Department of Gastroenterology and Hepatology, University of Colorado, Aurora, Colorado, USA.
Department of Gastroenterology, University of California, San Francisco, San Francisco, California, USA.
Gastrointest Endosc. 2019 Jun;89(6):1212-1221. doi: 10.1016/j.gie.2019.02.024. Epub 2019 Feb 27.
Polypectomy competency varies significantly among providers. Poor polypectomy technique may lead to interval cancer and/or adverse events. Our aim was to determine the effect of a polypectomy skills report card on subsequent polypectomy performance.
We conducted a 3-phase, prospective, single-blinded study. In phase 1 ("baseline"), we graded 10 polypectomies per endoscopist using the Direct Observation of Polypectomy Skills (DOPyS) tool (scores 1-4); mean overall scores ≥3 are competent. In phase 2 ("pre-report card"), we selected 10 additional polypectomies per endoscopist. We subsequently gave endoscopists a report card with baseline scores and instructional videos demonstrating optimal polypectomy technique. In phase 3 ("post-report card"), 10 additional polypectomies per endoscopist were selected. Raters, blinded to study phase, graded 10 pre- and 10 post-report card polypectomies per endoscopist. We compared mean DOPyS scores and rate of competent polypectomy in the pre- and post-report card phases.
We graded 110 pre- and 110 post-report card polypectomies performed by 11 endoscopists. The mean DOPyS score increased between the pre- and post-report card phases (2.7 ± .9 vs 3.0 ± .8, P = .01); this improvement was seen for diminutive (P < .0001) but not for small-to-large polyps. Rate of competent polypectomy significantly improved from the pre- to post-report card phase (56% vs 69%, P = .04); this improvement was seen for diminutive (57% vs 81%, P = .001) but not for small-to-large polyps (55% vs 36%, P = .2).
Report cards with educational videos effectively improved polypectomy technique, primarily because of improvements in resecting diminutive polyps. The improved competency and decreased piecemeal resection may reduce the risk of polyp recurrence. Further education is needed to improve larger polyp resection.
息肉切除术的能力在提供者之间差异很大。较差的息肉切除术技术可能导致间隔期癌症和/或不良事件。我们的目的是确定息肉切除术技能报告卡对后续息肉切除术表现的影响。
我们进行了一个 3 期、前瞻性、单盲研究。在第 1 阶段（“基线”），我们使用直接观察息肉切除术技能（DOPyS）工具对每位内镜医生的 10 个息肉切除术进行评分（得分 1-4）；总分≥3 为有能力。在第 2 阶段（“报告卡前”），我们为每位内镜医生选择了另外 10 个息肉切除术。随后，我们为内镜医生提供了一份报告卡，其中包括基线评分和演示最佳息肉切除术技术的教学视频。在第 3 阶段（“报告卡后”），每位内镜医生选择了另外 10 个息肉切除术。评分者对研究阶段进行了盲法，对每位内镜医生的 10 个术前和 10 个术后报告卡息肉切除术进行了评分。我们比较了术前和术后报告卡阶段的平均 DOPyS 评分和有能力的息肉切除术率。
我们对 11 位内镜医生的 110 个术前和 110 个术后报告卡息肉切除术进行了评分。与术前相比，术后报告卡阶段的 DOPyS 评分有所提高（2.7±0.9 与 3.0±0.8，P=0.01）；这一改善在微小息肉中更为明显（P<0.0001），但在大小息肉中不明显。与术前相比，术后报告卡阶段有能力的息肉切除术率显著提高（56%与 69%，P=0.04）；这一改善在微小息肉中更为明显（57%与 81%，P=0.001），但在大小息肉中不明显（55%与 36%，P=0.2）。
带教育视频的报告卡有效地改善了息肉切除术技术，主要是因为切除微小息肉的能力提高了。提高的能力和减少的分片切除可能会降低息肉复发的风险。需要进一步的教育来提高对较大息肉的切除能力。
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