Quality of colonoscopy by gastroenterology and surgical trainees

Following recent discussion in our department we would like to comment on the paper, by Leyden et al., “Quality of colonoscopy performance among gastroenterology and surgical trainees: a need for common training standards for all trainees?” [1].

Leyden et al. compared selected performance data of 13 trainees (7 gastroenterology and 6 surgical). The two groups had comparable experience in colonoscopy. End points of the retrospective single-center study were the significant differences between the two groups in terms of completion rate defined as intubation of the terminal ileum, incomplete examinations, polyp detection, and dosage of sedation.

The main limitation of the study is the lack of patient evaluation. The indications for colonoscopy differ between gastroenterological and surgical patients, and this is neglected in this study. Surgical colonoscopies generally have a surgical context, for example being undertaken prior to operation, and therefore there are different prerequisites for the examiner from the established “routine” criteria that are recommended by the American Society for Gastrointestinal Endoscopy (ASGE) and American College of Gastroenterology (ACG). Also colonoscopy in postoperative patients has different requirements. The study does not compare in detail the epidemiologic data of the two patient cohorts, giving only limited data. A sign of difference between the patient cohorts is the number of patients with sigmoid diverticulitis: these were significantly more frequent in the group of patients examined by the surgical trainees. The significantly lower reporting of poor bowel preparation in the patient group who underwent colonoscopy by surgical trainees is another sign that this patient group was different, and poor bowel preparation was still acceptable for certain acute indications.

All in all, the retrospective study by Leyden et al. reveals some interesting facts. However the conclusion drawn by the authors, by comparing the results of six surgical versus seven gastroenterological trainees without considering the differences between indications, may go further than the study design allows.

A minor additional comment is that in Table  2 of the paper, a P value of 0.005 seems unrealistic for the hypotension parameter.

• References

• 1 Leyden JE, Doherty GA, Hanley A et al. Quality of colonoscopy performance among gastroenterology and surgical trainees: a need for common training standards for all trainees?. Endoscopy 2011; 43: 935-940