Canadian credentialing guidelines for flexible sigmoidoscopy

Abstract

Technical competence for flexible sigmoidoscopy should be assessed after the completion of at least 25 observed procedures and 30 unassisted procedures; however, completion of this number of procedures does not imply competence (12). A competent sigmoidoscopist should be able to identify the splenic flexure (even though the splenic flexure is not reached in many sigmoidoscopies) and obtain retroflexion views within the rectum (14). The depth of insertion will vary depending on the patient's anatomy, prior surgery (43), the presence or absence of disease and patient tolerance, but generally, the rectum and sigmoid should be completely evaluated and often, the descending and more proximal colon can also be visualized. A competent sigmoidoscopist should be proficient in performing endoscopic biopsies. For the practising, credentialed sigmoidoscopist, rates of disease or lesion detection, and rates of referral for colonoscopy should be comparable with those of other competent endoscopists in the institution. Because therapeutic interventions are often undertaken at a subsequent colonoscopy, the findings at flexible sigmoidoscopy must be well documented. Polypectomy rates, for small polyps (smaller than 1 cm), should be comparable with those reported by other sigmoidoscopists. Because complications are very rare, any complication merits serious investigation, and the occurrence of two or more complications in one person's sigmoidoscopy practice may prompt a review of competence, with the possibility that remedial training may be required. Training should impart technical skills as well as sufficient knowledge to satisfy the intellectual requirements for flexible sigmoidoscopy, including basic anatomy, typical pathological findings in the distal colon and rectum, and the indications and contraindications for the procedure. Short courses and virtual reality simulators are not substitutes for supervised training by a competent endoscopist. Institutions that grant privileges for flexible sigmoidoscopy should be encouraged to develop endoscopic reporting mechanisms and databases that will allow clinicians to monitor the quality of their practice and effect improvements if they identify deficiencies, thus maintaining procedural competence and optimizing clinical care over the long term. © 2008 Pulsus Group Inc. All rights reserved.