Introduction Quality assurance in colonoscopy is underpinned by a framework of nationally agreed quality indicators and auditable outcomes to maintain minimum standards. High quality colonoscopy training is a vital part of ensuring these standards and is important that quality is assured during training lists so these patients receive the same standard of care. It is understandable that patients may be concerned if a trainee is performing their procedure and vital that evidence based consent is obtained to address concerns. This study aimed to compare quality delivered on training and non-training colonoscopy lists in order to inform patients.
Methods A 12 month period (Jan 2012 to Jan 2013) of data from the endoscopy reporting system was retrospectively analysed. Caecal intubation rates, procedure duration, endoscopist reported pain score, sedation usage and polyp detection rates were analysed for seven training endoscopists. Data was compared for seven training endoscopists between training and non-training lists. Statistical analyses used χ testing and linear regression in Stata 11.
Results Complete data were available for 422 training lists and 936 Service colonoscopies (300 BCSP)
Mean(SD) age was similar in service and trainee groups; 61.0(12.3) and 60.6(14.2) years respectively, p = 0.657. There was no difference in caecal intubation rates between groups (trainees 93.8% and service 94.4%, p-0.657).
Polyp detection was similar amongst trainees 119(28.2%) as non-BCSP service procedures 186(29.3%), p = 0.71.
Midazolam was used less frequently during service lists(737 [78.7%]) vs (367 [87.0%]) (p < 0.001). A statistically but not clinically significantly larger average doses was used 2.3 (0.7) and 2.2(0.7) mg, p = 0.001 during service lists. Interestingly mean doses of fentanyl were similar 59.5(23.2) and 57.7(22.2) mcg, p = 0.46, but lower mean doses of pethidine 36.8 (12.5) and 43.2 (12.2) mg, p = 0.001 were used during training lists.
Endoscopist reported pain scores were greater on service lists, with 223 (52.8%) trainees and 332 (35.5%) trainers reporting no symptoms, 431 (46.1%) and 143 (33.9%) mild, 149 (15.9%) and 53 (12.6%) moderate, and 24 (2.6%) and 3 (0.7%) severe symptoms respectively (p < 0.001).
As expected, procedure duration was longer on training procedures; 30.6 (12.3) vs. 46.6 (14.2) minutes, p < 0.001.
Conclusion In conclusion, colonoscopy is delivered at a similar high quality when performed by trainees compared with trained endoscopists. Although trainees took longer, caecal intubation rates and polyp detection were similar to those of trained endoscopists. Interestingly, patient discomfort reported by endocopist was lower during training colonoscopies and could possibly relate to longer procedure time. These conclusions will be used for patient information and monitored as quality assurance.
Disclosure of Interest None Declared
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