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Endosc Int Open ; 5(9): E931-E938, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28924602


BACKGROUND AND STUDY AIMS: There is very little literature defining characteristics of expert endoscopists. It is hypothesised that previously undetermined human factors may correlate with high performance in screening colonoscopists. The aim of this study was to determine factors contributing towards expertise in screening colonoscopy. MATERIALS AND METHODS: A focus group was used to hypothesise skills considered to be relevant to high performance in colonoscopy. The skills were then ranked in order of importance by an independent group of screening colonoscopists for both diagnostic and therapeutic colonoscopy. Twenty screening colonoscopists subsequently participated in individual semi-structured interviews to explore participants' views of expertise and the factors contributing to it. Data extracted from the interview transcripts were used to identify the thematic framework associated with expertise. RESULTS : The 5 initial highest-ranked themes were low complication rates, high adenoma detection rates, interpersonal skills with staff, communication skills, and manner with patients. Interviewees considered technical skills (20/20), previous experience of colonoscopy (19/20), judgment/decision-making (18/20), communication (18/20), teamwork (15/20), resources (11/20) and leadership (8/20) to be the most important themes related to expertise. CONCLUSIONS: Both technical and non-technical abilities are considered essential components of expertise by experienced colonoscopists. Further research into targeted interventions to improve the rate of acquisition of these skills in training endoscopists may be useful in improving performance.

Frontline Gastroenterol ; 8(2): 104-109, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28250907


OBJECTIVE: The aim was to describe the impact on polypectomy experience by the mandatory introduction of the Directly Observed Polypectomy Skills tool (DOPyS) and electronic portfolio as part of the formal colonoscopy certification process. DESIGN: Applications for colonoscopy certification in the UK in the year prior to the introduction of DOPyS were analysed retrospectively and compared with data collected prospectively for those in the following year. SETTING: UK National Health Service. PATIENTS: None. INTERVENTIONS: None. MAIN OUTCOME MEASURES: The outcomes studied included whether evidence of exposure to polypectomy, endoscopic mucosal resection (EMR) and colonoscopy changed over the 2-year period. The nature of the polyps removed by trainees was also studied. RESULTS: Thirty two per cent of candidates in the first year had evidence of any observed polypectomy with 7% of candidates referring to training in EMR. The median number of formative colonoscopy assessments was 3 (range 0-16). All of these candidates in the second year had evidence of polypectomy assessment, with a median number of DOPyS of 7 (range 3-27). Eighty nine per cent of applicants had evidence of assessed EMR. The median number of formative colonoscopy assessments in this cohort was 32 (range 9-199). There was a significant increase in the number of logged polypectomy assessments (p<0.001), experience of EMR (p<0.001) and formative colonoscopy assessments (p<0.001). There was no significant difference in the total number of colonoscopy procedures performed. CONCLUSIONS: Structured polypectomy assessment improves trainees' documented exposure to therapeutic endoscopy as well as providing formal evidence of skills acquisition. As polypectomy plays an increasing role globally in colorectal cancer prevention, the DOPyS provides an effective means of assessing and certifying polypectomy.

Dig Endosc ; 28(4): 405-416, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26710317


With a drive towards minimally invasive surgery, endoscopic submucosal dissection (ESD) is now gaining popularity. In a number of East Asian countries, ESD is now the treatment of choice for early non-metastatic gastric cancer, but the outcomes of ESD for colorectal lesions are unclear. The present review summarizes the mid-term outcomes of colorectal ESD including complication and recurrence rates. A systematic literature search was done in May 2014, identifying 20 publications reporting the outcomes of colorectal ESD which were included in this review. En-bloc resection rates, complete (R0) resection rates, endoscopic clearance rates, complication and recurrences rates were analyzed. Statistical pooling was done to calculate weighted means using random effects modeling. Twenty studies reporting the outcomes of 3060 colorectal ESD procedures were reported. Overall weighted en-bloc resection rate was 89% (95% CI: 83-94%), R0 resection rate 76% (95% CI: 69-83%), endoscopic clearance rate 94% (95% CI: 90-97%) and recurrence rate 1% (95% CI: 0.5-2%). Studies that followed up patients for over 1 year were found to have an en-bloc resection rate of 91% (95% CI: 86-96%), R0 resection rate of 81% (95% CI: 75-88%), endoscopic clearance rate 93% (95% CI: 90-97%) and recurrence rate of 0.8% (95% CI: 0.4-1%). Colorectal ESD can be carried out effectively and safely with a 1% recurrence rate. Further studies with longer follow-up periods are required to determine whether colorectal ESD is a viable alternative to conventional surgical therapy.

Colonoscopia , Neoplasias Colorretais/cirurgia , Ressecção Endoscópica de Mucosa , Adenoma , Dissecação , Extremo Oriente , Humanos , Recidiva Local de Neoplasia , Resultado do Tratamento
BMJ ; 346: f3442, 2013 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-23719644
BMJ ; 346: f2049, 2013 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-23553880
Gastrointest Endosc ; 77(3): 395-400, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23211749


BACKGROUND: Colonoscopy reduces colorectal cancer mortality and morbidity principally by the detection and removal of colon polyps. It is important to retrieve resected polyps to be able to ascertain their histologic characteristics. OBJECTIVE: The aim of the study was to evaluate the cause of polyp retrieval failure. DESIGN: Bowel cancer screening colonoscopy data were collected prospectively. SETTING: The Bowel Cancer Screening Program in the National Health Service. PATIENTS: Screening participants were referred to our screening center after a positive fecal occult blood test result. INTERVENTION: A total of 4383 polyps were endoscopically removed from 1495 patients from October 2006 to February 2011. MAIN OUTCOME MEASUREMENTS: The number, size, shape, and location of polyps; polyp removal method; quality of bowel preparation; total examination time; and insertion and withdrawal times in collected data were examined retrospectively. RESULTS: The polyp retrieval rate was 93.9%, and the failure rate was 6.1%, thus 267 polyps were not retrieved. In univariate analysis, factors affecting polyp retrieval failure were small polyp size, sessile polyps, and cold snare polypectomy (P < .001). Polyp retrieval was less successful in the proximal colon (P = .002). In multivariate analysis, polyp size and method of removal were independent risk factors for polyp retrieval failure (P < .001). LIMITATIONS: Retrospective study. CONCLUSION: Small polyp size and cold snare removal were found to be significantly associated with polyp retrieval failure. It was difficult to retrieve small, sessile, and proximal colon polyps. Optical diagnosis could be an efficacious option as a surrogate for histologic diagnosis for these lesions in the near future.

Colo/patologia , Pólipos do Colo/patologia , Pólipos do Colo/cirurgia , Colonoscopia , Idoso , Colonoscopia/métodos , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Falha de Tratamento
BMJ ; 345: e5376, 2012 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-22875960
BMJ ; 344: e3349, 2012 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-22581632