Abstract
Introduction
We aimed to assess the effect of Colonoscopy Skills Improvement (CSI) training on patient comfort and sedation-related complications during colonoscopy.
Methods
This retrospective cohort study was performed on 19 endoscopists practicing in a Canadian tertiary care center who completed CSI training between October 2014 and May 2016. Data from 50 procedures immediately prior to, immediately after, and eight months following CSI training were included for each endoscopist. The primary outcome variable was intraprocedural comfort, and secondary outcomes included intraprocedural hypotension and hypoxia. Data were extracted from an electronic medical record and analyzed using SPSS version 20.0. Univariate analysis and stepwise multivariable logistic regression were performed to determine if there was an association between patient comfort and CSI training. Predictors of these outcomes including patient age, gender, sedation use and dosing, procedure completion, quality of bowel preparation, endoscopist experience, and specialty were included in the analysis.
Results
2533 colonoscopies were included in the study. The mean dose of sedatives was reduced immediately following CSI training and at 8 months for both Fentanyl (75.4 mcg v. 67.8 mcg v. 65.9 mcg, p < 0.001) and Midazolam (2.57 mg v. 2.27 mg v. 2.19 mg, p < 0.001). The percentage of patients deemed to have a comfortable exam improved following endoscopist participation in CSI training and remained improved at 8 months (55.1% v. 70.2% v. 69.8%, p < 0.001). No significant change in rates of intraprocedural hypoxia or hypotension were noted following CSI training.
Conclusion
CSI training is associated with improved patient comfort and reduced sedation requirements during colonoscopy.
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Abbreviations
- CSI:
-
Colonoscopy skills improvement
- CRC:
-
Colorectal cancer
- ADR:
-
Adenoma detection rate
- CAG:
-
Canadian Association of Gastroenterology
- SEE:
-
Skills enhancement for endoscopy
- TET:
-
Train-the-endoscopy-trainer
- EPIC:
-
Endoscopic polypectomy improvement course
- MEI:
-
Magnetic endoscopic imaging
- GRS-C:
-
Global Rating Scale-Canada
- NAPCOMS:
-
Nurse-Assessed Patient Comfort Score
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Acknowledgements
We would like to acknowledge Eastern Health for their support of this project through a Quality Healthcare Scholarship.
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Drs. Bradley Evans, James Ellsmere, Intekhab Hossain, Lisa Bacque, Melissa Meng Ge, Jane Brodie, John Harnett, David Pace, and medical students Ennis and O’Brien have no competing interests or financial ties to disclose. Dr Mark Borgaonkar is on the speakers’ bureau of Abbvie, Amgen, Janssen, Pfizer, Shire, Takeda and is on the advisory board of Pendopharm and Sandoz. Please see the CAG website for more details on the SEE™ program: https://www.cag-acg.org/education/see-program
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Evans, B., Ellsmere, J., Hossain, I. et al. Colonoscopy skills improvement training improves patient comfort during colonoscopy. Surg Endosc 36, 4588–4592 (2022). https://doi.org/10.1007/s00464-021-08753-y
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DOI: https://doi.org/10.1007/s00464-021-08753-y