Recommendation statement | Level of evidence | Strength | |
1.1 | Competence in FS is defined as the ability to perform FS, including all relevant periprocedural and postprocedural aspects and demonstrating relevant endoscopic non-technical skills (ENTS) consistent with current UK endoscopy best practice standards and guidelines. | Very low | Strong |
1.2 | Competence in FS requires the ability to recognise normal findings, describe and document abnormal findings and take appropriate action. | Very low | Strong |
1.3 | Competence in FS includes the ability to identify and manage immediate and late complications of the procedure demonstrating effective clinical, endoscopic and ENTS to coordinate subsequent action. | Low | Strong |
1.4 | Competent endoscopists should be able to recognise the adequacy of the endoscopic procedure performed and recommend subsequent action. | Very low | Strong |
1.5 | When sedation is used in FS, doses should be within those defined by the current BSG colonoscopy guidance. | Low | Strong |
1.6 | Comfort scores in FS should be within those defined by the current BSG colonoscopy guidance. | Low | Strong |
1.7 | Competence in polypectomy should be based on achieving all competencies defined in the DOPyS form rather than a set minimum no of procedures. | Low | Strong |
1.8 | Endoscopists should be able to competently document polyps using the Paris classification. | Low | Strong |
1.9 | Endoscopists should competently use at least one validated optical diagnosis system to classify and document polyps. | Moderate | Strong |
1.10 | Competent endoscopists should be able to define the difficulty level of polypectomy using the SMSA scoring system. | Low | Strong |
1.11 | Endoscopists in colonoscopy should be competent to perform safe and effective polypectomy of SMSA level 1 polyps as a minimum. | Low | Strong |
1.12 | Endoscopists must be able to competently demonstrate safe and appropriate use of diathermy relevant to polypectomy. | Low | Strong |
1.13 | Endoscopists should be able to competently manage postpolypectomy perforation and bleeding using endoscopic clips and at least one other method of haemostasis while demonstrating relevant ENTS. | Low | Strong |
2.1 | Lower GI endoscopy training should take place in a unit that maintains its training environment to JAG standards. | Very low | Weak |
2.2 | FS trainers should meet trainer standards as defined by the JAG GRS training domain | Low | Strong |
2.3 | The training programme should include opportunities to gain experience and competencies in ENTS. | Low | Strong |
2.4 | Trainees in FS should attend a JAG approved Basic Skills in Colonoscopy course during training. | Low | Strong |
2.5 | Lower GI endoscopy trainees should apply for a JAG approved basic skills course at the start of LGI endoscopy training and attend this within their first 70 procedures. | Low | Strong |
2.6 | Virtual reality simulation training for endoscopic technical skills is encouraged in conjunction with conventional endoscopy training to enhance development of early endoscopic technical skills. Trainee simulator-based training should be directly supported by appropriately skilled trainers/supervisors. | Moderate | Strong |
2.7 | Training in polypectomy should start early during FS training and continue in parallel with this | Very low | Weak |
2.8 | Polypectomy training should include skills acquisition in cold biopsy, cold snare, hot snare and basic lift assisted polypectomy to a minimum of SMSA level 1. | Low | Strong |
2.9 | Trainees should receive training in the Paris polyp classification system and validated optical diagnosis systems. When available supportive web-based training tools should be utilised and any relevant modules completed prior to the basic skills course. | Moderate | Strong |
2.10 | Appropriate discussion and reflection related to polyp classification and management should occur throughout training. | Very low | Strong |
2.11 | Attendance at a hands on (tissue/tissue-like) model endoscopy course with exposure to differing polyp resection techniques, submucosal injection techniques, haemostatic therapy, polyp retrieval techniques and tattooing is encouraged. | Very low | Strong |
2.12 | All parameters described in DOPS/DOPyS should be included during skills training. | Very low | Strong |
2.13 | A trainee should undertake a minimum of 175 FS procedures during their training to be eligible for summative assessment. | Low | Strong |
2.14 | A trainee should have a minimum no of dedicated training lists as defined by the JAG training standards. | Very low | Strong |
2.15 | It is recommended that a trainee should receive a minimum of one DOPS per training list. | Low | Weak |
2.16 | It is recommended that a minimum of one DOPyS should be completed for every training list where a polypectomy has been attempted by a trainee. | Low | Weak |
2.17 | Trainees must complete a reflection tool on JETS every 50 procedures. This forms a framework for meetings with their endoscopy supervisor every 6 months or less. | Low | Strong |
3.1 | DOPS should be used as the competency assessment tool in lower gastrointestinal endoscopy. | Low | Strong |
3.2 | Each formative DOPS should be performed on a single pre-selected case. | Low | Strong |
3.3 | The last five DOPS prior to summative assessment must be rated competent without supervision in >90% of all items, with none requiring maximal or significant supervision. | Low | Strong |
3.4 | DOPyS should be used as the polypectomy competency assessment tool for both technical and non-technical skills. | Low | Strong |
3.5 | For competence at SMSA level 1 polypectomy, a minimum of two SMSA level 1 DOPyS should be competently performed using the following methods: cold snare polypectomy, diathermy-assisted resection of stalked polyps and diathermy-assisted EMR. The last four DOPyS (level 1) should score ‘competent for independent practice’ in all items. | Very low | Strong |
3.6 | Eligibility for summative assessment in FS may be triggered once the following are met:
| Low | Strong |
3.7 | For successful completion of the summative DOPS assessment, the trainee should be rated as 'ready for independent practice' in all items within four DOPS by a minimum of two different assessors who are not the trainee’s usual trainer. | Low | Strong |
4.1 | Newly certified endoscopists should have access to a named individual and meet on a regular basis to discuss cases and to review progress. | Very low | Strong |
4.2 | Endoscopy departments should have systems in place to ensure appropriate list size and caseload selection for newly certified endoscopists. | Very low | Strong |
4.3 | Certified endoscopists should perform at least 100 procedures a year to maintain competence. | Very low | Strong |
4.4 | Certified endoscopists should have access to mentored lists. | Very low | Strong |
BSG, British Society of Gastroenterology; DOPS, Direct observation of procedure skills; DOPyS, direct observation of polypectomy skills; FS, flexible sigmoidoscopy; GRS, global rating scale; JAG, Joint Advisory Group; JETS, JAG Endoscopy Training System; KPI, key performance indicator; LGI, lower GI; SMSA, size, morphology, site, access.