Colonoscopy proficiency requires minimum of 150 procedures
Competence in technically efficient screening and diagnostic colonoscopy generally requires experience with more than 150 cases, according to a prospective multicenter trial published in the April issue of Gastrointestinal Endoscopy.

The researchers noted that various training programs in colonoscopy recommend that trainees should perform at least 100 to 200 procedures to be considered technically competent at diagnostic colonoscopy.

As a result, Suck-Ho Lee, MD, department of internal medicine at Soonchunhyang University in Seoul, Korea, and colleagues undertook the study to determine the adequate level of training for technical competence in screening and diagnostic colonoscopy.

Over eight months, the researchers prospectively evaluated the procedures of 24 first-year gastrointestinal fellows in 15 tertiary care academic medical centers. The investigators assessed a total of 4,351 colonoscopies prospectively with variable clinical factors.

The authors wrote that cecal intubation was documented by photographing the identified cecal landmarks, including the appendiceal orifice and the ileocecal valve.

The researchers evaluated acquisition of competence (success rate) for colonoscopic training on the basis of two objective criteria: adjusted completion rate (>90 percent) and cecal intubation time (<20 minutes).

The overall success rate was 83.5 percent (3,635/4,351), according to researchers.

Lee and colleagues found that the mean cecal intubation time was 9.23 minutes. The success rate significantly improved and reached the requisite standard of competence after 150 procedures (71.5 percent, 82.6 percent, 91.3 percent, 94.4 percent, 98.4 percent, and 98.7 percent, respectively, for every 50 consecutive blocks), the authors wrote.

The researchers noted that the polyp detection rate did not improve significantly during the eight months and was not correlated with the learning curve. In addition, the mean time to cecal intubation decreased significantly, from 11.16 to 8.39 minutes, after 150 procedures, according to investigators.

The researchers found that logistic regression analysis found that prolonged cecal intubation was caused by the following factors: elderly patients, female sex, low body mass index, poor bowel preparation, poor American Society of Anesthesiologists status, abdominal pain as an indication, instructor’s supervision and low case volume.

As a noted limitation, the investigators said that they did not record final pathologic reports of detected polyps and withdrawal time.

Lee and colleagues also noted that factors associated with prolonged cecal intubation for typical trainees did not differ from those for experienced colonoscopists.