Teaching Basic Colonoscopy Skills: Quality and Safety Standards Can Be Fulfilled in an Outpatient University Center

Abstract

BACKGROUND: Recent studies have shown that endoscopy fellows can perform colonoscopy effectively and safely. However, little is known about the performance of surgical residents without prior knowledge of endoscopic techniques. OBJECTIVE: To assess whether quality indicators were met at an outpatient endoscopy center and whether surgical residents, without prior upper or lower endoscopy skills, could perform colonoscopy adequately. METHODS: A prospective non-randomized cohort study was undertaken. All exams were performed either by assistant physicians or by residents. Quality measures were compared between those groups. RESULTS: A total of 2720 colonoscopies were analyzed. In the resident group, we observed older patients (57.7±12.7 years vs 51.5±14.5 years, P<0.001), a higher prevalence of screening colonoscopies (52% vs 39.4%, P<0.001) and a higher prevalence of colorectal cancer (6.4% vs 1.8%, P<0.001). The cecal intubation rate was higher in the attending group (99.9% vs 89.3%; P<0.001). The polyp detection rate was 40.8%, and no differences were observed between the studied groups. The residents had a higher rate of perforation in all exams (0.4% vs 0%; P=0.02). Postpolypectomy bleeding and 7-day readmission rates were the same (0.2%). All readmissions in 7 days occurred due to low digestive bleeding, and none required intervention. CONCLUSION: Quality indicators were met at a university outpatient endoscopy center; however, medical residents achieved lower rates of cecal intubation and higher rates of perforation than the attending physicians.

Análise dos resultados cirúrgicos das operações anais realizadas em um centro de treinamento de nível secundário

“…Historicamente, em Ribeirão Preto, as cirurgias anais costumavam ser realizadas em centros hospitalares de níveis terciário, o que se associava ao surgimento de grandes filas à espera de cirurgia, por falta de capacidade de atendimento integral dessa grande demanda. Uma solução para esse problema foi a criação de centros hospitalares de nível secundários, capazes de atender a demanda por procedimentos cirúrgicos de menor porte (22). Desde 2009, o complexo hospitalar do Hospital das Clínicas de Ribeirão Preto tem realizado as cirurgias anais por doenças benignas, de forma ambulatorial, em centro de nível secundário de atenção à Saúde, o Hospital Estadual de Ribeirão Preto.…”