An adequate level of training for technically competent colonoscopic polypectomy

Abstract

Goals. The purpose of this study is to investigate the learning curve for colonoscopic polypectomy (CP) by trainee endoscopists. Background. The amount of training required to achieve technical competence for CP is uncertain. Study. The CP times and en bloc resection rates of three experienced colonoscopists were obtained from 240 procedures. These data were compared to those of three gastroenterology trainees who performed 750 CP procedures. A trainee procedure was deemed to be a success if en bloc resection was obtained and the CP time was within twice the median CP time of the experienced colonoscopists. Trainees were deemed to be technically competent when they achieved a CP success rate of greater than or equal to 80%. Results. The median CP times and en bloc resection rates for the experienced colonoscopists and trainees were 79 s (range, 20–301 s) and 99.6% (239/240), and 118 s (range, 36–1051 s) and 95.6% (717/750), respectively. The trainee success rate of CP was 72% (540/750). The success rate of the procedure was associated with increased trainee experience (p = 0.003) and reached 80% after 250 procedures. The CP time significantly decreased (p < 0.001) and en bloc resection rate significantly increased (p = 0.011) as trainee experience accumulated. The level of experience was an independent predictor for successful CP. Conclusions. The achievement of technical competence with CP was associated with an accumulation of approximately 250 procedures. These findings suggest that dedicated education and training programs for CP are warranted.

Key Words:

• colonoscopic polypectomy
• technical competence
• training

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.