The level of competency to perform high-quality endoscopy and to remove high-risk lesions is also
dependent on the competency of the support team and the available equipment: a highly competent
endoscopist requires equally competent support staff and the right equipment and supplies to perform
the procedure and deal with any problems that might arise (such as clips for uncontrolled bleeding).
It is recognised that the methodology does not currently exist to reliably recognise who has achieved
the proposed levels of competence. Thus, until a competency–based assessment process is available
the clinical lead of the service should be satisfied that:
the professionals have the necessary competence;
the unit has the necessary equipment; and
in the event of a serious adverse event, it will be possible to manage the patient locally or transfer
the patient safely to another institution with the expertise and facilities to care for the patient.
A review of capabilities may identify shortcomings that can be addressed with further training or investment . This training and investment should occur before screening
begins.
The need for sedation
The use of sedation for lower gastrointestinal endoscopic procedures varies between European countries.
Three main patterns are readily discernible:
infrequent use of sedation;
frequent use of conscious sedation with opiates and benzodiazepines;
and
almost exclusive use of deep sedation with propofol or general anaesthesia.
