Endoscopy 2021; 53(12): 1229-1234
DOI: 10.1055/a-1352-4583
Original article

The effect of train-the-colonoscopy-trainer course on colonoscopy quality indicators

 1  Department of Research, Telemark Hospital Skien, Skien, Norway
 3  University of Oslo, Oslo, Norway
Edoardo Botteri
 2  Cancer Registry of Norway, Oslo, Norway
Gert Huppertz-Hauss
 4  Department of Medicine, Telemark Hospital Skien, Skien, Norway
Jan Magnus Kvamme
 5  Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
 6  Department of Medicine, University Hospital, North Norway, Tromsø, Norway
Øyvind Holme
 2  Cancer Registry of Norway, Oslo, Norway
 7  Institute of Health and Society, University of Oslo, Oslo, Norway
 8  Department of Medicine, Sørlandet Hospital Kristiansand, Kristiansand, Norway
Lars Aabakken
 9  Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet and Faculty of Medicine, University of Oslo, Oslo, Norway
Stein Dahler
10  Department of Medicine, Telemark Hospital Notodden, Notodden, Norway
11  Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
Ingrid Blomgren
12  Department of Medicine, Helse Fonna Hospital Trust, Haugesund, Norway
Per Sandvei
13  Department of Gastroenterology, Østfold Hospital Trust, Kalnes, Norway
Ole Darre-Næss
14  Department of Medicine, Vestre Viken Hospital Trust, Bærum, Norway
Øystein Kjellevold
15  Department of Medicine, Telemark Hospital Kragerø, Kragerø, Norway
Birgitte Seip
 2  Cancer Registry of Norway, Oslo, Norway
16  Department of Medicine, Vestfold Hospital, Tønsberg, Norway
› Author Affiliations


Background Systematic training in colonoscopy is highly recommended; however, we have limited knowledge of the effects of “training-the-colonoscopy-trainer” (TCT) courses. Using a national quality register on colonoscopy performance, we aimed to evaluate the effects of TCT participation on defined quality indicators.

Methods This observational study compared quality indicators (pain, cecal intubation, and polyp detection) between centers participating versus not participating in a TCT course. Nonparticipating centers were assigned a pseudoparticipating year to match their participating counterparts. Results were compared between first year after and the year before TCT (pseudo)participation. Time trends up to 5 years after TCT (pseudo)participation were also compared. Generalized estimating equation models, adjusted for age, sex, and bowel cleansing, were used.

Results 11 participating and 11 nonparticipating centers contributed 18 555 and 10 730 colonoscopies, respectively. In participating centers, there was a significant increase in detection of polyps ≥ 5 mm, from 26.4 % to 29.2 % (P = 0.035), and reduction in moderate/severe pain experienced by women, from 38.2 % to 33.6 % (P = 0.043); no significant changes were found in nonparticipating centers. Over 5 years, 20 participating and 18 nonparticipating centers contributed 85 691 and 41 569 colonoscopies, respectively. In participating centers, polyp detection rate increased linearly (P = 0.003), and pain decreased linearly in women (P = 0.004). Nonparticipating centers did not show any significant time trend during the study period.

Conclusions Participation in a TCT course improved polyp detection rates and reduced pain experienced by women. These effects were maintained during a 5-year follow-up.

Figs. 1s–5s, Tables 1s–3s

Publication History

Received: 17 September 2020

Accepted after revision: 15 December 2020

Publication Date:
23 February 2021 (online)

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