A Longitudinal Study of Adenoma Detection Rate in Gastroenterology Fellowship Training

Gianotti, Robert; Oza, Sveta Shah; Tapper, Elliot B.; Kothari, Darshan; Sheth, Sunil G.

doi:10.1007/s10620-016-4228-9

Cited by 26 publications

(32 citation statements)

References 14 publications

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“…As mentioned earlier, ADR is the most robust colonoscopy quality metric for practicing gastroenterologists, but the value of ADR as a competency measurement for the evaluation of gastroenterology fellows during their different stages of training is not well established. Limited literature has been published on this topic, with inconsistent results [ 14 - 21 ]. The aim of this study was to calculate ADR and evaluate its utility as a measure of competency for gastroenterology fellows.…”

Section: Introductionmentioning

confidence: 99%

Should We Measure Adenoma Detection Rate for Gastroenterology Fellows in Training?

et al. 2018

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BackgroundAdenoma detection rate (ADR) is a proven quality metric for colonoscopy. The value of ADR for the evaluation of gastroenterology fellows is not well established. The aim of this study is to calculate and evaluate the utility of ADR as a measure of competency for gastroenterology fellows.MethodsColonoscopies for the purposes of screening and surveillance, on which gastroenterology fellows participated at the Richard L. Roudebush VAMC (one of the primary training sites at Indiana University), during a 9-month period, were included. ADR, cecal intubation rate, and indirect withdrawal time were measured. These metrics were compared between the levels of training.ResultsA total of 591 screening and surveillance colonoscopies were performed by 14 fellows. This included six, four and four fellows, in the first, second and third year of clinical training, respectively. Fellows were on rotation at the VAMC for a mean of 1.9 months (range 1 to 3 months) during the study period. The average ADR was 68.8% (95% CI 65.37 - 72.24). The average withdrawal time was 27.59 min (95% CI 23.45 - 31.73). The average cecal intubation rate was 99% (95% CI 98-100%). There was no significant difference between ADRs, cecal intubation rates, and withdrawal times at different levels of training; however, a trend toward swifter withdrawal times with advancing training was noted.ConclusionsADR appears not to be a useful measure of competency for gastroenterology fellows. Consideration should be given to alternative metrics that could avoid bias and confounders.

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Section: Introductionmentioning

confidence: 99%

Should We Measure Adenoma Detection Rate for Gastroenterology Fellows in Training?

et al. 2018

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“…In a prospective tandem colonoscopy study it was found that fellows with a higher colonoscopy volume had lower adenoma miss rates (AMR), and it was estimated that 450 colonoscopies would be required to achieve an AMR of < 25%[ 17 ]. In a retrospective study in which trainees were followed throughout their fellowship training, it was found that fellows’ ADRs and polyp detection rates (PDR) improved when the fellows had conducted > 140 colonoscopies[ 18 ]. There are several limitations to these studies, including the small number of procedures performed by the fellows, inclusion of non-screening colonoscopies in calculating the ADR, and including fellows from various stages of training during only a limited part of their fellowship.…”

Section: Introductionmentioning

confidence: 99%

Colonoscopy procedural volume increases adenoma and polyp detection rates in gastroenterologytrainees

Qayed

Vora

Levy

et al. 2017

WJGE

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AIMTo investigate changes in polyp detection throughout fellowship training, and estimate colonoscopy volume required to achieve the adenoma detection rate (ADRs) and polyp detection rate (PDRs) of attending gastroenterologists.METHODSWe reviewed colonoscopies from July 1, 2009 to June 30, 2014. Fellows’ procedural logs were used to retrieve colonoscopy procedural volumes, and these were treated as the time variable. Findings from screening colonoscopies were used to calculate colonoscopy outcomes for each fellow for the prior 50 colonoscopies at each time point. ADR and PDR were plotted against colonoscopy procedural volumes to produce individual longitudinal graphs. Repeated measures linear mixed effects models were used to study the change of ADR and PDR with increasing procedural volume.RESULTSDuring the study period, 12 fellows completed full three years of training and were included in the analysis. The average ADR and PDR were, respectively, 31.5% and 41.9% for all fellows, and 28.9% and 38.2% for attendings alone. There was a statistically significant increase in ADR with increasing procedural volume (1.8%/100 colonoscopies, P = 0.002). Similarly, PDR increased 2.8%/100 colonoscopies (P = 0.0001), while there was no significant change in advanced ADR (0.04%/100 colonoscopies, P = 0.92). The ADR increase was limited to the right side of the colon, while the PDR increased in both the right and left colon. The adenoma per colon and polyp per colon also increased throughout training. Fellows reached the attendings’ ADR and PDR after 265 and 292 colonoscopies, respectively.CONCLUSIONWe found that the ADR and PDR increase with increasing colonoscopy volume throughout fellowship. Our findings support recent recommendations of ≥ 275 colonoscopies for colonoscopy credentialing.

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“…7 ADR of trainees is generally lower than that of experts 23,24 and has been reported to be 23%-36%. [25][26][27] Although a previous study reported no significant difference in ADR between EAC and CAC, 19 differences between these procedures when performed by trainees remain unclear. In the present study, the cecal intubation rate and time were similar between the two groups.…”

Section: Discussionmentioning

confidence: 96%

“…In the present study, even though trainees were experienced in performing colonoscopies, ADR and MAP were relatively higher in both the EAC and CAC groups compared to the results of previous studies. [25][26][27] However, we did not investigate ADR of CC, so it is unclear whether ADR improved compared to CC. Furthermore, because we did not investigate the efficacy of EAC and CAC performed by experts, differences between trainees and experts remain unclear.…”

Section: Discussionmentioning

confidence: 99%

Endocuff-Assisted versus Cap-Assisted Colonoscopy Performed by Trainees: A Retrospective Study

et al. 2020

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Background/Aims: The adenoma detection rate (ADR) of screening colonoscopies performed by trainees is often lower than that of colonoscopies performed by experts. The efficacy of cap-assisted colonoscopy (CAC) in adenoma detection is well documented, especially that of CACs performed by trainees. Endocuff, a new endoscopic cap, is reportedly useful for adenoma detection; however, no trials have compared the efficacy of Endocuff-assisted colonoscopy (EAC) and CAC conducted by trainees. Therefore, the present study retrospectively compared the efficacy between EAC and CAC in trainees. Methods: This was a single-center, retrospective study involving 305 patients who underwent either EAC or CAC performed by three trainees between January and December 2018. We evaluated the ADR, mean number of adenomas detected per patient (MAP), cecal intubation rate, cecal intubation time, and occurrence of complications between the EAC and CAC groups. Results: The ADR was significantly higher in the EAC group than in the CAC group (54.3% vs. 37.3%, p=0.019), as was the MAP (1.36 vs. 0.74, p=0.003). No significant differences were found between the groups with respect to the cecal intubation rate or cecal intubation time. No major complications occurred in either group. Conclusions: Our results suggest that EAC exhibits increased ADR and MAP compared to CAC when performed by trainees. Clin

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A Longitudinal Study of Adenoma Detection Rate in Gastroenterology Fellowship Training

Cited by 26 publications

References 14 publications

Should We Measure Adenoma Detection Rate for Gastroenterology Fellows in Training?

Should We Measure Adenoma Detection Rate for Gastroenterology Fellows in Training?

Colonoscopy procedural volume increases adenoma and polyp detection rates in gastroenterologytrainees

Endocuff-Assisted versus Cap-Assisted Colonoscopy Performed by Trainees: A Retrospective Study

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