ORIGINAL ARTICLE Association of trainee participation with adenoma and polyp detection rates

Abstract

AIMTo investigate whether adenoma and polyp detection rates (ADR and PDR, respectively) in screening colonoscopies performed in the presence of fellows differ from those performed by attending physicians alone.METHODSWe performed a retrospective review of all patients who underwent a screening colonoscopy at Grady Memorial Hospital between July 1, 2009 and June 30, 2015. Patients with a history of colon polyps or cancer and those with poor colon preparation or failed cecal intubation were excluded from the analysis. Associations of fellowship training level with the ADR and PDR relative to attendings alone were assessed using unconditional multivariable logistic regression. Models were adjusted for sex, age, race, and colon preparation quality.RESULTSA total of 7503 colonoscopies met the inclusion criteria and were included in the analysis. The mean age of the study patients was 58.2 years; 63.1% were women and 88.2% were African American. The ADR was higher in the fellow participation group overall compared to that in the attending group: 34.5% vs 30.7% (P = 0.001), and for third year fellows it was 35.4% vs 30.7% (aOR = 1.23, 95%CI: 1.09-1.39). The higher ADR in the fellow participation group was evident for both the right and left side of the colon. For the PDR the corresponding figures were 44.5% vs 40.1% (P = 0.0003) and 45.7% vs 40.1% (aOR = 1.25, 95%CI: 1.12-1.41). The ADR and PDR increased with increasing fellow training level (P for trend < 0.05).CONCLUSIONThere is a stepwise increase in ADR and PDR across the years of gastroenterology training. Fellow participation is associated with higher adenoma and polyp detection.

Is there a difference in adenoma detection rates between gastroenterologists and surgeons?

“…Although the differences in the ADR between both specialties were not significant in our study, a higher ADR in colorectal surgeons was observed with a higher trainee involvement. This finding is mirrored by Qayed et al[ 17 ], who observed a significantly greater ADR with trainee participation than without, and attributed this to the presence of an additional observer and more focused examination behind each colonic fold during withdrawal of the colonoscope due to active supervision. Although this association was not statistically analysed for in our study, greater trainee involvement may increase ADRs, and may be implemented to increase ADRs.…”

Cimetropium bromide does not improve polyp and adenoma detection during colonoscope withdrawal

“…[ 34 ] Second, the most important factor in polyp detection is the quality of the endoscopist, as appropriate withdrawal techniques and vigilance for polyps can improve the ADR regardless of antispasmodic use. [ 35 ] During the most recent monthly quality assessment, the ADR had resulted to be approximately 50% for all endoscopists in the present study, and was high for both non-expert and expert endoscopists, which may also have reduced the difference in polyp and adenoma detection between the cimetropium and placebo groups. In contrast, for beginning endoscopists who cannot perform the appropriate withdrawal techniques, the use of an antispasmodic may help in the detection of polyps by improving the visualization of the mucosa.…”

Proximal Sessile Serrated Adenomas Are More Prevalent in Caucasians, and Gastroenterologists Are Better Than Nongastroenterologists at Their Detection

“…It has been shown in previous studies that fellow participation is associated with improved ADR [ 41 ] and small adenoma (<5 mm) detection rates [ 42 ]. A stepwise increase in ADR was also noted across the years of gastroenterology fellowship training [ 43 , 44 ]. As compared to adenomas, sessile serrated polyps are particularly challenging to detect due to their subtle features and proximal location [ 12 , 13 ].…”