Expertise in colonoscopy intubation does not predict diagnostic accuracy: a simulation-based study

Background and study aims  Studies have linked cecal intubation rate with adenoma detection rate; however, the direct association between technical performance during colonoscopy intubation and withdrawal has never been explored. Thus, it remains unclear whether gentle and efficient intubation predicts superior mucosal inspection. The aim of this study was to investigate the correlation between performance during intubation and withdrawal in a simulation-based setup. Methods  Twenty-four physicians with various experience in colonoscopy performed twice on the Endoscopy Training System (ETS). Intubation skills were evaluated by assessing tasks on the ETS related to intubation (scope manipulation and loop management) and use of a computerized assessment tool called the 3D-Colonoscopy Progression Score (3D-CoPS). Diagnostic accuracy was defined by the number of polyps found during the ETS task of mucosal inspection. Pearson's correlations were calculated to explore associations between intubation skill and diagnostic accuracy. Results  The correlation analysis between 3D-CoPS and number of polyps found during mucosal inspection revealed a weak and insignificant correlation (0.157, P  = 0.3). Likewise, an insignificant correlation was seen between ETS intubation and number of polyps found (0.149, P  = 0.32). Conclusions  We found no evidence to support that technical performance during intubation is correlated with mucosal inspection performance in a simulation-based setting.