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Involvement of trainees in routine unsedated colonoscopy: review of a pilot experience.

Abstract：

BACKGROUND:Unsedated colonoscopy is not required by the Accreditation Council of Graduate Medical Education in the curriculum of GI trainees. OBJECTIVE:We describe our pilot experience with trainee participation in unsedated colonoscopy. DESIGN:A retrospective review of a performance improvement program to provide access to colonoscopy. SETTING:A Veteran's Affair ambulatory care facility that discontinued sedated colonoscopy because of a nursing shortage. PATIENTS:A total of 145 of 483 patients who chose unsedated colonoscopy after both sedated and unsedated options were discussed. INTERVENTIONS:GI fellows performed unsedated colonoscopy under the supervision of the attending physician. MAIN OUTCOME MEASUREMENTS:Cecal intubation rate, patient assessment of the reasons for the choice, the unsedated experience, willingness to have another colonoscopy, and the rate of return for unsedated colonoscopy among eligible patients. RESULTS:Cecal intubation was achieved in 112 of 145 patients. The adjusted success rate (excluding inadequate bowel preparation and an obstructing lesion) was 81%. The most frequently acknowledged reason for the choice was the ability to communicate with the colonoscopist. Eighty-six patients reported a good experience and were likely to accept another unsedated colonoscopy. To date, all 8 patients eligible for 3-year follow-up successfully completed another unsedated examination. LIMITATION:An uncontrolled, nonrandomized review in predominantly male older veterans. CONCLUSIONS:An unsedated colonoscopy might be acceptable to some populations, particularly when communication with clinicians and procedural convenience are highly valued. Involvement of trainees is feasible. Randomized controlled comparisons of sedated and unsedated options in terms of safety (eg, sedation and procedure-related complications) and cost in settings with and without a nursing shortage deserve to be considered.

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Leung FW,Aharonian HS,Guth PH,Chu SK,Nguyen BD,Simpson P

doi

10.1016/j.gie.2007.11.040

subject

Has Abstract

pub_date

2008-04-01 00:00:00

pages

718-22

issue

4

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(07)03118-5

journal_volume

67

pub_type

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