Impact of cap-assisted colonoscopy on the learning curve and quality in colonoscopy: a randomized controlled trial - 21/02/18
Abstract |
Background and Aims |
Colonoscopy competency assessment in trainees traditionally has been informal. Comprehensive metrics such as the Assessment of Competency in Endoscopy (ACE) tool suggest that competency thresholds are higher than assumed. Cap-assisted colonoscopy (CAC) may improve competency, but data regarding novice trainees are lacking. We compared CAC versus standard colonoscopy (SC) performed by novice trainees in a randomized controlled trial.
Methods |
All colonoscopies performed by 3 gastroenterology fellows without prior experience were eligible for the study. Exclusion criteria included patient age <18 or >90 years, pregnancy, prior colon resection, diverticulitis, colon obstruction, severe hematochezia, referral for EMR, or a procedure done without patient sedation. Patients were randomized to either CAC or SC in a 1:1 fashion. The primary outcome was the independent cecal intubation rate (ICIR). Secondary outcomes were cecal intubation time, polyp detection rate, polyp miss rate, adenoma detection rate, ACE tool scores, and cumulative summation learning curves.
Results |
A total of 203 colonoscopies were analyzed, 101 in CAC and 102 in SC. CAC resulted in a significantly higher cecal intubation rate, at 79.2% in CAC compared with 66.7% in SC (P = .04). Overall cecal intubation time was significantly shorter at 13.7 minutes for CAC versus 16.5 minutes for SC (P =.02). Cecal intubation time in the case of successful independent fellow intubation was not significantly different between CAC and SC (11.6 minutes vs 12.7 minutes; P = .29). Overall ACE tool motor and cognitive scores were higher with CAC. Learning curves for ICIR approached the competency threshold earlier with cap use but reached competency for only 1 fellow. The polyp detection rate, polyp miss rate, and adenoma detection rate were not significantly different between groups.
Conclusions |
CAC resulted in significant improvement in ICIR, overall ACE tool scores, and trend toward competency on learning curves when compared with SC in colonoscopy trainees without prior colonoscopy experience. (Clinical trial registration number: NCT02472730.)
El texto completo de este artículo está disponible en PDF.Abbreviations : ACE, ADR, BTGH, CAC, CUMSUM, ICIR, PDR, SC
Esquema
| DISCLOSURE: Funding was provided by a grant from the Alliance for Academic Internal Medicine Innovations (Patel). The Alliance had no role in the study design, collection, analysis, or interpretation of the data or in writing of the report. Reveal distal attachment caps were provided by US Endoscopy (Mentor, Ohio). The study was conducted independently of US Endoscopy, and US Endoscopy had no role in study design, collection, analysis, or interpretation of the data or in the writing of the report. All authors disclosed no financial relationships relevant to this publication. |
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| If you would like to chat with an author of this article, you may contact Dr Patel at kalpeshp@bcm.edu. |
Vol 87 - N° 3
P. 723 - mars 2018 Regresar al número
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