Learning Curves for Colonoscopy: A Prospective Evaluation of Gastroenterology Fellows at a Single Center
2
조회
0
다운로드
7
인용
0
참고문헌
키워드
초록
Background/Aims: Colonoscopy training programs and the minimal experience with colonoscopy required to be considered technically competent are not well established. The aim of this study was to determine the colonoscopy learning curves and factors associated with this difficult procedure at a single center. Methods: A total of 3,243 colonoscopies were performed by 12 first-year gastroenterology fellows, and various clinical factors were assessed prospectively for 22 months. Acquisition of competence (success rate)was evaluated based on two objective criteria: (i) the adjusted completion rate (＞90%) and (ii) cecal intubation time (＜20 minutes). Results: The overall success rate in reaching the cecum in less than 20minutes was 72.8%. The cecal intubation time was 9.34±4.13 minutes (mean±SD). Trainees’ skill at performing cecal intubation in ＜20 minutes reached the requisite standard of competence after 200procedures. Cecal intubation time decreased significantly from 11.3 to 9.4 minutes after 100 procedures and improved continuously thereafter. Female patients and advanced patient age (over 60 years)were associated with prolonged cecal intubation time (＞20 minutes). Surgery of the uterus and ovaries was significantly correlated with delayed cecal intubation time, but not after sufficient colonoscopy experience. Conclusions: The minimum number of procedures to reach technical competence was 200. The cecal intubation time was longer in female and older patients.
Abstract
Background/Aims: Colonoscopy training programs and the minimal experience with colonoscopy required to be considered technically competent are not well established. The aim of this study was to determine the colonoscopy learning curves and factors associated with this difficult procedure at a single center. Methods: A total of 3,243 colonoscopies were performed by 12 first-year gastroenterology fellows, and various clinical factors were assessed prospectively for 22 months. Acquisition of competence (success rate)was evaluated based on two objective criteria: (i) the adjusted completion rate (＞90%) and (ii) cecal intubation time (＜20 minutes). Results: The overall success rate in reaching the cecum in less than 20minutes was 72.8%. The cecal intubation time was 9.34±4.13 minutes (mean±SD). Trainees’ skill at performing cecal intubation in ＜20 minutes reached the requisite standard of competence after 200procedures. Cecal intubation time decreased significantly from 11.3 to 9.4 minutes after 100 procedures and improved continuously thereafter. Female patients and advanced patient age (over 60 years)were associated with prolonged cecal intubation time (＞20 minutes). Surgery of the uterus and ovaries was significantly correlated with delayed cecal intubation time, but not after sufficient colonoscopy experience. Conclusions: The minimum number of procedures to reach technical competence was 200. The cecal intubation time was longer in female and older patients.
참고문헌 (15)
- Oh SY, "Factors affecting the technical difficulty of colonoscopy", Hepatogastroenterology, 54, pp.1403~1406 (2007)
- Zuber-Jerger I, "Factors affecting cecal and ileal intubation time in colonoscopy", Med Klin (Munich), 103, pp.477~481 (2008)
- Shah HA, "Factors associated with incomplete colonoscopy: a population-based study", Gastroenterology, 132, pp.2297~2303 (2007)
- Lee SH, "An adequate level of training for technical competence in screening and diagnostic colonoscopy: a prospective multicenter evaluation of the learning curve", Gastrointest Endosc, 67, pp.683~689 (2008)
- Winawer SJ, "Prevention of colorectal cancer by colonoscopic polypectomy: the National Polyp Study Workgroup", N Engl J Med, 329, pp.1977~1981 (1993)
- Citarda F, "Barcherini S, Crespi M. Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence", Gut, 48, pp.812~815 (2001)
- Waye JD, "Total colonoscopy: is it always possible?", Gastrointest Endosc, 37, pp.152~154 (1991)
- Lieberman DA, "Assessment of the quality of colonoscopy reports: results from a multicenter consortium", Gastrointest Endosc, 69, pp.645~653 (2009), Logan JR
- Marshall JB, "The frequency of total colonoscopy and terminal ileal intubation in the 1990s", Gastrointest Endosc, 39, pp.518~520 (1993)
- Bair D, "The quality of screening colonoscopies in an office-based endoscopy clinic", Can J Gastroenterol, 23, pp.41~47 (2009)
- "Guidelines for credentialing and granting privileges for gastrointestinal endoscopy: American Society for Gastrointestinal Endoscopy", Gastrointest Endosc, 48, pp.679~682 (1998)
- Cass OW, "Objective evaluation of endoscopy skills during training", Ann Intern Med, 118, pp.40~44 (1993)
- Hull T, "Colonoscopy: how difficult, how painful?", Surg Endosc, 8, pp.784~787 (1994)
- Church JM, "Complete colonoscopy: how often? And if not, why not?", Am J Gastroenterol, 89, pp.556~560 (1994)
- Anderson JC, "Factors predictive of difficult colonoscopy", Gastrointest Endosc, 54, pp.558~562 (2001)