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Accredited residents perform colonoscopy to the same high standards as consultants

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Abstract

Background

Endoscopy remains a critical component of General Surgery and Gastroenterology training. Whilst residents need to gain experience, the quality of endoscopy which patients receive cannot be compromised. We conducted this study to compare quality indicators between consultants and residents with regards to colonoscopy.

Methods

A review of colonoscopies from a prospectively collected database was performed from September 2011 to February 2016. Quality indicators such as caecum intubation rate, adenoma detection rate, adherence to a 6-min withdrawal rule, mean number of polyps detected per colonoscope, and complications were collected and compared between the two groups.

Results

In total, out of 25,749 colonoscopies that were performed, 14,168 (55.0%) were performed by Consultants. Consultants achieved a better caecum intubation rate compared with residents (96.0% vs 94.9%, p < 0.001), and were more compliant to the 6-min withdrawal rule (74.7% vs 68.6%, p < 0.001). There were, however, no statistically significant differences in the adenoma detection rate (33.5% vs 34.5%, p = 0.098). Bleeding was a rare complication that was encountered more frequently in colonoscopies performed by consultants than for residents (0.002% vs 0.00008%, p < 0.001). There were only three (%) perforations in the entire series, and all were from colonoscopies performed by Consultants.

Conclusion

Given the proper training, residents are able to perform colonoscopy with the same level of competence as consultants. Whilst colonoscopic related complications are often tied to the difficulty of the procedures, the adherence to the 6-min withdrawal rule must be reinforced and continually educated to both residents and consultants.

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Acknowledgements

All authors have obtained no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work, and no other relationships or activities that could appear to have influenced the submitted work.

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Authors and Affiliations

  1. Division of Colorectal Surgery, University Surgical Cluster, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore

    Dedrick Kok Hong Chan & Ker-Kan Tan

  2. Department of Medicine, National University of Singapore, Singapore, Singapore

    Reuben Kong Min Wong & Khay Guan Yeoh

  3. Division of Gastroenterology and Hepatology, University Medical Cluster, National University Health System, Singapore, Singapore

    Khay Guan Yeoh

  4. Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Ker-Kan Tan

Authors
  1. Dedrick Kok Hong Chan
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  2. Reuben Kong Min Wong
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  3. Khay Guan Yeoh
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Contributions

Author contributions

Dedrick Kok Hong Chan participated in the writing of the manuscript, the collection of data, the analysis of data, and the drafting and final editing of the manuscript. Ker-Kan Tan participated in the analysis of data, the drafting and final editing of the manuscript, and the overall management of the project.

Corresponding author

Correspondence to Ker-Kan Tan.

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Disclosures

Dedrick Kok Hong Chan, Reuben Kong Min Wong, Khay Guan Yeoh and Ker-Kan Tan have no conflicts of interest or financial ties to disclose.

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Chan, D.K.H., Wong, R.K.M., Yeoh, K.G. et al. Accredited residents perform colonoscopy to the same high standards as consultants. Surg Endosc 32, 1377–1381 (2018). https://doi.org/10.1007/s00464-017-5818-0

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  • DOI: https://doi.org/10.1007/s00464-017-5818-0

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