Association of Trainee Participation with Adenoma and Polyp Detection Rates in Screening Colonoscopy Open Access

Qayed, Emad (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/7h149q145?locale=en
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Abstract

Background: Colonoscopy is an important screening modality for colon cancer. It is unclear whether the participation of gastroenterology fellows in screening colonoscopy affects adenoma and polyp detection rates (ADR and PDR, respectively).

Objective: The primary aim of this study was to investigate whether the ADR and PDR in screening colonoscopies performed in the presence of fellows were different from those performed by attending physicians alone.

Methods: We 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 uncondtional multivariable logistic regression. Models were adjusted for sex, age, race, and colon preparation quality.

Results: A total of 7,503 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 in the fellow participation group overall compared to that in the attending group was 34.5% vs. 30.7% (p=0.001), and for third year fellows it was 35.4% vs. 30.7% (adjusted odds ratio [aOR] 1.23, 95% confidence interval [CI] 1.09-1.39). 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).

Conclusions: These results suggest that there may be a stepwise increase in ADR and PDR on screening colonoscopies across the years of gastroenterology fellow training, and that fellow participation in these colonoscopies may be associated with higher adenoma and polyp detection, especially for fellows after their first year of training. Further studies that document the exact involvement of fellows in the procedure, withdrawal time, and location of polyps would help identify factors related to higher ADR and PDR in more experienced fellows.

Table of Contents

1. Introduction

1.1 Colon cancer epidemiology. 1

1.2 Colon cancer screening. 1

1.3 Colonoscopy quality indicators. 2

1.4 Effect of fellow involvement on effectiveness of screening colonoscopy. 4

1.5 Study aims. 5

2. Methods. 6

2.1 Study Design. 6

2.2 Study Variables. 6

2.3 Colonoscopy information. 7

2.4 Statistical analysis. 8

3. Results. 9

3.1 Patient population. 9

3.2 Adenoma, advanced adenoma, and polyp detection rates. 9

4. Discussion and Conclusions. 11

5. Appendix. 15

Figure 1: Study flow diagram. 15

Table 1. Characteristics of patients undergoing screening colonoscopy (n = 7,503), by fellow participation 16

Table 2. Associations of training level with ADR, PDR, and advanced ADR.. 17

References 19

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