An endoscopist’s adenoma detection rate (ADR) is inversely related to interval colorectal cancer risk and cancer mortality. Previous studies evaluating the impact of gastroenterology fellow participation in colonoscopy on ADR have generated conflicting results.
We aimed to determine the impact of fellow participation, duration of fellowship training, and physician sex on ADR and advanced ADR (AADR).
We retrospectively analyzed average-risk patients undergoing screening colonoscopy at Veterans Affairs New York Harbor Healthcare System Brooklyn Campus and Kings County Hospital Center. Review of colonoscopy and pathology reports were performed to obtain adenoma-specific details, including the presence of advanced adenoma and adenoma location (right vs. left colon).
There were 893 colonoscopies performed by attending only and 502 performed with fellow participation. Fellow participation improved overall ADR (44.6% vs. 35.4%, p < 0.001), right-sided ADR (34.1% vs. 25.2%, p < 0.001), and AADR (15.3% vs. 8.3%, p < 0.001); however, these findings were institution-specific. Year of fellowship training did not impact overall ADR or overall AADR, but did significantly improve right-sided AADR (p-value for trend 0.03). Female attending physicians were associated with increased ADR (47.1% vs. 37.0%, p = 0.0037). Fellow sex did not impact ADR.
Fellow participation in colonoscopy improved overall ADR and AADR, and female attending physicians were associated with improved ADR. Year of fellowship training did not impact overall ADR or AADR.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Adenoma detection rate
Advanced adenoma detection rate
Boston bowel preparation scale
Body mass index
Nonsteroidal anti-inflammatory drug
Winawer SJ, Zauber AG, Ho MN et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 1993; 329: 1977–1981
Zauber AG, Winawer SJ, O’Brien MJ et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012;366:687–696
Corley DA, Jensen CD, Marks AR et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med 2014;370:1298–1306
Kaminski MF, Regula J, Kraszewska E et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 2010;362:1795–1803
Rex DK, Schoenfeld PS, Cohen J et al. Quality indicators for colonoscopy. Am J Gastroenterol 2015;110:72–90
Mehrotra A, Dellon ES, Schoen RE et al. Applying a natural language processing tool to electronic health records to assess performance on colonoscopy quality measures. Gastrointest Endosc 2012;75:e1214
Adler A, Wegscheider K, Lieberman D et al. Factors determining the quality of screening colonoscopy: a prospective study on adenoma detection rates, from 12,134 examinations (Berlin colonoscopy project 3, BECOP-3). Gut 2013;62:236–241
Lee TJ, Rees CJ, Blanks RG et al. Colonoscopic factors associated with adenoma detection in a national colorectal cancer screening program. Endoscopy 2014;46:203–211
Mehrotra A, Morris M, Gourevitch RA et al. Physician characteristics associated with higher adenoma detection rate. Gastrointest Endosc 2018;87:e775
Cadoni S, Falt P, Rondonotti E et al. Water exchange for screening colonoscopy increases adenoma detection rate: a multicenter, double-blinded, randomized controlled trial. Endoscopy 2017;49:456–467
Cohen J, Grunwald D, Grossberg LB, Sawhney MS. The effect of right colon retroflexion on adenoma detection: a systematic review and meta-analysis. J Clin Gastroenterol 2017;51:818–824
Min M, Deng P, Zhang W et al. Comparison of linked color imaging and white-light colonoscopy for detection of colorectal polyps: a multicenter, randomized, crossover trial. Gastrointest Endosc 2017;86:724–730
Chalifoux SL, Rao DS, Wani SB et al. Trainee participation and adenoma detection rates during screening colonoscopies. J Clin Gastroenterol 2014;48:524–529
Gianotti RJ, Oza SS, Tapper EB et al. A longitudinal study of adenoma detection rate in gastroenterology fellowship training. Dig Dis Sci 2016;61:2831–2837
Peters SL, Hasan AG, Jacobson NB et al. Level of fellowship training increases adenoma detection rates. Clin Gastroenterol Hepatol 2010;8:439–442
Qayed E, Shea L, Goebel S et al. Association of trainee participation with adenoma and polyp detection rates. World J Gastrointest Endosc 2017;9:204–210
Friedman M, Arora G, Green J. Fellow involvement during colonoscopy does not reduce adenoma detection rate. Dig Dis Sci 2011;56:919
Eckardt AJ, Kheder J, Basil A et al. Trainee participation during screening colonoscopy does not affect ADR at subsequent surveillance, but may result in early follow-up. Endosc Int Open 2020;8:E1732–E1740
Kim YD, Bae WK, Choi YH et al. Difference in adenoma detection rates according to colonoscopic withdrawal times and the level of expertise. Korean J Gastroenterol 2014;64:278–283
Nishizawa T, Suzuki H, Takahashi M et al. Trainee participation during colonoscopy adversely affects polyp and adenoma detection rates. Digestion 2011;84:245–246
Facciorusso A, Buccino VR, Tonti P et al. Impact of fellow participation on colon adenoma detection rates: a multicenter randomized trial. Gastrointest Endosc 2020;92:1228–1235
Corley DA, Jensen CD, Marks AR et al. Variation of adenoma prevalence by age, sex, race, and colon location in a large population: implications for screening and quality programs. Clin Gastroenterol Hepatol 2013;11:172–180
Shrubsole MJ, Wu H, Ness RM et al. Alcohol drinking, cigarette smoking, and risk of colorectal adenomatous and hyperplastic polyps. Am J Epidemiol 2008;167:1050–1058
Laiyemo AO, Doubeni C, Sanderson AK 2nd et al. Likelihood of missed and recurrent adenomas in the proximal versus the distal colon. Gastrointest Endosc 2011;74:253–261
Tziatzios G, Gkolfakis P, Triantafyllou K. Effect of fellow involvement on colonoscopy outcomes: A systematic review and meta-analysis. Dig Liver Dis 2019;51:1079–1085
Barclay RL, Vicari JJ, Doughty AS et al. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med 2006;355:2533–2541
Rex DK. Colonoscopic withdrawal technique is associated with adenoma miss rates. Gastrointest Endosc 2000;51:33–36
Conflict of interest
None of the authors declare any relevant conflicts of interest.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
An editorial commenting on this article is available at https://doi.org/10.1007/s10620-021-06889-4.
About this article
Cite this article
Araujo, J.L., Jaiswal, P., Ragunathan, K. et al. Impact of Fellow Participation During Colonoscopy on Adenoma Detection Rates. Dig Dis Sci (2021). https://doi.org/10.1007/s10620-021-06887-6
- Adenoma detection rate
- Colorectal neoplasms
- Colorectal cancer screening
- Gastroenterology fellowship training