Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. May 16, 2017; 9(5): 204-210
Published online May 16, 2017. doi: 10.4253/wjge.v9.i5.204
Association of trainee participation with adenoma and polyp detection rates
Emad Qayed, Lauren Shea, Stephan Goebel, Roberd M Bostick
Emad Qayed, Lauren Shea, Stephan Goebel, Department of Medicine, Division of Digestive diseases, Emory University School of Medicine, Atlanta, GA 30324, United States
Emad Qayed, Grady Memorial Hospital, Atlanta, GA 30303, United States
Roberd M Bostick, Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA 30324, United States
Roberd M Bostick, Emory University, Winship Cancer Institute Atlanta, GA 30324, United States
Author contributions: Qayed E designed the research, collected and analyzed the data, drafted, and revised the manuscript; Shea L collected the data and revised the manuscript, Goebel S collected the data and revised the manuscript; Bostick RM designed the research and revised the manuscript for important intellectual content; all authors read and approved the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by Emory University Institutional Review Board.
Informed consent statement: Informed consent was waived by the Institutional Review Board due to the retrospective nature of the study, the large number of patients, the rights and welfare of the subjects will not be adversely affected by this research.
Conflict-of-interest statement: The authors report no conflict of interest.
Data sharing statement: Statistical code is available from the corresponding author at eqayed@emory.edu. Consent was not obtained, but the presented data are anonymized with no risk of identification. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Emad Qayed, MD, MPH, Chief of Gastroenterology, Grady Memorial Hospital, 49 Jesse Hill Junior Drive, Atlanta, GA 30303, United States. eqayed@emory.edu
Telephone: +1-404-7781685 Fax: +1-404-7781681
Received: December 7, 2016
Peer-review started: December 8, 2016
First decision: January 7, 2017
Revised: January 12, 2017
Accepted: February 28, 2017
Article in press: March 2, 2017
Published online: May 16, 2017
Abstract
AIM

To 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.

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 unconditional multivariable logistic regression. Models were adjusted for sex, age, race, and colon preparation quality.

RESULTS

A 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).

CONCLUSION

There is a stepwise increase in ADR and PDR across the years of gastroenterology training. Fellow participation is associated with higher adenoma and polyp detection.

Keywords: Screening colonoscopy, Adenoma detection rate, Polyp detection rate, Gastroenterology training, Colorectal cancer

Core tip: In this large sample of screening colonoscopies, we found that fellow participation has an overall favorable effect on adenoma and polyp detection rates, especially for fellows after their first year of training. The higher detection rate was evident in both the right and left colon. There were no differences overall regarding adenoma per colon or polyp per colon, between the fellow participation and attending groups. In summary, performance of screening colonoscopies by fellows under the strict supervision of attendings does not negatively affect the quality of the procedure, but rather increases adenoma and polyp detection.