Competency in Colonoscopy by Surgeons Improves with Experience

M. O’Leary, BSc, M. Borgaonkar, MD, MSc, D. Pace, MD, N. Hickey, BSc, V. Falk, MD, J. McGrath, MD, MSc, D. Boone, MD, G. Fallows, MD

Memorial University of Newfoundland Faculty of Medicine, Queen’s University Faculty of Medicine

Introduction: High quality colonoscopy is critical to the success of colorectal cancer screening programs. This study asks whether cecal intubation and adenoma detection rates by surgeons are meeting guidelines set by the Canadian Association of Gastroenterologists (CAG) and American Society of Gastrointestinal Endoscopy (ASGE), and whether achieving such targets depends on the level of experience.

Methods: A retrospective study of adults who underwent colonoscopy in St. John’s, NL by one of 8 surgeons between January 2012 and June 2012 was conducted. Data had been collected prospectively and were extracted from an electronic database. Maximal insertion of the colonoscope was based upon the surgeon’s assessment as stated in the procedure report. Adenoma detection rate was calculated on a per-patient basis and required histologic confirmation. Of the eight surgeons studied, five had five or more years of experience performing colonoscopy and three had less than five years experience. Cecal intubation and adenoma detection rates were compared to CAG/ASGE guidelines in unadjusted and adjusted analyses (excluding patients with mechanical obstruction or poor bowel preparation). Chi-square test was used to test for a relationship between endoscopist experience, cecal intubation rate, and reasons for procedure termination. All statistics were performed using SPSS version 19.0.

Results: Of 558 patients (mean age=60.1, SD=11.5), 46.1% were male. Overall cecal intubation rate was 91%. After adjusting for cases of poor bowel prep/obstruction, the cecal intubation rate increased to 93.2%.
In surgeons with less than 5 years experience, the cecal intubation rate was 85.1% (n=114), whereas the cecal intubation rate was 93.3% (n=444) in surgeons with 5 or more years of experience (p=0.013). Surgeons with less than five years experience were more likely to have an incomplete exam due to patient discomfort than the more experienced group (5.3% vs. 1.2%; p=0.006). There was a non-significant trend toward more incomplete colonoscopies due to colonic redundancy in the less experienced surgeon group (7.1% vs. 4.2%; p=0.212). Adenoma detection rates were 22% overall, 26.3% in males and 18.5% in females, which exceed the recommended literature detection rates of 25% and 15% in men and women.

Conclusions: Surgeons performing colonoscopy at our institution met quality benchmarks. However, those with less than 5 years of endoscopy practice had a lower cecal intubation rate than their more senior colleagues.

Session: Poster Presentation

Program Number: P083

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