Introduction Despite considerable developments in polypectomy techniques, the training of the skills necessary for removal of complex polyps remains a challenge. Little is known about the level of formal training in polypectomy among colonoscopists currently practising in the UK.
Methods As part of a national survey of advanced polypectomy, targeted at BSG members and Bowel Cancer Screening Programme (BCSP) colonoscopists, individuals were asked about the training they had received in polypectomy and their perceived training needs.
Results Respondents 268 fully trained colonoscopists with a median lifetime experience of 3000 procedures. 64% were BCSP colonoscopists. All but 4 had been involved in a hands-on colonoscopy-related training course and almost half had acted as course faculty.
Competence 86% reported competence in endoscopic mucosal resection (EMR) of sessile polyps > 2cm and half of responders had been doing EMR for > 5years. 30% felt comfortable removing lesions up to 3cm with good access, 35% would tackle larger lesions (by EMR) or smaller lesions with difficult access. 30% considered themselves able to remove very large flat or polypoid lesions that were also suitable for surgery.
Formal Training In relation to EMR, 58% regarded themselves as predominantly self-taught. 24% had been on an attachment at a recognised training centre and 36% had attended a hands-on advanced colonoscopy or polypectomy course. 20% reported that their only formal education in EMR was at a demonstration workshop or study day.
Training Needs When asked what limited their advanced polypectomy practise, 18% identified lack of formal training in EMR, 18% lack of opportunity to gain experience and 7.5% lack of guidelines in the management of large polyps. Surprisingly, even colonoscopists claiming to operate at the most expert level admitted that they might decide against tackling a potentially resectable polyp because of lack of confidence in assessing surface morphology (7%). 2.5% indicated uncertainty about the correct techniques to use and 2.5% lacked confidence in managing immediate complications. Lack of formal training in endoscopic submucosal dissection was mentioned as a constraint to practise by 40% of responders. Overall 58% indicated they would welcome a national training scheme for complex polypectomy.
Conclusion Less than half of this self-selected group of experienced colonoscopists felt they had been formally trained in advanced polypectomy. Lack of confidence appears to limit practise. Some of this stems from uncertainties that could be addressed through guidelines and formal courses in advanced polypectomy. There is support for a national training programme in this area.
Disclosure of Interest J. Anderson: None Declared, P. O’Toole: None Declared, J. Geraghty Grant/Research Support from: COOK MEDICAL, R. Valori: None Declared, S. Sarkar: None Declared
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