{"title":"Is painless colonoscopy associated with trainee learning? A single-center study of insertion speed and adenoma detection curves in 1,769 procedures.","authors":"Yiming Ding, Hongjuan Wang, Xiangchun Lin","doi":"10.3389/fmed.2026.1965959","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To compare the learning curves of cecal intubation time and adenoma detection rate (ADR) between painless (sedated) and conventional (non-sedated) colonoscopy performed by trainees.</p><p><strong>Methods: </strong>This single-center retrospective cohort comprised the first 1,769 colonoscopies performed by eight trainees without prior colonoscopy experience, grouped by sedation status into a conventional group (<i>n</i> = 852) and a painless group (<i>n</i> = 917). Mixed-effects models characterized the learning trajectories of cecal intubation time and ADR, and an extended model allowing a random case-order slope tested individual heterogeneity. The caseload to independent cecal intubation competency was estimated with a rolling 20-procedure success-rate threshold and Bernoulli cumulative sum (CUSUM) analysis.</p><p><strong>Results: </strong>Cecal intubation time was shorter in the painless group (median 6 vs. 10 min, <i>P</i> < 0.001). The case-order × procedure-type interaction fell from -0.113/SD (<i>P</i> < 0.001) in the random-intercept model to -0.027/SD (<i>P</i> = 0.589) in the random-slope model and was not significant under an exact trainee-level permutation test (exact <i>P</i> = 0.23); the overall shortening of intubation time with painless colonoscopy was robust to all specifications. Sedation status, calendar era, and scope model were highly correlated at the trainee level (<i>r</i> = 0.92), precluding separation of their independent effects. The overall ADR was 13.0% and declined early with experience (odds ratio 0.80/SD, <i>P</i> = 0.002). Fewer procedures were required to reach independent cecal intubation competency in the painless group (rolling threshold 37 vs. 114; CUSUM 107 vs. 134); however, this difference could not be separated from calendar era and equipment upgrades.</p><p><strong>Conclusion: </strong>Intubation time was shorter overall under sedation, but the faster learning of the painless group vanished once individual heterogeneity was modeled, and ADR showed no robust improvement. Sedation, era, and equipment were confounded; no causal inference regarding the effect of sedation on learning can be drawn from these data, and prospective confirmation is required. Intubation speed alone should not serve as a benchmark of overall colonoscopy competence.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1965959"},"PeriodicalIF":3.6000,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677516/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3389/fmed.2026.1965959","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: To compare the learning curves of cecal intubation time and adenoma detection rate (ADR) between painless (sedated) and conventional (non-sedated) colonoscopy performed by trainees.
Methods: This single-center retrospective cohort comprised the first 1,769 colonoscopies performed by eight trainees without prior colonoscopy experience, grouped by sedation status into a conventional group (n = 852) and a painless group (n = 917). Mixed-effects models characterized the learning trajectories of cecal intubation time and ADR, and an extended model allowing a random case-order slope tested individual heterogeneity. The caseload to independent cecal intubation competency was estimated with a rolling 20-procedure success-rate threshold and Bernoulli cumulative sum (CUSUM) analysis.
Results: Cecal intubation time was shorter in the painless group (median 6 vs. 10 min, P < 0.001). The case-order × procedure-type interaction fell from -0.113/SD (P < 0.001) in the random-intercept model to -0.027/SD (P = 0.589) in the random-slope model and was not significant under an exact trainee-level permutation test (exact P = 0.23); the overall shortening of intubation time with painless colonoscopy was robust to all specifications. Sedation status, calendar era, and scope model were highly correlated at the trainee level (r = 0.92), precluding separation of their independent effects. The overall ADR was 13.0% and declined early with experience (odds ratio 0.80/SD, P = 0.002). Fewer procedures were required to reach independent cecal intubation competency in the painless group (rolling threshold 37 vs. 114; CUSUM 107 vs. 134); however, this difference could not be separated from calendar era and equipment upgrades.
Conclusion: Intubation time was shorter overall under sedation, but the faster learning of the painless group vanished once individual heterogeneity was modeled, and ADR showed no robust improvement. Sedation, era, and equipment were confounded; no causal inference regarding the effect of sedation on learning can be drawn from these data, and prospective confirmation is required. Intubation speed alone should not serve as a benchmark of overall colonoscopy competence.
目的：比较实习生进行无痛（镇静）和常规（非镇静）结肠镜检查时盲肠插管时间和腺瘤检出率（ADR）的学习曲线。方法：该单中心回顾性队列包括8名无结肠镜检查经验的受训者进行的前1769次结肠镜检查，按镇静状态分为常规组（n = 852）和无痛组（n = 917）。混合效应模型表征了盲肠插管时间和不良反应的学习轨迹，扩展模型允许随机病例-顺序斜率检验个体异质性。通过滚动20例成功率阈值和伯努利累积和（CUSUM）分析来估计独立盲肠插管能力的病例量。结果：在随机斜率模型中，无痛组盲肠插管时间较短（中位数6 vs. 10 min, P P P = 0.589），在精确培训水平排列检验下无显著性差异（精确P = 0.23）；无痛结肠镜检查对插管时间的总体缩短在所有指标上都是稳健的。镇静状态、日历年代和范围模型在受训者水平上高度相关（r = 0.92），排除了它们独立影响的分离。总不良反应为13.0%，随经验增加而降低（优势比0.80/SD, P = 0.002）。无痛组达到独立盲肠插管能力所需的手术较少（滚动阈值37比114；CUSUM 107比134）；然而，这种差异离不开日历时代和设备升级。结论：镇静下插管时间总体较短，但个体异质性建模后无痛组学习较快的现象消失，ADR无明显改善。镇静，时间和设备混淆；从这些数据中不能得出关于镇静对学习的影响的因果推论，需要前瞻性的证实。插管速度本身不应作为整体结肠镜检查能力的基准。
期刊介绍：
Frontiers in Medicine publishes rigorously peer-reviewed research linking basic research to clinical practice and patient care, as well as translating scientific advances into new therapies and diagnostic tools. Led by an outstanding Editorial Board of international experts, this multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide.
In addition to papers that provide a link between basic research and clinical practice, a particular emphasis is given to studies that are directly relevant to patient care. In this spirit, the journal publishes the latest research results and medical knowledge that facilitate the translation of scientific advances into new therapies or diagnostic tools. The full listing of the Specialty Sections represented by Frontiers in Medicine is as listed below. As well as the established medical disciplines, Frontiers in Medicine is launching new sections that together will facilitate
- the use of patient-reported outcomes under real world conditions
- the exploitation of big data and the use of novel information and communication tools in the assessment of new medicines
- the scientific bases for guidelines and decisions from regulatory authorities
- access to medicinal products and medical devices worldwide
- addressing the grand health challenges around the world
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
