Anesthesia Assistance in Screening Colonoscopy and Adenoma Detection Rate Among Trainees
Background and Aims
The use of anesthesia assistance (AA) for screening colonoscopy has been increasing substantially over the past decade, raising concerns about procedure safety and cost without demonstrating a proven improvement in overall quality indicators such as adenoma detection rate (ADR). The effect of AA on ADR has not been extensively studied among trainees learning colonoscopy. We aimed to determine whether type of sedation used during screening colonoscopy affects trainee ADR.
Using the electronic endoscopy databases of two hospitals in our medical center, we identified colonoscopies performed by 15 trainees from 2014 through 2018, including all screening examinations in which the cecum was reached. Multivariable logistic regression was used to determine factors associated with adenoma detection.
We identified 1420 unique patients who underwent screening colonoscopy by a trainee meeting the inclusion criteria. Of these, 459 (32.3%) were performed with AA. Overall trainee ADR was 39.6%, with ADR increasing from 35.0% in year one of training to 42.8% in year three (p = 0.047). ADR for cases with AA was 37.9%, while ADR for conscious sedation cases was 32.0% (p = 0.374). Despite this 5.9% absolute difference, the use of AA was not associated with finding an adenoma on multivariable analysis when controlling for patient age, sex, smoking status, body mass index, trainee year of training, mean withdrawal time, supervising attending ADR, and bowel preparation quality (OR 0.85; 95% CI 0.67–1.09).
Despite providing the ability to more consistently sedate patients, the use of AA did not affect trainee ADR. These results on trainee ADR and sedation type suggest that the overall lack of association between AA use and ADR is applicable to the trainee setting.
KeywordsColonoscopy Sedation Propofol Trainee Adenoma density under the curve
AK, AP, JK, XFK, RGC, BL, and SK were involved in study concept and design. AK, AP, JK, and BL contributed to acquisition of data. AK and BL were involved in analysis and interpretation of data. AK, BL, and SK drafted the manuscript. AK, AP, JK, XFK, RGC, BL, and SK were involved in critical revision of the manuscript for important intellectual content. AK and BL were involved in statistical analysis. SK and BL contributed to study supervision. All authors approve the final manuscript submitted and they approve the authorship list.
Compliance with Ethical Standards
Conflict of interest
All authors declare that they have no conflict of interest and nothing to declare.
This analysis was approved by the Institutional Review Board of Columbia University.
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