[How many procedures are necessary to achieve competency in colonoscopy?]

Area of Science:

• Gastroenterology
• Medical Education
• Surgical Skills Training

Background:

• Colonoscopy competency requires technical and cognitive skills.
• The American Society for Gastrointestinal Endoscopy suggests 100 supervised procedures for competency.
• Brazil lacks specific colonoscopy training recommendations.

Purpose of the Study:

• To evaluate the technical progress of trainees in a standard colonoscopy training program.
• To assess the learning curve for colonoscopy procedures.

Main Methods:

• Two gastrointestinal fellows at the Federal University of São Paulo were prospectively evaluated during their first year of training.
• Data collected included frequency and time to cecal intubation, total procedure duration, lesion identification, and patient discomfort.
• A total of 271 colonoscopies were performed, with 27 excluded due to obstructive lesions or prior surgery.

Main Results:

• The mean success rate for reaching the cecum was 82.5% for Fellow A and 56.9% for Fellow B.
• Fellow A's cecal intubation rate improved from 76% in the first 100 procedures to 91.5% after the 101st.
• Mean procedure times were 17.7 minutes for Fellow A and 23.5 minutes for Fellow B, with Fellow A showing improvement after 100 procedures.

Conclusions:

• Colonoscopy training demonstrates a statistically significant improvement in cecal intubation rates and procedure times with increasing experience.
• Individual learning curves vary, suggesting that 100 procedures may be insufficient for acquiring full technical proficiency in colonoscopy.
• Further research with larger cohorts may be needed to establish definitive training benchmarks.