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Background Colonoscopy is a widely used diagnostic and therapeutic tool for colonic diseases and serves as the preferred screening method for colorectal cancer (CRC). A common difficulty during colonoscopy is the looping of the colon, which can result in patient discomfort, prolonged cecal intubation time (CIT), and the need for auxiliary maneuvers. This study aimed to evaluate the efficacy and safety of using an abdominal binder during colonoscopy performed by trainees. Methods This randomized, double-blind, sham-controlled trial was conducted at a tertiary center. Participants were outpatients aged 20–80 years undergoing elective colonoscopy. They were randomly assigned to either the abdominal binder (AB) group or the sham binder (SB) group. The primary outcome measured was cecal intubation time. Secondary outcomes included the need for manual abdominal compression and postural adjustments during the procedure. Results A total of 211 participants were enrolled in the study. The median CIT was significantly shorter in the AB group compared to the SB group (728 s vs. 774 s, p = 0.008). Additionally, the AB group demonstrated a significantly reduced need for manual abdominal compression (p ≤ 0.001) and postural adjustments (p = 0.01). The requirement for abdominal compression decreased by 40% (95% CI 27.7–52.9%), while the need for postural changes was reduced by 9.4% (95% CI 1.9–88.7%). Conclusion The use of an abdominal binder during colonoscopy performed by trainees significantly reduced cecal intubation time and minimized the need for ancillary maneuvers, such as manual abdominal compression and postural adjustments. Graphical abstract

Adenoma detection rate (ADR) is a key measure of quality in colonoscopy. Low ADRs are associated with development of interval cancer after \"negative\" colonoscopy. Uncontrolled studies mandating longer withdrawal time, and other incentives, have not significantly improved ADR. We hypothesized that an endoscopist training program would increase ADRs. Our Endoscopic Quality Improvement Program (EQUIP) was an educational intervention for staff endoscopists. We measured ADRs for a baseline period, then randomly assigned half of the 15 endoscopists to undergo EQUIP training. We then examined baseline and post-training study ADRs for all endoscopists (trained and un-trained) to evaluate the impact of training. A total of 1,200 procedures were completed in each of the two study phases. Patient characteristics were similar between randomization groups and between study phases. The overall ADR in baseline phase was 36% for both groups of endoscopists. In the post-training phase, the group of endoscopists randomized to EQUIP training had an increase in ADR to 47%, whereas the ADR for the group of endoscopists who were not trained remained unchanged at 35%. The effect of training on the endoscopist-specific ADRs was estimated with an odds ratio of 1.73 (95% confidence interval 1.24-2.41, P=0.0013). Our results indicate that ADRs can be improved considerably through simple educational efforts. Ultimately, a trial involving a larger number of endoscopists is needed to validate the utility of our training methods and determine whether improvements in ADRs lead to reduced colorectal cancer.

ObjectiveSuboptimal adenoma detection rate (ADR) at colonoscopy is associated with increased risk of interval colorectal cancer. It is uncertain how ADR might be improved. We compared the effect of leadership training versus feedback only on colonoscopy quality in a countrywide randomised trial.Design40 colonoscopy screening centres with suboptimal performance in the Polish screening programme (centre leader ADR ≤25% during preintervention phase January to December 2011) were randomised to either a Train-Colonoscopy-Leaders (TCLs) programme (assessment, hands-on training, post-training feedback) or feedback only (individual quality measures). Colonoscopies performed June to December 2012 (early postintervention) and January to December 2013 (late postintervention) were used to calculate changes in quality measures. Primary outcome was change in leaders’ ADR. Mixed effect models using ORs and 95% CIs were computed.ResultsThe study included 24 582 colonoscopies performed by 38 leaders and 56 617 colonoscopies performed by 138 endoscopists at the participating centres. The absolute difference between the TCL and feedback groups in mean ADR improvement of leaders was 7.1% and 4.2% in early and late postintervention phases, respectively. The TCL group had larger improvement in ADR in early (OR 1.61; 95% CI 1.29 to 2.01; p<0.001) and late (OR 1.35; 95% CI 1.10 to 1.66; p=0.004) postintervention phases. In the late postintervention phase, the absolute difference between the TCL and feedback groups in mean ADR improvement of entire centres was 3.9% (OR 1.25; 95% CI 1.04 to 1.50; p=0.017).ConclusionsTeaching centre leaders in colonoscopy training improved important quality measures in screening colonoscopy.Trial registration numberNCT01667198.

ObjectiveSerrated polyps (SPs) are an important cause of postcolonoscopy colorectal cancers (PCCRCs), which is likely the result of suboptimal SP detection during colonoscopy. We assessed the long-term effect of a simple educational intervention focusing on optimising SP detection.DesignAn educational intervention, consisting of two 45 min training sessions (held 3 years apart) on serrated polyp detection, was given to endoscopists from 9 Dutch hospitals. Hundred randomly selected and untrained endoscopists from other hospitals were selected as control group. Our primary outcome measure was the proximal SP detection rate (PSPDR) in trained versus untrained endoscopists who participated in our faecal immunochemical test (FIT)-based population screening programme.ResultsSeventeen trained and 100 untrained endoscopists were included, who performed 11 305 and 51 039 colonoscopies, respectively. At baseline, PSPDR was equal between the groups (9.3% vs 9.3%). After training, the PSPDR of trained endoscopists gradually increased to 15.6% in 2018. This was significantly higher than the PSPDR of untrained endoscopists, which remained stable around 10% (p=0.018). All below-average (ie, PSPDR ≤6%) endoscopists at baseline improved their PSPDR after training session 1, as did 57% of endoscopists with average PSPDR (6%–12%) at baseline. The second training session further improved the PSPDR in 44% of endoscopists with average PSPDR after the first training.ConclusionA simple educational intervention was associated with substantial long-term improvement of PSPDR in a prospective controlled trial within FIT-based population screening. Widespread implementation of such interventions might be an easy way to improve SP detection, which may ultimately result in fewer PCCRCs.Trial registration number NCT03902899.

The learning curve for endoscopic diagnosis varies, and an optimal educational strategy is not available. Working memory (WM) refers to an individual’s ability to store and process information quickly and simultaneously. This study aimed to determine whether educational methods, optimized by individual WM, facilitate learning about endoscopic diagnoses. In the development phase, the standard WM profile for general endoscopists was determined by 79 endoscopists. In the validation phase, 60 trainees from four Japanese institutions were assessed for visuospatial or verbal WM dominance, based on the standard WM profile, and randomly assigned to receive matched (Matched-E group) or unmatched (Unmatched-E group) education. In the Matched-E group, the visuospatial and verbal WM-dominant trainees learned the endoscopic diagnosis of colorectal polyps by pattern recognition and through the description text of narrow-band imaging classification, respectively. In the Unmatched-E group, participants received education that was opposite to their dominant WM type. The diagnostic accuracy of the endoscopic diagnosis of colorectal polyps was compared between the groups after each educational session. Among the 60 trainees, 40 (21 in Matched-E and 19 in Unmatched-E) completed the validation test. The diagnostic accuracy was significantly higher in the Matched-E group than that in the Unmatched-E group (61.6% vs. 53.9%, P = 0.008). The diagnostic accuracy for non-neoplastic lesions was higher in the Matched-E group than that in the Unmatched-E group (68.0% vs. 48.4%, P = 0.002), whereas it did not differ for adenoma, intramucosal cancer, or invasive cancer. The personalized education based on the WM profile facilitated learning endoscopic diagnosis.

Adequate bowel preparation is essential for diagnostic, screening, and surveillance colonoscopy. Virtual reality (VR) has the characteristics of immersion, interaction, and imagination and has been widely used in medicine for training and teaching, indicating that it could be used in the education of outpatients for bowel preparation before colonoscopy. To investigate whether using VR videos for patient education before colonoscopy could improve bowel preparation. A prospective, single-blinded, randomized clinical trial of 346 patients undergoing colonoscopy with local anesthesia in a tertiary care hospital was conducted between October 1, 2018, and November 1, 2020. Outpatients who had indications for colonoscopy and had not received one before were enrolled. Statistical analysis was performed from November 1 to December 31, 2020. All data were analyzed according to the intention-to-treat approach. Conventional bowel preparation education (oral instructions and written materials that had the same contents) or conventional education plus VR videos. The primary outcome was the quality of bowel preparation measured by the Boston Bowel Preparation Scale score (range, 0-9, where 0 indicates extremely unsatisfactory bowel preparation and 9 indicates complete bowel preparation). Secondary outcomes included polyp and adenoma detection rates, compliance with complete bowel cleansing, preprocedure anxiety, overall satisfaction, and willingness to undergo a follow-up colonoscopy. A total of 346 outpatients were enrolled in the trial, with 173 patients randomly assigned to each group (control group: 87 women [50.3%]; mean [SD] age, 50.5 [12.5] years; VR video group: 84 women [48.6%]; mean [SD] age, 52.6 [11.4] years). Baseline characteristics, including demographic information, medical history, lifestyle, and the characteristics of stool, were comparable between the VR video group and the control group. The mean (SD) Boston Bowel Preparation Scale score was significantly higher in the VR video group than in the control group (7.61 [1.65] vs 7.04 [1.70]; P = .002). The detection rate of polyps (72 of 172 [41.9%] vs 46 of 172 [26.7%]; P = .003) and the detection rate of adenomas (56 of 172 [32.6%] vs 38 of 172 [22.1%]; P = .03) were also higher in the VR video group. Patients who received VR education had better compliance (119 [68.8%] vs 87 [50.3%]; P < .001) and higher mean (SD) overall satisfaction (8.68 [1.70] vs 8.16 [2.15]; P = .01) with bowel preparation. Patients who received VR video education before colonoscopy had better bowel preparation, higher polyp and adenoma detection rates, and improved compliance and satisfaction. ClinicalTrials.gov Identifier: NCT03667911.

Background Colonoscopy is important for diagnosis, assessment and dysplasia screening in inflammatory bowel disease (IBD). A good bowel preparation is required for complete and adequate assessment. Trial design Randomised, assessor blinded parallel arm trial with 1:1 allocation. Methods Patients with IBD undergoing colonoscopy were randomised to control group (standard preparation with written instructions) or experimental group (additional brief video educational intervention). Outcome assessors and colonoscopist were masked to the allocation. Primary outcome was adequacy of bowel preparation (Boston bowel preparation score of ≥ 6). Results Of 130 patients randomised, 107 (57% males, mean age 38.4 years, 84% with ulcerative colitis) were analysed. The groups were similar for baseline characters (age, gender, rural residence, educational status, duration of illness, IBD therapies, and endoscopic activity). Adequate bowel preparation was present similar numbers in experimental group compared to control group (43.1% versus 35%) ( p  = 0.43). The groups were similar for perfect preparation (7.8% versus 8.9%) ( p  = 0.84), worsening of disease activity (3.9% versus 3.7%) ( p  = 1.00), time to cecal intubation (240, 191 s versus 268, 228 s) ( p  = 0.43), tolerance (45.1% versus 30.4%)( p  = 0.12), and willingness to undergo a repeat colonoscopy (54.9% versus 55.4%)( p  = 0.97). Conclusion A brief educational video intervention did not improve bowel preparation in patients with IBD undergoing colonoscopy. Trial registration CTRI/2023/09/057436 on 11 September 2023.

We recently completed a randomized controlled trial of an endoscopic quality improvement program (EQUIP) that demonstrated an improved adenoma detection rate (ADR) through simple educational interventions. The aim of this study (phase III) is to examine whether the improvement in ADR in the trained endoscopists remained stable with further follow-up. We prospectively followed up 15 staff endoscopists who had previously been randomized to a quality improvement intervention. In the current study, we examined an additional 1,200 colonoscopy procedures conducted over a 5-month time period following the original study, referred to as phase III. During this time, all physicians received quarterly ADR and other quality metric feedback, and the previous control group was offered the educational intervention voluntarily. ADRs and adenoma per patient (APP) rates were estimated in the endoscopists who were and were not randomized to EQUIP training and compared with those obtained in phases I and II of the original study. The study was conducted in a tertiary care Academic Medical Center. The study sample comprised 1200 patients undergoing routine colonoscopy. The main outcome measurement was adenoma detection rate. The previously observed increase in ADR in the trained group from 36% in phase I to 47% in phase II was maintained into phase III (46%). The ADR of the untrained group remained unchanged from phase I (36%) to phase II (35%); it was increased only marginally in phase III to 39%, which was still lower than the 46% ADR in the trained group. The trained group had an increase in APP, from 0.72 in Phase I to 0.87 in Phase II and 0.98 in Phase III. For the previously untrained group, there was no change in APP from phase I (0.68) to phase II (0.68), but there was possibly a small increase (to 0.74) in Phase III. This study provides evidence that improvements in ADR obtained through the endoscopic quality-training program can persist for at least 5 months after completion of the program. It further suggests that a focus on ADR does not lead to a \"one and done\" phenomenon. The limitations of this study were as follows: single-center setting, and lack of sessile polyp information/standardization.

ObjectiveTo compare water-assisted colonoscopy (WAC) using the water immersion technique with conventional carbon dioxide insufflation colonoscopy (CC) in novice endoscopists, focusing on procedure time, safety and learning curves.MethodsWe conducted a prospective, randomised (1:1), single-centre trial at Chiang Mai University Hospital, Thailand. Six gastroenterology fellows with <150 prior colonoscopies received standardised training before performing elective screening colonoscopies using either WAC or CC techniques. Patients were randomly assigned to WAC or CC groups. The primary outcome was caecal intubation time (CIT). Secondary outcomes included technical failure, procedural difficulty, patient discomfort, complications, withdrawal time and adenoma detection rate (ADR).ResultsOf 250 randomised patients, 230 completed the protocol (WAC, n=113; CC, n=117). Mean CIT was comparable between groups (10.6±4.2 min vs 9.8±3.9 min; p=0.35). Technical failure occurred in 6.2% of WAC and 5.1% of CC procedures, with no significant differences in procedural difficulty ratings, analgesic requirements or patient discomfort scores. ADR was similar between arms (40.7% vs 33.3%; p=0.25). Learning curves demonstrated parallel, progressive reductions in CIT among fellows in both groups.ConclusionWAC is a safe and effective alternative to CC for novice endoscopists, with similar procedure times, learning curves and safety profiles. These findings support the inclusion of WAC in gastroenterology training programmes.Trial registration numberTCTR20230324001.