SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
Originalité :
Très original
Solidité :
Très solide
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Professeur Emmanuel CORON
Coup de coeur :
 
 
Gut
  2016/04  
 
  2016;65:616-624  
  doi:10.1136/gutjnl-2014-307503  
 
  Leadership training to improve adenoma detection rate in screening colonoscopy: a randomised trial  
 
  Michal F Kaminski, John Anderson, Roland Valori, Ewa Kraszewska, Maciej Rupinski, Jacek Pachlewski, Ewa Wronska, Michael Bretthauer, Siwan Thomas-Gibson, Ernst J Kuipers, Jaroslaw Regula  
  http://www.ncbi.nlm.nih.gov/pubmed/?term=Leadership+training+to+improve+adenoma+detection+rate+in+screening+colonoscopy%3A+a+randomised+trial  
 
 

Objective Suboptimal adenoma detection rate (ADR) at colonoscopy is associated with increased risk of interval colorectal cancer. It is uncertain how ADR might be improved. We compared the effect of leadership training versus feedback only on colonoscopy quality in a countrywide randomised trial.

 

Design 40 colonoscopy screening centres with suboptimal performance in the Polish screening programme (centre leader ADR ≤25% during preintervention phase January to December 2011) were randomised to either a Train-Colonoscopy-Leaders (TCLs) programme (assessment, hands-on training, post-training feedback) or feedback only (individual quality measures). Colonoscopies performed June to December 2012 (early postintervention) and January to December 2013 (late postintervention) were used to calculate changes in quality measures. Primary outcome was change in leaders’ ADR. Mixed effect models using ORs and 95% CIs were computed.

 

Results The study included 24 582 colonoscopies performed by 38 leaders and 56 617 colonoscopies performed by 138 endoscopists at the participating centres. The absolute difference between the TCL and feedback groups in mean ADR improvement of leaders was 7.1% and 4.2% in early and late postintervention phases, respectively. The TCL group had larger improvement in ADR in early (OR 1.61; 95% CI 1.29 to 2.01; p<0.001) and late (OR 1.35; 95% CI 1.10 to 1.66; p=0.004) postintervention phases. In the late postintervention phase, the absolute difference between the TCL and feedback groups in mean ADR improvement of entire centres was 3.9% (OR 1.25; 95% CI 1.04 to 1.50; p=0.017).

 

Conclusions Teaching centre leaders in colonoscopy training improved important quality measures in screening colonoscopy.

 
Question posée
 
Quelle est la meilleure façon d’améliorer son TDA ?
 
Question posée
 
Cette étude polonaise randomisée contrôlée, effectuée à l’échelon national, montre que les centres qui suivent un programme structuré d’enseignement (critères qualité, enseignement pratique de type ‘hands-on’…) est la méthode la plus efficace pour améliorer le TDA, à court et à long terme.
 
Commentaires

Reste à régler le problème de faisabilité pratique (disponibilité, financement…) pour organiser un tel programme d’entrainement, alors que le gain en terme de TDA est relativement modeste à long terme.

 
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