TEACHING BASIC COLONOSCOPY SKILLS: QUALITY AND SAFETY STANDARDS CAN BE FULFILLED IN AN OUTPATIENT UNIVERSITY CENTER

Recent studies have shown that endoscopy fellows can perform colonoscopy effectively and safely. However, little is known about the performance of surgical residents without prior knowledge of endoscopic techniques.

To assess whether quality indicators were met at an outpatient endoscopy center and whether surgical residents, without prior upper or lower endoscopy skills, could perform colonoscopy adequately.

A prospective non-randomized cohort study was undertaken. All exams were performed either by assistant physicians or by residents. Quality measures were compared between those groups.

A total of 2720 colonoscopies were analyzed. In the resident group, we observed older patients (57.7±12.7 years vs 51.5±14.5 years, P<0.001), a higher prevalence of screening colonoscopies (52% vs 39.4%, P<0.001) and a higher prevalence of colorectal cancer (6.4% vs 1.8%, P<0.001). The cecal intubation rate was higher in the attending group (99.9% vs 89.3%; P<0.001). The polyp detection rate was 40.8%, and no differences were observed between the studied groups. The residents had a higher rate of perforation in all exams (0.4% vs 0%; P=0.02). Postpolypectomy bleeding and 7-day readmission rates were the same (0.2%). All readmissions in 7 days occurred due to low digestive bleeding, and none required intervention.

Quality indicators were met at a university outpatient endoscopy center; however, medical residents achieved lower rates of cecal intubation and higher rates of perforation than the attending physicians.