Impact of Fellow Participation During Colonoscopy on Adenoma Detection Rates

Abstract

Background

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.

Aims

We aimed to determine the impact of fellow participation, duration of fellowship training, and physician sex on ADR and advanced ADR (AADR).

Methods

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).

Results

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.

Conclusions

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.

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Abbreviations

ADR:

Adenoma detection rate

AADR:

Advanced adenoma detection rate

BBPS:

Boston bowel preparation scale

BMI:

Body mass index

NSAID:

Nonsteroidal anti-inflammatory drug

VA:

Veterans Affairs

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Affiliations

Authors

Contributions

Study was conceptualized and designed by JLA, PJ, KR, EG, SV. Data acquisition was performed by JLA, PJ, KR, FMA, GSC, CL, WK, AL, NG, TC. Data analysis and interpretation was done by JLA, PJ, KR, CAK, SS, RMM, SV. Manuscript was drafted by JLA, PJ. Critical revision of the manuscript for important intellectual content was performed by JLA, PJ, KR, FMA, GSC, CL, WK, AL, NG, TC, CAK, SS, RMM, EG, SV. All authors approved the final manuscript. All authors had access to the study data and reviewed and approved the final manuscript.

Corresponding author

Correspondence to James L. Araujo.

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None of the authors declare any relevant conflicts of interest.

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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

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Keywords

  • Adenoma detection rate
  • Colonoscopy
  • Colorectal neoplasms
  • Colorectal cancer screening
  • Gastroenterology fellowship training