|
|
Back to 2014 Annual Meeting Posters
Impact of Colorectal and General Surgery Resident Participation on the Rate of Cecal Intubation in Colonoscopy
Julia Zakhaleva*1,2, Andrea Ferrara1, Joseph Gallagher1, Paul Williamson1, Samuel Dejesus1, Renee Mueller1, Mark Soliman1, Amanda Mcclure1,2, Warren J. Strutt1,2
1Colon and Rectal Clinic of Orlando, Orlando, FL; 2Orlando Regional Medical Center, Orlando, FL
Purpose:
The U.S. Multi-Society Task Force on Colorectal Cancer states that a target for cecal intubation, as a measure of colonoscopy quality, should be at least 90% in all colonoscopies and at least 95% in screening colonoscopies. We examined colonoscopies performed by 5 board-certified colorectal surgeons in a fellowship program to identify the rate of incomplete colonoscopies and associated factors. All procedures were conducted in an ambulatory center. The mentorship colonoscopy training model was adapted, where colorectal and general surgery residents were paired up with a surgeon for all endoscopy procedures.
Methods:
A retrospective chart review from July 1, 2011, to August 31, 2013, was done. We identified all colonoscopies, and categorized them as complete only if an endoscopy report stated that the cecum had been intubated. We used the chi-square, ANOVA, and t-tests to evaluate the association between a surgeon, trainee participation, gender, previous abdominal surgeries, point of termination, time to termination, and incomplete colonoscopies.
Results:
A total of 3548 colonoscopies were conducted, of which 588 were screening. Incomplete colonoscopies constituted 65 (1.8%) of all colonoscopies, and included 12 (2%) of screening colonoscopies. Of 65 patients, 20 (31%) were men (p<0.01). Residents and fellows participated in 41 (63%) of incomplete colonoscopies, the remaining 24 colonoscopies were conducted by surgeons alone (p 0.04). There was no significant difference in the gender distribution between the groups with and without trainees. The overall incomplete colonoscopy rates varied from 0.4% to 3.8% among the surgeons. Colorectal or general surgery resident participation didn't result in a statistically significant difference of an individual surgeon's incompletion rate (p 0.76). Time to termination was 18.8 minutes with a trainee involvement and 14.7 minutes when surgeons were doing endoscopy alone (p 0.089). Colonoscopy was most frequently terminated in sigmoid colon (57.8%), followed by the splenic flexure (15.6%) and hepatic flexure (7.8%) in both groups (p 0.01). There were no perforations. Propofol was administered to all patients by a CRNA. Of 45 female patients, 11 women (24%) had hysterectomies, and 11 additional patients had other previous abdominal operations. As a follow-up, 40 patients had normal barium enemas, 13 patients had surgery, and 6 patients had complete repeat colonoscopy.
Conclusions:
In a colorectal fellowship program, the rate of incomplete colonoscopies was lower than set by the U.S. Multi-Society Task Force on Colorectal Cancer. The mentorship colonoscopy training model adapted by the program appears to be very safe and effective. It doesn't result in increased incompletion rates or complications.
Back to 2014 Annual Meeting Posters
|
