L’utilizzo del cappuccio facilita il training per la colonscopia

Impact of cap-assisted colonoscopy on learning curve and quality in colonoscopy: a randomized controlled trial.Tang Z, Zhang DS, Thrift AP, Patel KK. Gastrointest Endosc. 2017 Jun 22. [Epub ahead of print]

BACKGROUND AND AIMS:Colonoscopy competency assessment in trainees have traditionally been informal. Comprehensive metrics such as the Assessment of Competency in Endoscopy (ACE) tool suggest competency thresholds are higher than assumed. cap-assisted colonoscopy (CAC) may improve competency but data in novice trainees are lacking. We compare CAC versus standard colonoscopy (SC) among novice trainees in a randomized controlled trial.

METHODS:All colonoscopies performed by 3 gastroenterology fellows without prior experience were eligible for enrollment. Exclusion criteria included age <18 or >90, pregnancy, prior colon resection, diverticulitis, colonic obstruction, severe hematochezia, referral for endoscopic mucosal resection, or unsedated procedure. Patients were randomized to either CAC or SC in a 1:1 fashion. Primary outcome was independent cecal intubation rate (ICIR). Secondary outcomes were cecal intubation time (CIT), polyp detection rate (PDR), polyp miss rate (PMR), adenoma detection rate (ADR), ACE tool scores, and cumulative summation learning curves.RESULTS:A total of 203 colonoscopies were analyzed, 101 in CAC and 102 in SC. CAC resulted in significantly higher cecal intubation rate, at 79.2% in CAC compared with 66.7% in SC (P=0.04). Overall cecal intubation time was significantly shorter at 13.7 minutes for CAC versus 16.5 minutes for SC (P=0.02). Cecal intubation time in the case of successful independent fellow intubation was not significantly different between CAC and SC (11.6 minutes vs 12.7 minutes, P=0.29). Overall ACE tool motor and cognitive scores were higher with CAC. Learning curves for ICIR approached the competency threshold earlier with cap use but only reached competency for one fellow. PDR, PMR, and ADR were not significantly different between groups.CONCLUSIONS:CAC resulted in significant improvement in ICIR, overall ACE tool scores, and trend toward competency on learning curves when compared with SC in colonoscopy trainees without prior colonoscopy experience.

leggi l'articolo

Informazioni aggiuntive