Introduction There has been increasing demand for gastroenterologist to maintain JAG competencies year on year.1 However there are few studies into the adequate number required despite the bowel cancer screening programme suggesting > 100 per annum. The study aims to compare competencies standards in relation to the number of colonoscopies performed in a year.
Methods Data was collected retrospectively within the trust between 1/12/2010 and 30/11/2011. These include colonoscopies performed in the 3 main hospitals within the UHMBT – Royal Lancaster Infirmary, Furness General Hospital and Westmoreland General Hospital. A total of 2502 colonoscopies performed were retrieved. The endoscopy reporting system ‘Endobase’ and ‘Indigo 4 Review’ were used to retrieve endoscopy report and pathology report respectively. The caecal intubation rate (completion rate), polyp detection rate, adenoma detection rate, adequacy of bowel prep and sedation rate were set standards. Chi squared test for correlation was used to compare all standards. Two groups were formed to compare the set standards as colonoscopist who performed > 100 colonoscopies per annum (pa) and those who performed < 100 colonoscopies pa. Withdrawal time, polyp recovery and complication rates were not included in this audit.
Results Of the 2502 colonoscopies performed, 633 were performed by colonoscopist who performed < 100, 1869 colonoscopies were performed by colonoscopist who performed > 100 colonoscopies. Completion rate for < 100 colonscopies was 85.62% and > 100 colonoscopies was 92.24% (p < 0.0001). Polyp detection rate (PDR) for <100 colonscopies was 17.85% and > 100 colonoscopies was 30.34% (p < 0.0001). Adenoma detection rate for < 100 colonoscopies was 25.28% and > 100 colonoscopies was 32.98% (p = 0.0003). Comparison of completion rates between both good and satisfactory bowel prep was 91.27% against poor prep 81.25% (p < 0.001). Reasons for non completion in order of frequency were patient discomfort, excess looping, pathology encountered limiting progression, inadequate bowel preparation, tight stricture and instrument inadequacy. For sedation, the number of times pethidine given > 50 mg was 0.15% and number of times midazolam given > 5 mg was 0.05%.
Conclusion Performing at least 100 colonoscopies a year statistically improves completion rate, polyp detection rate and adenoma detection rate. Good and satisfactory bowel prep statistically improves completion rate. This audit supports the JAG recommendation that a colonoscopist should perform > 100 colonoscopies per annum to maintain competency.
Disclosure of Interest None Declared
Valori R, Barton R. BSG quality and safety indicators for endoscopy. JAG: Joint Advisory Group on GI Endoscopy. 2007; 1–13.
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