Colonoscopy training intervention in Bhutan: outcome evaluation

Introduction: Bhutan faces rising rates of colorectal cancer. Limited access to colonoscopes and trained procedurists delays diagnosis, with many cases presenting late or in crisis. However, the surgical workforce is highly competent in esophagogastroduodenoscopy due to Helicobacter pylori endemicity, offering a unique training opportunity. Methods: A 3-day colonoscopy training was conducted at Bhutan’s national referral hospital to equip local doctors and nurses with the skills for safe diagnostic and therapeutic colonoscopy. The curriculum included didactic lectures, simulation-based training, and supervised live procedures. Results: Ten doctors and 15 nurses from 9 districts participated. Half of the doctors had no prior colonoscopy experience; four had performed fewer than 10 procedures. Across 53 live colonoscopies, 24 polyps and 4 cancers were detected. All participants succeeded in sigmoidoscopy, and 3 of 8 assessed were able to independently intubate the terminal ileum. Conclusion: Participants reported high satisfaction. Evaluation showed strong gains in confidence, knowledge, and procedural skills. This initiative lays the foundation for expanding nationwide colonoscopy services and advancing colorectal cancer prevention strategies.