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2024
- ISIDORE Id: 10670/1.49cc63...
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Hajar Cherkaoui et al., « Learning curve in colonoscopy: What really works. A literature review », Cahiers Santé Médecine Thérapeutique, ID : 10670/1.49cc63...
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Training in diagnostic colonoscopy is one of the keystones for proper training in gastroenterology. However, there is no curriculum that deals strictly with the purely technical aspects of colonoscopy. Our aim is to carry out a review of the literature focusing on the number of colonoscopies required to achieve autonomy in diagnostic colonoscopy, and the different means used to improve technical success in endoscopy. Materials and methods: This literature review covers the last 30 years, focusing on observational studies and clinical trials that have examined residents in digestive endoscopy, their success rates in performing endoscopies, and the different technical means used to improve their success in diagnostic endoscopy. We adhered to the PRISMA recommendations to conduct this literature review and the Cochrane register of clinical trials to determine the quality of the clinical trials included. In addition, this literature review was carried out using the key words: trainees, colonoscopy, competence, evaluation, and learning curve on the search bases PubMed and MEDLINE. All articles were analyzed based on title and abstract. Results: After reviewing the literature and excluding articles based on title and abstract, we retained 32 articles for analysis. The number of colonoscopies required to achieve autonomy in diagnostic endoscopy varies between 50 and 400, although most authors seem to agree on 200 colonoscopies. Video feedback is validated by all the studies as the best means of improving the learning curve in colonoscopy. The colonoscopy simulator shows satisfactory results in the technical success of colonoscopies. Virtual reality, however, has contradictory results as a predictor of colonoscopy success. An objective means of evaluating endoscopy training is the adenoma detection rate. In addition, certain factors appear to predict successful examinations, including loop-free progression of the sigmoid, rapid progression to the right colon, and the use of long colonoscopes. Conclusion: Based on the findings of this literature review, we can conclude that 200 diagnostic colonoscopies are necessary to obtain a cecal intubation technical success rate of 90%. Simulators and video feedback play an important role at the start of training, helping to improve the technical success rate.
