DDW 2022 Author Disclosures
Kotchakon Maipang: NO financial relationship with a commercial interest | Uayporn Kaosombatwattana: NO financial relationship with a commercial interest | Manus Rugivarodom: NO financial relationship with a commercial interest | Julajak Limsrivilai: NO financial relationship with a commercial interest | Nonthalee Pausawasdi: NO financial relationship with a commercial interest | Somchai Leelakusolvong: NO financial relationship with a commercial interest | Phutthaphorn Phaophu: NO financial relationship with a commercial interest | Nichcha Subdee: NO financial relationship with a commercial interest | Phunchai Charatcharoenwitthaya: NO financial relationship with a commercial interest
Background
The first wave of coronavirus disease 2019 (COVID-19) pandemic in Thailand has resulted in the postponement of elective gastrointestinal endoscopic procedures according to the hospital policy from March to June 2020, causing gastroenterology fellows’ colonoscopy training to be interrupted. This ambispective study aimed to determine whether this policy affected gastroenterology fellows’ competency achievement during colonoscopy training.
Methods
We analyzed the data on the colonoscopy performance of gastroenterology fellows who had no prior experience with colonoscopy. The procedural performance of six in-training fellows over the academic year 2019-2021 (interrupted group) was compared with those of five recently graduated fellows over the academic year 2017-2019 (control group). The acquisition of competence (success rate) was determined using two objective criteria: (1) independent cecal intubation (ICI) and (2) cecal intubation time (CIT) less than 20 minutes (min).
Results
The study comprised 2,757 colonoscopies, including 1,295 from the interruption group and 1,462 from the control group. The baseline characteristics of the patients, indication for the colonoscopy, and the quality of the bowel preparation were comparable between groups. In both groups, the independent cecal intubation rate (ICIR) improved after every 50 procedures (figure1A). The ICIR by 200 cases was considerably lower in the interrupted group than in the control group (87.7% vs. 93.3%; p=0.047). The interrupted group took a long time to reach the cecum with median CIT of 11 min (5-15) compared to that of the control group with 9 min (7-13 (p=0.016). When the CIT was confined to 20 minutes, the interrupted group had a lower rate of ICI (77% vs. 85%; p<0.001) than the control group (figure 1B). The overall colonoscopy success rate (ICI+CIT20 min) was significantly lower in the interrupted group (65.1% vs.
77.4%; p<0.001) (table1). Both groups had similar rates of polyp detection and adenoma detection. Patients with a BMI of <23 kg/m2 were shown to have a higher risk of prolonged CIT (OR 1.34, 95%CI 1.10–1.62; p=0.003).
Conclusion
Gastroenterology fellows' colonoscopy performance has increased during their training. During the
COVID-19 pandemic, however, the interruption of elective endoscopy significantly impacted accomplishing competency requirements such as ICI >90% and CIT <20 minutes.
Table 1.
Colonoscopy performance according to level of experience between two groups
Figure 1.
Colonoscopy performance according to level of experience compared between the interrupted group and controlled group, (A) Independent cecal intubation rate, (B) Cecal intubation time < 20 min
CONTROL ID: 3698945