B0285 - Standardized General Endoscopy Lexicon for Learners

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Jamie Bering, MS, MD

Mayo Clinic
Scottsdale, AZ

Jamie Bering, MS, MD¹, Umar Sarah, MD², Douglas Faigel, MD¹
¹Mayo Clinic, Scottsdale, AZ; ²Mayo Clinic Arizona, Scottsdale, AZ

Introduction: Physicians completing subspecialty training in gastroenterology are expected to develop competence in performing general endoscopic procedures including upper endoscopy, colonoscopy, and flexible sigmoidoscopy. Endoscopy education is often provided through an apprenticeship model where trainees work with various endoscopists and develop skills in real-time procedures. Inherent to this model is heterogeneity in the education provided. Recent research exploring essential teaching competencies for those involved in endoscopic education suggests usage of succinct standardized language when teaching endoscopy, but to date no one has examined the breadth of terms used or developed consensus around specific language to be used in this aspect of medical training. In this study we surveyed terminology used worldwide by expert teachers of endoscopy and, through a Delphi process, developed a standardized lexicon for general endoscopic education.

Methods: We invited 26 physicians identified as expert endoscopy educators from various countries around the world to participate in this Delphi process. A total of 20 physicians participated. Four rounds of surveys were completed. Common terminology was identified in round 1. Rounds 2 through 4 consisted of surveys where participants indicated terms they were most likely to use when instructing learners during endoscopy. A consensus threshold of 70% was defined for term inclusion into the lexicon. Terms that achieved a 70% minimum consensus were included as “recommended terms”. Terms that offered balance to the lexicon but did not reach the threshold consensus were included as “suggested terms”.

Results: After 4 rounds of surveys, 36 recommended terms and 5 suggested terms were included in our general endoscopy lexicon (Table 1).

Discussion: Through this international Delphi project, we constructed a general endoscopy lexicon for learners. The use of standardized language has been shown to have several benefits in other areas of healthcare including improved communication, quality of patient care, and knowledge generation. We expect that adopting a uniform lexicon will improve quality of endoscopic education for learners. In addition, because this study was conducted on an international level, we anticipate this lexicon to be applicable to trainees throughout the world. Future projects exploring standardized language for advanced endoscopic procedural education should be considered.

Endoscopy Instruction	Committee Consensus (%)	Final Stance
Scope Manipulation
Rotate (torque)clockwise/counterclockwise Rotate (torque) right/left	100*	Recommended
Big wheel/dial up	94.42	Recommended
Big wheel/dial down	88.9	Recommended
Little wheel/dial up	88.9	Recommended
Little wheel/dial down	88.89	Recommended
Advance scope	77.78	Recommended
Pull scope Back	100%	Recommended
Brush Manipulation
Put brush out Advance brush	100%*	Recommended
Pull brush in Withdraw brush	83.33*	Recommended
Brush tissues	56.25	Suggested
Clip Manipulation
Open clip	93.75	Recommended
Close clip	81.25	Recommended
Rotate clip	87.5	Recommended
Deploy clip Fire clip	91.67*	Recommended
Cautery - Monopolar, Bipolar – Manipulation
Advance cautery probe	75	Recommended
Start cautery Cut/coagulate	58.33*	Suggested
Forceps Manipulation
Open forceps	93.75	Recommended
Close forceps	81.25	Recommended
Advance forceps	91.67	Recommended
Withdraw forceps	100	Recommended
Pictures/Video
Take a picture/video	77.78	Recommended
Air (blue button)
Insufflate	72.22	Recommended
Water (blue button)
Clean your lens	88.89	Recommended
Suction (red button)
Suction	77.78	Recommended
Through the Scope Balloon Dilator Manipulation
Advance dilator	56.25	Suggested
Inflate balloon	100	Recommended
Deflate balloon	56.25	Suggested
Bougie Dilator Manipulation
Advance wire	81.25	Recommended
Advance dilator over wire	87.5	Recommended
Net Manipulation
Open net	93.75	Recommended
Close net	93.75	Recommended
Use of Electrocautery Pedals (blue, yellow)
Blue pedal	81.25	Recommended
Yellow pedal	81.25	Recommended
Snare Manipulation
Open snare	93.75	Recommended
Close snare	93.75	Recommended
Cut	56.25	Suggested

Table: *The committee consensus to include both terms in the lexicon.

Disclosures:

Jamie Bering indicated no relevant financial relationships.

Umar Sarah indicated no relevant financial relationships.

Douglas Faigel indicated no relevant financial relationships.

Jamie Bering, MS, MD¹, Umar Sarah, MD², Douglas Faigel, MD¹. B0285 - Standardized General Endoscopy Lexicon for Learners, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.