INtegrated Colonoscopy Improvement Program in Italy

Study Overview
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Brief Summary
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The Italian Society of Digestive Endoscopy (SIED) and the Italian Association of Gastroenterologists and Hospital Digestive Endoscopists (AIGO) want to develop an effective training program for endoscopists to improve the quality of colonoscopies through careful evaluation of quality indicators and how they can be improved with an appropriate educational program. Primary objective of this study is to evaluate the variation of Polyp Detection Rate (PDR) and Adenoma Detection Rate (ADR) obtained by operators at high and low volume of colonoscopy before and after a training period. Secondary objectives are to compare high and low volume endoscopists' performance before and after training comparing by evaluation of withdrawal time; Number polyps / patient and Number adenomas / patient; the percentage and time of intubation of the cecum, ; patient's pain perception based on the Nurse Assessed Patient Comfort Score (NAPCOMS) scale. The study is structured as follow: A first phase when all endoscopists collect the results of 200 colonoscopies in an electronic Case Report Form (eCRF) is formed(maximum enrollment period 4 months). A second phase of training through an e-platform in which the endoscopists are offered with an online refresh reviewing the international standard parameters to perform a quality colonoscopy. Once the final training exam have been passed, the endoscopist will be able to access the third phase A third phase in which the endoscopists will collect prospectively the colonoscopies they perform in an eCRF (maximum enrollment period 4 months).

Official Title
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INtegrated Colonoscopy Improvement Program in Italy (INCIPIT)

Conditions
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Colon Lesion, Colon Polyp

Intervention / Treatment
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* Diagnostic Test: colonoscopy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients between 50 and 75 years old colonoscopy for cancer screening program, post polypectomy follow up, patients with abdominal symptoms suggestive for colonic pathology. Exclusion Criteria: patients aged < 50 or > 75 yrs presence of alarm symptoms American Society of Anesthesiologists (ASA) Classification ≥ 3 presence of colonic stenosis previous colonic resection Presence of diverticulitis history of Inflammatory Bowel Disease (IBD) History of polyposis syndrome Pregnancy or breastfeeding inability to provide informed consent Severe cardiovascular illness contraindication to undergo to sedation Anticoagulant therapy Melanosis coli

Ages Eligible for Study
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Minimum Age: 50 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Diagnostic Test: colonoscopy|endoscopists' performance outcome|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Adenoma detection rate | to evaluate Adenoma Detection Rate obtained by operators at high and low volume of colonoscopy before and after a training period(ADR) | 9 months | 
| Polyps detection rate | to evaluate the variation of Polyp Detection Rate (PDR) obtained by operators at high and low volume of colonoscopy before and after a training period | 9 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Withdrawal time | to evaluate the amount of time spent viewing during the withdrawal of the scope | 9 months | 
| Number polyps / patient | Number of polyps found in each patient | 9 months | 
| Number adenomas / patient | Number of adenomas found in each patient | 9 months | 
| percentage of intubation of the cecum | percentage of colonoscopy in which endoscopist reach cecum | 9 months | 
| time of intubation of the cecum | the amount of time spent by endoscopist to reach cecum | 9 months | 
| patient's pain perception assessed by Nurse Assessed Patient Comfort Score (NAPCOMS) | evaluate tolerability of colonoscopy. NAPCOMS includes 3 domains: pain, sedation, and a global subjective assessment of tolerability. The pain domain is defined by using the dimensions of intensity (0. None or minimal; 1 mild; 2. Moderate; 3 severe), frequency (0. None; 1. Few 1 or 2 episodes; 2. Several times (3-4 episodes); 3. Frequent); and duration (0. None; 1 short duration; 2 Moderate duration; 3 Long duration). Sedation is rated according to level of consciousness ranging from 0 (wide awake) to 3 (unconscious), whereas the global tolerability score is rated from 0 (very well tolerated) to 3 (poorly tolerated). The overall NAPCOMS was defined as the sum of the severity, frequency, and duration of pain domains. Level of sedation and overall global tolerability ratings were assessed separately A NAPCOMS of 6 or greater corresponded with a patient rating of moderate to severe discomfort. | 9 months |