Colonoscopy is a procedure used for the diagnosis and treatment of many colorectal diseases. In addition, it constitutes the most used colorectal cancer screening test; therefore, it should be performed according to the highest quality and safety standards¹.

Colonoscopy safety has been evaluated in the present study through the analysis of the complications associated with the method, which represent an important outcome measure. The rate of these complications must not exceed the internationally accepted standards to be considered a safe and high-quality practice.

Adverse events^2,3 which occur during or after the procedure, shift the expected course as they lead to changes in patient management and delay recovery. These complications also expose the patient to additional interventions such as repeat colonoscopy, blood transfusions, interventional radiology procedures or surgery.

This multicenter, retrospective study, which included 24,907 colonoscopies performed over 5 years in different centers in the provinces of the country and in a training center in the city of Buenos Aires, demonstrated that colonoscopy performed by colorectal surgeons is safe, since the rate of specific complications (post-polypectomy syndrome, bleeding and perforation) is within the accepted parameters.

Their results are also similar to those of the university hospital. This outcome is due to the fact that colonoscopies were performed by colorectal surgeons who were trained in the technique within a systematic residency training program in the subspecialty. This aspect is of utmost importance, since as we know, colonoscopy represents between 25-30% of proctologist’s activity worldwide.

In our country there are few standardized training programs in endoscopy for general surgeons but are not incorporated in general surgery residencies. On the other hand, trainees in colorectal surgery can acquire the necessary skills for the practice of endoscopy through different training programs (residency programs, fellowship or university courses)⁴.

We emphasize the importance of a training program to perform a safe practice. Nowadays, the first stage is performed using endoscopy simulators, and once the basic knowledge is acquired the next step consists of performing procedures on patients, always under the supervision of an already trained physician, thus reducing the probability of adverse events during the learning process⁵.

It is now important to ensure the highest quality in endoscopy, which means that besides an accepted complication rate, it complies with a series of indicators such as: adenoma detection rate (ADR), cecal intubation rate or withdrawal time, among others. These standards should be measured later to evaluate endoscopists performance and detect possible deviations that can be corrected.

Adenoma detector rate⁶ constitutes the key for prevention, as it indicates complete and meticulous mucosal inspection, adequate bowel cleaning and complete examination (cecal intubation > 95%). An inverse association exists between ADR and risk for interval cancer (cancer detected between two screening colonoscopies). Adenoma detector rate should be at least of 25% for each endoscopist and has an inverse correlation with the risk for not detecting a polyp during the study, also known as mixed lesion. For all these reasons, we must try to improve and increase our ADR permanently.

It is also important to characterize colonic lesions⁷ during screening to define the subsequent management. The adequate technique of endoscopic resection, either polypectomy or mucosectomy, constitutes another fundamental cornerstone for success in the prevention of colorectal cancer.

Finally, compliance with all the quality parameters will yield a safe endoscopic practice and define the appropriate surveillance intervals for each patient⁹.

The Committee on Flexible Endoscopy of Asociación Argentina de Cirugía has always highlighted the need for systematic training programs and continuous improvement to reach the highest quality standards.