Colonoscopy conversion after flexible sigmoidoscopy screening: results from the <scp>UK</scp> Bowel Scope Screening Programme

Siau, Keith; Yew, A; Ishaq, Sauid; Jewes, Sarah; Shetty, Shishir; Brookes, Matthew; Veitch, Andrew; McKaig, Brian; Murugananthan, Aravinth

doi:10.1111/codi.13982

Cited by 3 publications

(4 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Within the UK Bowel Scope guidelines, the presence of adenomas ≥10 mm is an indication for colonoscopy to exclude proximal lesions 44 45. It is reasonable to expect endoscopists in FS to resect lesions <10 mm.…”

Section: Recommendation Statementsmentioning

confidence: 99%

“…Within the UK Bowel Scope guidelines, the presence of adenomas ≥10 mm is an indication for colonoscopy to exclude proximal lesions. 44 45 It is reasonable to expect endoscopists in FS to resect lesions <10 mm. As SMSA has replaced size criteria alone for evaluating difficulty of polypectomy (ie, level 1: <10 mm polyp; level 2: 10–20 mm polyp), competency in FS should include competency in SMSA level 1 polyps as a minimum.…”

Section: Recommendation Statementsmentioning

confidence: 99%

See 1 more Smart Citation

JAG consensus statements for training and certification in flexible sigmoidoscopy

Siau

Pelitari

Green

et al. 2023

Frontline Gastroenterol

View full text Add to dashboard Cite

IntroductionJoint Advisory Group (JAG) certification in endoscopy is awarded when trainees attain minimum competency standards for independent practice. A national evidence-based review was undertaken to update standards for training and certification in flexible sigmoidoscopy (FS).MethodsA modified Delphi process was conducted between 2019 and 2020 with multisociety representation from experts and trainees. Following literature review and Grading of Recommendations, Assessment, Development and Evaluations appraisal, recommendation statements on FS training and certification were formulated and subjected to anonymous voting to obtain consensus. Accepted statements were peer-reviewed by national stakeholders for incorporation into the JAG FS certification pathway.ResultsIn total, 41 recommendation statements were generated under the domains of: definition of competence (13), acquisition of competence (17), assessment of competence (7) and postcertification support (4). The consensus process led to revised criteria for colonoscopy certification, comprising: (A) achieving key performance indicators defined within British Society of Gastroenterology standards (ie, rectal retroversion >90%, polyp retrieval rate >90%, patient comfort <10% with moderate-severe discomfort); (B) minimum procedure count ≥175; (C) performing 15+ procedures over the preceding 3 months; (D) attendance of the JAG Basic Skills in Lower gastrointestinal Endoscopy course; (E) satisfying requirements for formative direct observation of procedural skill (DOPS) and direct observation of polypectomy skill (SMSA level 1); (F) evidence of reflective practice as documented on the JAG Endoscopy Training System reflection tool and (G) successful performance in summative DOPS.ConclusionThe UK standards for training and certification in FS have been updated to support training, uphold standards in FS and polypectomy, and provide support to the newly independent practitioner.

show abstract

Section: Recommendation Statementsmentioning

confidence: 99%

Section: Recommendation Statementsmentioning

confidence: 99%

JAG consensus statements for training and certification in flexible sigmoidoscopy

Siau

Pelitari

Green

et al. 2023

Frontline Gastroenterol

View full text Add to dashboard Cite

show abstract

“…For instance, in MiMiC-Bowel the adjustment of definitions of pre-cancer states were based on the UK Flexible Sigmoidoscopy Screening randomized controlled trial (UKFSST), which was the only data source that reported detection of advanced and HRA [16]. However, the detection rates of CRC and HRA were higher in the trial compared with the subsequent Bowel Cancer Screening Programme (BCSP) in England and this discrepancy has been ascribed to the inclusion criteria and uptake characteristics [34,35].…”

Section: Reasons For Indirect Uncertainty In Calibration Targetsmentioning

confidence: 99%

Calibrating Natural History of Cancer Models in the Presence of Data Incompatibility: Problems and Solutions

et al. 2022

View full text Add to dashboard Cite

Calibration of cancer natural history models is often challenged by a lack of representative calibration targets forcing modellers to rely on potentially incompatible datasets. Using a microsimulation colorectal cancer model as an example, the purposes of this paper are to: (1) highlight the reasons for uncertainty in calibration targets,(2) illustrate practical and generalizable approaches for dealing with incompatibility in calibration targets, and(3) discuss the importance of future research in the area of incorporating uncertainty in calibration.Low quality of data and differences in populations, outcome definitions, and healthcare systems may result in incompatibility between the model and the data. Acknowledging reasons for data incompatibility allows assessment of the risk of incompatibility before calibrating the model. Only a few approaches are available to address data incompatibility, for instance addressing biases in calibration targets and their adjustment, relaxing the goodness-of-fit metric, and validation of the calibration targets to the data not used in the calibration.However, these approaches lack explicit comparison and validation and so more research is needed to describe the nature and causes of indirect uncertainty (i.e. uncertainty that cannot be expressed in absolute quantitative forms) and identify methods for managing this uncertainty in healthcare modelling. Key points• Extensive practical and theoretical recommendations discuss modelling parameter uncertainty; however, uncertainty related to the selection and compatibility of calibration targets is widely overlooked.

show abstract

“…Flexible sigmoidoscopy (FS) is the third most commonly performed lower gastrointestinal examination in the UK, with ove r 5 0 0 , 0 0 0 pro c e du re s performed each year [1]. Flexible sigmoidoscopy is the first line investigation for anorectal symptoms and it is a primary colorectal cancer screening modality in England and Canada [2]. Over the last two decades, the focus on colonoscopy quality has catalysed reforms in colonoscopy training, instigating competency-based curricula, research into skills acquisition, and the development of a plethora of direct observational competency assessment tools to assure quality training [3].…”

Section: Introductionmentioning

confidence: 99%

Training and Assessment in Flexible Sigmoidoscopy: using a Novel Direct Observation of Procedural Skills (DOPS) Assessment Tool

Siau

Crossley

Dunckley

et al. 2019

JGLD

View full text Add to dashboard Cite

Background & Aims: Data supporting milestone development during flexible sigmoidoscopy (FS) training are lacking. We aimed to present validity evidence for our formative direct observation of procedural skills (DOPS) assessment in FS, and use DOPS to establish competency benchmarks and define learning curves for a national training cohort.Methods: This prospective UK-wide (211 centres) study included all FS formative DOPS assessments submitted to the national e-portfolio. Reliability was estimated from generalisability theory analysis. Item and global DOPS scores were correlated with lifetime procedure count to study learning curves, with competency benchmarks defined using contrasting groups analysis. Multivariable binary logistic regression was performedto identify independent predictors of DOPS competence.Results: This analysis included 3,616 DOPS submitted for 468 trainees. From generalisability analysis, sources of overall competency score variance included: trainee ability (27%), assessor stringency (15%), assessor subjectivity attributable to the trainee (18%) and case-to-case variation (40%), which enabled the modelling of reliability estimates. The competency benchmark (mean DOPS score: 3.84) was achieved after 150-174 procedures. Across the cohort, competency development occurred in the order of: pre-procedural (50-74), non-technical (75-149), technical (125-174) and post-procedural (175-199) skills. Lifetime procedural count (p<0.001), case difficulty (p<0.001), and lifetime formative DOPS count (p=0.001) were independently associated with DOPS competence, but not trainee or assessor specialty.Conclusion: Sigmoidoscopy DOPS can provide valid and reliable assessments of competency during training and can be used to chart competency development. Contrary to earlier studies, based on destination-orientated endpoints, overall competency in sigmoidoscopy was attained after 150 lifetime procedures.

show abstract

Colonoscopy conversion after flexible sigmoidoscopy screening: results from the UK Bowel Scope Screening Programme

Abstract: Male gender, polyps ≥ 10 mm and villous-preponderant histology at FS were predictors of adenomas < 10 mm and ≥ 10 mm at colonoscopy. Further data are required to assess the role for gender-based stratification of conversion criteria.

Cited by 3 publications

References 19 publications

JAG consensus statements for training and certification in flexible sigmoidoscopy

JAG consensus statements for training and certification in flexible sigmoidoscopy

Calibrating Natural History of Cancer Models in the Presence of Data Incompatibility: Problems and Solutions

Training and Assessment in Flexible Sigmoidoscopy: using a Novel Direct Observation of Procedural Skills (DOPS) Assessment Tool

Contact Info

Product

Resources

About