Introduction: Methods to objectively determine the performance of laparoscopic cholecystectomy have been established. We describe a new method to evaluate the quality of colonoscopy in patients where anatomical landmarks and instrument position can be identified.
Methods: Fourteen colonoscopies were evaluated (6 by specialists and 8 by residents). The colonoscopy image was mixed together with the digital image from ScopeGuideR (Olympus, Japan) and recorded on a laptop computer. The result was then stored on digital media. Endoscopists and patients graded their experience of the colonoscopy on a VAS-scale immediately after the examination. A new experimental evaluation protocol (Enochsson-Ritter) was used to objectively evaluate the progression and outcome of the colonoscopy. Two independent observers who were blinded with regard to identity of the endoscopist made the formal evaluation.
Results: The specialists reached the splenic flexure faster than the residents (3.8±1.0 vs. 22.8±7.9 min, P<0.05). Residents found the colonoscopies to be technically more difficult and generally “worse than expected” compared with the specialists. The time for both specialists and residents to reach each segment of the left colon correlated with the parameter “worse than expected” as scored by the patient. The estimated technical difficulties for the specialist correlated better than that of the residents with the objectively measured time for the passage of the endoscope. Prolonged passage in the right colon during endoscopy by specialists increased the pain in patients.
Conclusion: A new method to estimate the quality and progression of colonoscopy in patients is described. The method can distinguish between residents and experts and also demonstrates differences in examination quality that correlates with patient satisfaction. The method might be a valuable future tool to monitor the quality and technical skills of endoscopists.