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

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doi:10.1016/j.gie.2007.11.040 Copyright © 2008 American Society for Gastrointestinal Endoscopy Published by Mosby, Inc.

New method

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

Felix W. Leung MD, FACG, a, H. Aharonian MDa, H. Guth MDa, K. Chu MDa, Bichthuy D. Nguyen MDa and Simpson MDa aCurrent affiliations: Research and Medical Services, Sepulveda Ambulatory Care Center and Nursing Home, VAGLAHS, North Hills, Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California, USA Received 16 December 2006; accepted 12 November 2007. North Hills, California, USA. Available online 25 March 2008.

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.

Abbreviations: VA, Veterans Affairs

Presented at the Veterans Integrated Service Network 21 and 22 Joint Leadership Retreat June 29, 2006, Las Vegas, Nevada, and Digestive Disease Week, May 16, 2006, Los Angeles, California.Reprint requests: Felix W. Leung, MD, FACG, 111G, Division of Gastroenterology, Sepulveda Ambulatory Care Center, VAGLAHS, 16111 Plummer St, North Hills, CA 91343.

Gastrointestinal Endoscopy Volume 67, Issue 4, April 2008, Pages 718-722