Colonoscopic perforation:A report from World Gastroenterology Organization endoscopy training center in Thailand

AIM： To determine the incidence of colonoscopic perforation （CP）, and evaluate clinical findings, management and outcomes of patients with CP from the World Gastroenterology Organization （WGO） Endoscopy Training Center in Thailand. METHODS： All colonoscopies and sigmoidoscopies performed between 1999 and 2007 in the Endoscopic unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok were reviewed. Incidence of CP, patients＇ characteristics, endoscopic information, intraoperative findings, management and outcomes were analyzed. RESULTS： A total of 17357 endoscopic procedures of the colon （13 699 colonoscopies and 3658 flexible sigmoidoscopies） were performed in Siriraj hospital over a 9-year period. Fifteen patients （0.09%） had CP： 14 from colonoscopy and 1 from sigmoidoscopy. The most common site of perforation was in the sigmoid colon （80%）, followed by the transverse colon （13%）. Perforations were caused by direct trauma from either the shaft or the tip of the endoscope （n = 12,80%） and endoscopic polypectomy （n = 3, 20%）. All patients with CP underwent surgical management： primary repair （27%） and bowel resection （73%）. The mortality rate was 13% and postoperative complication rate was 53%. CONCLUSION： CP is a rare but serious complication following colonoscopy and sigmoidoscopy, with high rates of morbidity and mortality. Incidence of CP was 0.09%. Surgery is still the mainstay of CP management.

Endoscopic non-technical skills team training:The next step in quality assurance of endoscopy training

AIM: To investigate whether novel, non-technical skills training for Bowel Cancer Screening (BCS) endoscopy teams enhanced patient safety knowledge and attitudes.

Impact of a simulation-based induction programme in gastroscopy on trainee outcomes and learning curves

BACKGROUND Pre-clinical simulation-based training(SBT)in endoscopy has been shown to augment trainee performance in the short-term,but longer-term data are lacking.AIM To assess the impact of a two-day gastroscopy induction course combining theory and SBT(Structured PRogramme of INduction and Training–SPRINT)on trainee outcomes over a 16-mo period.METHODS This prospective case-control study compared outcomes between novice SPRINT attendees and controls matched from a United Kingdom training database.Study outcomes comprised:(1)Unassisted D2 intubation rates;(2)Procedural discomfort scores;(3)Sedation practice;(4)Time to 200 procedures;and(5)Time to certification.RESULTS Total 15 cases and 24 controls were included,with mean procedure counts of 10 and 3(P=0.739)pre-SPRINT.Post-SPRINT,no significant differences between the groups were detected in long-term D2 intubation rates(P=0.332)or discomfort scores(P=0.090).However,the cases had a significantly higher rate of unsedated procedures than controls post-SPRINT(58%vs 44%,P=0.018),which was maintained over the subsequent 200 procedures.Cases tended to perform procedures at a greater frequency than controls in the post-SPRINT period(median:16.2 vs 13.8 per mo,P=0.051),resulting in a significantly greater proportion of cases achieving gastroscopy certification by the end of follow up(75% vs 36%,P=0.017).CONCLUSION In this pilot study,attendees of the SPRINT cohort tended to perform more procedures and achieved gastroscopy certification earlier than controls.These data support the role for wider evaluation of pre-clinical induction involving SBT.