Colon Cancer :: Flaws in colonoscopies may increase risk of colon cancer

Colonoscopies are considered the gold standard for detecting colon cancer, the second leading cause of cancer deaths in the United States. Research presented today at Digestive Disease Week 2007 discusses contributing factors that could prevent patients from getting optimal results from their colonoscopy, including age of the patient, location of the screening and proper technician training.

DDW is the largest international gathering of physicians and researchers in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.

Adequate Level of Training for Technical Competence in Colonoscopy: A Prospective Multicenter Evaluation of the Learning Curve (Abstract # 659)For a physician to be considered “competent” at diagnostic colonoscopies, training programs recommend that trainees complete between 100 and 200 procedures. This study conducted by researchers from the Soonchunhyang University College of Medicine in Korea argues that there are other markers of competency, most notably cecal intubation (the process of inserting of a tube into the first portion of the large bowel), which has been known to cause complications if it takes too long.

Investigators evaluated the procedures of 24 first-year fellows in 15 tertiary care academic centers ? a total of 4,351 colonoscopies. Procedures were excluded if they were related to the following: emergency colonoscopies, colonic obstructions, previous histories of colonic operations, therapeutic procedures, monitoring for inflammatory bowel disease (IBD) and age (no one older than 80 or younger than 18). The success rate was measured by the completion rate (greater than 90%) and the cecal intubation time (less than 20 minutes).

After examining the completion rate and the cecal intubation time, the team concluded that competence in efficient colonoscopy generally requires more than 150 cases. Overall, 83.5 percent of the colonoscopies were successful and the average cecal intubation time was 9.23 minutes. The success rate was significantly improved and reached the competency standard after 150 procedures (71.5, 82.6, 91.3, 94.4, 98.4 and 98.7%, respectively, for every 50 procedures). After 150, procedures cecal intubation time decreased from 14.2 to nine minutes.

“We feel this study was extremely valuable in further assessing the level of technical competency that will minimize patient complications when undergoing colonoscopy,” said Suck-Ho Lee of the Soonchunhyang University College of Medicine, and lead author of the study. “We hope that institutions will be cognizant of these statistics as they train new technicians in order to obtain the best results for our patients with the least risk possible.”