted the form, experienced severe pain and 91.1% were very content with the examination.
Conclusions Colonoscopies performed by newly trained endoscopists were performed with high quality, achieving recommended benchmark standards. Our results confirm that intensive training of inexperienced endoscopists is feasible in a screening setting with good results.