Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States and the third most common cancer in men and the second most common cancer among women. Early detection of localized adenocarcinoma and adenomatous polyps helps reduce the mortality related to colon cancer. According to the American Gastroenterological Association, colonoscopy (CSPY) is the gold standard in screening for CRC. To improve the results of screening, the CSPY preparation (prep) needs to be optimal. This study was undertaken to determine whether a supplemental standardized educational video on bowel preparation in the viewer's native language would improve bowel preparation at the time of CSPY. After institutional review board approval, the records of adult patients who presented to the gastroenterology clinic were reviewed. Patients who underwent a CSPY were assigned according to whether they watched a supplemental educational video on CSPY bowel preparation in their native language. This video reflects the same information provided in written and verbal form at the time of CSPY scheduling. Bowel prep was rated by the endoscopist using the Boston Bowel Preparation Scale (BBPS) and quantifies the adequacy of the preprocedure bowel prep. Participant characteristics and BBPS scores were statistically assessed for significant differences. We identified a total of 186 patients, 91 in March 2015 (pre–video intervention) and 95 in March 2016 (post–video intervention). Mean BBPS score was 7.9 and 8.54 for the March 2015 and 2016 group, respectively (p value of .0039). Although there was no statistical difference between the 2 groups with concern to gender and age, the racial makeup and BBPS score were statistically different. Multivariate analysis was performed. There was no interaction between gender or race and year effect to account for any difference in that factors' performance. Thus, it can be implied that there is not a consistent race effect but there is a consistent gender effect with females having higher success rates, regardless of video intervention (p value of .003). After controlling for both gender and race, the year effect is modestly significant (p value of .025), with the post–video subjects having higher prep success rates. A supplemental educational video incorporated into precolonoscopy teaching may provide a standardized method of effectively conveying simple bowel prep instructions in an efficient manner. This study demonstrated that using such a video produced significant results in improving the quality of bowel preparation.
Background: In Chile, the mortality rate from colorectal cancer has been increasing rapidly. The Prevention Project for Neoplasia of the Colon and Rectum (PRENEC) program was introduced in 2012 with intense support from Tokyo Medical and Dental University (TMDU) in Japan, as part of an international collaboration. Japanese experts in colonoscopy have been dispatched from TMDU to Chile, not only to perform colonoscopy, but also to teach Chilean trainees how to perform colonoscopy in PRENEC. This study assesses the efficacy of the training system in colonoscopy under the guidance of a Japanese expert in PRENEC. Methods: From March 2016 to August 2017, a Japanese expert (board certified endoscopist in Japan) taught 13 trainees. All trainees were beginners who had no prior experience performing a colonoscopy. In PRENEC, the trainees follow a step-by-step process for learning colonoscopy, which is described as follows: Firstly, trainees acquire the strategy for insertion and observation through attending lectures and observing actual colonoscopies performed by a Japanese expert. Secondly, trainees repeatedly practice the strategy with colon model simulator. Thirdly, trainees start performing actual colonoscopies with direct hands-on support until they are able to handle the colonoscope as instructed. Finally, trainees perform colonoscopies by themselves with mostly verbal guidance from a Japanese expert. We divided all colonoscopies into 3 groups. The groups were separated by operators as follows: group A by 13 trainees under the guidance of a Japanese expert; group B by a Japanese expert; and group C by 16 experienced Chilean colonoscopists. We assessed each group's quality by the success rates of total colonoscopy, complication (perforation and bleeding) rates, and adenoma detection rates (ADR). In addition, we assessed the self-completion rates of total colonoscopy by 5 trainees who had learned colonoscopy for 3 consecutive months at the 1st, 2nd and 3rd month, respectively. Results: A total of 1568 colonoscopies were performed during this period, which consisted of 443 in group A, 146 in group B and 979 in group C. In group A, B and C, mean patient age was 65.0AE7.5/63.2AE7.8/63.0AE7.1 years, respectively (no significant difference [NS]). Male/female ratio (%) was 30.7/25.9/53.2 (NS). Success rates of total colonoscopy (%) were 99.5/99.3/96.6 (group A vs Group B [NS], group A, B>group C p<0.01). Complication rates (%) were 0.45/0.00/0.34 (NS). ADR (%) were 66.6/64.4/40.0 (group A vs group B [NS], group A, B>group C p<0.01). Mean self-completion rates of total colonoscopy (%) at the 1st, 2nd and 3rd month by the 5 trainees were 56.5AE19.6/66.5AE26.1/86.4AE12.9, respectively. Conclusion: The colonoscopy training system in PRENEC was effective because trainees were able to steadily improve their skills in short periods of time without sacrificing clinical outcomes.
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