Desarrollo de un listado de procedimientos mínimos para certificar la competencia en endoscopia digestiva por método Delphi / Development of a list of minimum procedures to certify competence in digestive endoscopy by the Delphi method

Introducción: En el marco de referencia de cada especialidad médica, resulta un aspecto clave ofrecer un listado consensuado del tipo y número de prácticas que caracteriza el quehacer profesional de una especialidad. Es así que, el objetivo de este estudio es definir un listado de procedimientos mínimos para asegurar la competencia en Endoscopía Digestiva en base a un proceso de consenso estructurado, así como explorar las opiniones de referentes expertos en endoscopía digestiva sobre la formación de médicos endoscopistas en la Argentina y la necesidad de certificación de competencias. Materiales y métodos: Para esta investigación se realizó un estudio prospectivo de metodología mixta, a partir de la implementación del método Delphi, como técnica de investigación cualitativa grupal, seguido de la implementación de una encuesta estructurada. Resultados: El listado consolidado final incluyó 17 procedimientos considerados fundamentales para la certificación de la competencia en endoscopía digestiva. Dado la dispersión en el rango del número mínimo necesario para alcanzar la competencia se definió utilizar la mediana. En el caso de la endoscopía digestiva alta el número de procedimientos mínimo acordado fue de 200, mientras que en el caso de la videocolonoscopía fue de 150. Conclusión: Este listado es una pieza fundamental en el desarrollo de un marco formativo a nivel nacional en endoscopía digestiva, así como en un programa de certificación de la competencia (AU)

Definition of minimum procedures required to certify competence in gastrointestinal endoscopy using the Delphi method.

INTRODUCTION: As part of the training framework for medical specialities, it is vital to provide an agreed list of the type and number of practices involved in the professional work of a given specialty. Thus, the purpose of this study is to define a list of minimum procedures to ensure competence in Gastrointestinal Endoscopy based on a structured and agreed upon process, as well as to explore the opinions of experts in gastrointestinal endoscopy on the training of endoscopy physicians in Argentina and the need to certify competencies. MATERIALS AND METHODS: a mixed-method prospective study was carried out using the Delphi method as a qualitative group research technique, followed by the implementation of a structured survey. RESULTS: The final consolidated list included 17 procedures considered essential for certification of competence in gastrointestinal endoscopy. Median was used given the range in the minimum number of procedures required to achieve competence. In the case of upper gastrointestinal endoscopy, the minimum number of procedures agreed was 200, while in the case of colonoscopy it was 150. CONCLUSION: This list is a fundamental element to develop a national training framework in gastrointestinal endoscopy, as well as a competence certification program.

Implementation of a program to improve the quality of colonoscopy increases the neoplasia detection rate: a prospective study.

BACKGROUND AND STUDY AIMS: Endoscopists worldwide have been encouraged to report quality indicators in order to evaluate their performance. We aimed to determine whether a program to improve the quality of colonoscopy results in better rates of neoplasia detection. PATIENTS AND METHODS: This is a prospective study set in a private endoscopy center. From May 2009 to March 2010, we evaluated 1573 consecutive colonoscopies (group 1). After the implementation of a quality program, from February 2011 to January 2012, we prospectively evaluated 1583 colonoscopies (group 2). Our quality-enhancing intervention consisted of instructing both patients and endoscopists. We measured the cecal intubation rate and the neoplasia detection rate. Overall neoplasias, high-risk adenomas, carcinomas, right colon adenomas, and adenomas detected in screening studies were analyzed. RESULTS: Cecal intubation was documented in 1384 cases from group 1 (88 %) and 1534 from group 2 (96.9 %) (P < 0.0001). The neoplasia detection rates in groups 1 and 2 were, respectively: neoplasias 288 (18.3 %) and 427 (27 %) (P < 0.0001), high-risk adenomas 76 (4.8 %) and 142 (9 %) (P < 0.0001), carcinomas 16 (1 %) and 21 (1.3 %) (P = 0.52), right colon adenomas 112 (7.1 %) and 154 (9.7 %) (P = 0.01), and adenomas 141 (16.5 %) and 233 (28 %) (P < 0.0001). CONCLUSIONS: Implementation of a quality program improves the neoplasia detection rate. Because of the small number of cancerous lesions found in both groups, we were unable to identify differences in the carcinoma detection rate.

Los adenomas metacrónicos de colon presentan un patrón de desarrollo diferente en pacientes obesos.

INTRODUCTION: XSome authors have assessed the link between obesity and colon adenoma risk. Moreover, it has been reported that obesity could increase the risk of proximal adenoma development. Accordingly, obese patients may have a distinctive pattern of adenoma recurrence. AIM: To determine whether metachronous adenoma features differ between obese and non-obese subjects submitted to colonoscopy surveillance. MATERIALS AND METHODS: We prospectively evaluated all patients over 18 years old that underwent surveillance colonoscopy at our institution between June 2013 and June 2014. Date of prior colonoscopy was registered. A body mass index ≥ 30 was used to define obesity. Analysis looking for variables significantly associated with metachronous adenoma was performed. Metachronous adenoma rate was compared between obese and non-obese subjects, as well as size, location, morphological and histopathological characteristics. RESULTS: Overall, 825 subjects were enrolled. Median time of surveillance colonoscopy was 38.9 months. Obesity was statistically more frequent in those subjects with metachronous adenomas (40% vs 25.71%, p < 0.001). On multivariate analysis, obesity [OR 1.7 (1.01-2.9)] and age [OR 1.02 (1-1.05)] were independently associated with metachronous adenoma presence. Obesity was also significantly associated with a higher risk of right colon adenomas [OR 2.4 (1.76-3.26)] and advanced adenoma [OR 1.99 (1.29-3.06)]. The risk is significantly higher in men and in those with a family history of colorectal cancer/adenoma. CONCLUSION: Obesity was associated with a higher risk of metachronous adenomas on surveillance colonoscopy. A higher risk of right-sided lesions and advanced adenomas was also found in this population.