Development and implementation of paediatric colonoscopy re-certification in Australia

Abstract

Objectives and Study: Re-certification of endoscopy practice remains a controversial topic despite it being a tool to ensure ongoing technical proficiency. In Australia, as part of the national bowel cancer screening program, colonoscopy re-certification is now mandatory in adult gastroenterology. Criteria for re-certification in adults however are not applicable to paediatric patients because of different disease prevalence and indications. Additionally, fewer colonoscopies are performed in children, so procedure numbers are much lower. Our aims were therefore to investigate and develop achievable criteria for re-certification in paediatric colonoscopy in Australia Methods: An email was sent to a representative of all tertiary paediatric hospitals performing paediatric colonoscopy. Required information included number of procedures, number of endoscopists including trainees, caecal and ileal intubation rates. The number of colonoscopies performed each year was then divided by the number of endoscopists including trainees to determine mean annual individual procedure numbers. An online survey was then conducted as to which metrics including procedure numbers, caecal intubation rate (CIR) and ileal intubation rate (IIR) were acceptable. Multiple requests were posted on the Australian paediatric bulletin board to strongly encourage everyone to complete the survey. The survey findings were then then widely circulated among paediatric gastroenterologists electronically, but also discussed at the annual meeting. These criteria were then subjected to a vote and the guidelines set. Review of participation in re-certification was conducted 2 years after implementation. Results: Responses were received from 6/7 paediatric hospitals in Australia. Mean annual number of colonoscopies ranged from 20-42 per endoscopist, varying between states and hospitals. There was an estimated 62% response (31/50 paediatric gastroenterologists) to the online survey. There was however significant variation between individual endoscopists. 87% agreed that quality metrics are important for patient safety and outcomes. Ileal intubation was thought to be a more suitable measure in paediatrics than caecal intubation. 89% of survey responders recommended IIR of ≥ 70%, although 80% was the most frequent rate nominated (43% of responders). 70% of responders recommended 90% CIR, which is the current requirement for initial certification of colonoscopy training. There was an even split of procedure numbers between 60, and < 50 over 3 years (28% each) although 28% thought it should be ≥100 colonoscopies over 3 years. These metrics were then subjected to a vote at the annual meeting and the indicators agreed upon were 50 colonoscopies over 3 years, 90% CIR, and 80% IIR with and a plan to review these after 1- 3 years. These paediatric re-certification criteria were then added to the national colonoscopy recertification recommendations in September 2017. Review of participation at the end of December 2019 found almost half 49% (25/51) of paediatric colonoscopists in Australia were re-certified despite it being optional. Conclusion: Paediatric colonoscopy re-certification is achievable, but not equivalent to adult recertification, and requires collective buy in from paediatric gastroenterologists.L6351738262021-06-08 <br />