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BACKGROUND: Recent studies have shown that endoscopy fellows can perform colonoscopy effectively and safely. However, little is known about the performance of surgical residents without prior knowledge of endoscopic techniques. OBJECTIVE: To assess whether quality indicators were met at an outpatient endoscopy center and whether surgical residents, without prior upper or lower endoscopy skills, could perform colonoscopy adequately. METHODS: A prospective non-randomized cohort study was undertaken. All exams were performed either by assistant physicians or by residents. Quality measures were compared between those groups. RESULTS: A total of 2720 colonoscopies were analyzed. In the resident group, we observed older patients (57.7±12.7 years vs 51.5±14.5 years, P<0.001), a higher prevalence of screening colonoscopies (52% vs 39.4%, P<0.001) and a higher prevalence of colorectal cancer (6.4% vs 1.8%, P<0.001). The cecal intubation rate was higher in the attending group (99.9% vs 89.3%; P<0.001). The polyp detection rate was 40.8%, and no differences were observed between the studied groups. The residents had a higher rate of perforation in all exams (0.4% vs 0%; P=0.02). Postpolypectomy bleeding and 7-day readmission rates were the same (0.2%). All readmissions in 7 days occurred due to low digestive bleeding, and none required intervention. CONCLUSION: Quality indicators were met at a university outpatient endoscopy center; however, medical residents achieved lower rates of cecal intubation and higher rates of perforation than the attending physicians.

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Background: Reports on the development of Fournier's Gangrene (FG) in patients with coronavirus disease 2019 (COVID-19) are rare. Aim: This study reports a series of cases of patients with both diseases and to summarize the literature on the subject. Methods: We retrospectively examined electronic medical records dated between March 2020 and December 2021 of all adult patients with COVID-19 admitted to the Clinics Hospital of Ribeirão Preto (HCFMRP-USP) to identify those who had a diagnosis of FG. The diagnosis of COVID-19 was made by RT-PCR. We assessed the following patient characteristics: age; sex; tobacco use; laboratory data; and comorbidities such as human immunodeficiency virus (HIV), obesity, diabetes mellitus, systemic arterial hypertension, and alcoholism. Results: Four patients met the inclusion criteria. All the patients were female and had at least two comorbidities, including obesity (n=4, 100%), systemic arterial hypertension (n=3, 75%), diabetes mellitus (n=2, 50%), cardiovascular disease (n=1, 25%), chronic kidney disease (n=1, 25%), and hematologic disorders (n=1, 25%). They were all admitted to the intensive care unit and underwent surgical debridement under anesthesia. All the patients received hyperbaric oxygen therapy. The mean age was 62.75 years (range 60-66 years), and the mean length of stay was 30 days (range 22-37 days). One patient died (n=1, 25%). Conclusion: This is the first report in the literature on a series of cases of FG in patients with COVID-19. FG associated with COVID-19 is a serious, potentially lethal condition.