Decreased Sedation Usage Following Colonoscopy Skills Improvement (CSI) Training Maintained At Eight Months.
B. Evans1, M. Borgaonkar1, D. Pace1, M. Goldring1, D. Boone1, J. McGrath1

1Memorial University, Faculty of Medicine, St. John’s, Canada

The Canadian Association of Gastroenterology (CAG) has implemented the Colonoscopy Skills Improvement (CSI) program across Canada with a goal of improving colonoscopy quality. The programs' efficacy has not yet been formally assessed.
This retrospective cohort study was performed on fifteen endoscopists practicing in a tertiary referral center who have undergone CSI training between October 2014 and December 2015. Fifty consecutive procedures immediately prior to, immediately after, and eight months after undergoing training were included for each endoscopist. Data were extracted from the electronic medical record (EMR) and entered into SPSS version 20.0 for analysis. Student’s T-test was used to compare groups for continuous data; Chi-squared tests were used for categorical data.
Thus far, partial data for analysis have been collected for 2250 procedures. The most common indication for colonoscopy was family history of colorectal cancer in 413 (36.5%) patients. Patient groups pre, post and late post CSI training were comparable in terms of: mean age (59.5yrs v. 59.9yrs v. 59.9yrs), sex (44% male v. 46% v. male v. 45% male), indication, and completion rate (98.6% v. 98.7% v. 99.3%). Fentanyl and versed were the only sedation agents used. Intravenous sedation was used in 1982 (88.1%) cases. There was no difference in the rate of sedation usage between groups. There was a statistically significant decrease in average dose of fentanyl (77.8mcg v. 68.5mcg, p<0.001) and average dose of versed (2.6mg v. 2.3mg, p<0.001) used during each procedure immediately before and after CSI training. This decrease in mean sedation dose was maintained eight months after undergoing training for both fentanyl (77.8mcg v. 66.4mcg, p<0.001) and versed (2.6mg v. 2.2mg, p<0.001).
Participation in the CSI program is associated with decreased sedation usage during colonoscopy. This was maintained in the eight-month follow up period.