Colonoscopy procedural volume increases adenoma and polyp detection rates in gastroenterologytrainees

Table 1 Characteristics of screening colonoscopies performed by 12 gastroenterology fellows throughout their 3 years of clinical training (n = 3123), and 8 attendings alone (n = 2174), July 1 2009 to June 30 2014

Fellow	Number of screening colonoscopies	Total colonoscopy procedure volume	Patient’s mean age (yr)	Male patients (%)	Black patients (%)	Adequate exam (%)	Mean ADR (%)	Mean PDR (%)	Mean advanced ADR (%)
A	326	751	58.5	39.4	86.3	90.5	31.0	38.1	6.9
B	277	702	58.2	36.3	83.1	91.9	28.4	34.9	9.1
C	282	680	57.8	39.1	88.7	90.8	28.8	42.4	6.7
D	328	668	58.4	35.4	87.1	92.8	31.2	37.5	10.7
E	214	566	57.8	35.4	89.2	92.6	35.7	53.8	8.9
F	275	546	57.9	37.7	86.1	93.1	32.7	47.8	6.7
G	254	561	58.4	41.2	87.7	85.3	21.6	32.5	8.6
H	226	689	58.0	35.9	90.4	81.1	31.5	41.2	6.5
I	229	600	57.0	37.9	85.2	89.4	34.6	41.8	7.5
J	206	586	58.0	35.2	90.8	91.7	28.2	36.5	4.8
K	244	549	58.2	36.5	84.0	91.8	34.5	44.8	5.7
L	261	569	58.6	35.7	90.5	91.7	39.8	51.5	12.0
All fellows	3123	7467	58.1	37.2	87.3	89.8	31.5	41.9	7.8
Attendings alone	2174		57.9	36.3	89.3	90.1	28.9	38.2	8.5

Adequate colonoscopies were those in which the cecum was reached and the preparation quality was either good or fair-adequate. ADR: Adenoma detection rate; PDR: Polyp detection rate.

Table 2 Adjusted mean polyp-related outcomes, estimated initial status, and changes in outcomes per 100 screening colonoscopies¹ among the entire group of fellows (n = 12)

Outcome1	Overall mean2 (95%CI)	Mean after first 50 colonoscopies (95%CI)	Change in outcome per 100 colonoscopies (95%CI)	P value3	Number of procedures to achieve mean attending value4
ADR (%)	31.5 (28.7-34.3)	25.1 (21.1-29.2)	1.8 (0.8-2.7)	0.002	265
ADR-right (%)	22.3 (20.1-24.4)	15.3 (10.6-20.0)	1.9 (0.7-3.2)	0.01
ADR-left (%)	14.2 (12.4-16.0)	11.6 (8.3-14.9)	0.6 (0.001-1.3)	0.05
PDR (%)	41.9 (37.9-45.9)	31.4 (26.7-36.0)	2.8 (1.7-3.9)	0.0001	292
PDR-right (%)	26.5 (23.8-29.2)	16.0 (10.6-21.4)	2.9 (1.5-4.3)	0.001
PDR-left (%)	24.9 (21.5-28.3)	18.7 (13.1-24.3)	1.6 (0.3-2.9)	0.02
AADR (%)	7.8 (6.6-9.1)	7.4 (4.6-10.2)	0.04 (-0.80-0.90)	0.92
APC	0.58 (0.52-0.65)	0.39 (0.28-0.49)	0.05 (0.03-0.07)	0.0001	399
APC-right	0.37 (0.32-0.42)	0.20 (0.12-0.28)	0.04 (0.02-0.06)	0.001
APC-left	0.22 (0.19-0.25)	0.18 (0.11-0.26)	0.01 (-0.01-0.02)	0.24
PPC	0.84 (0.74-0.94)	0.51(0.36-0.66)	0.09 (0.06-0.12)	< 0.0001	375
PPC-right	0.45 (0.39-0.50)	0.21 (0.11-0.31)	0.06 (0.04-0.09)	< 0.0001
PPC-left	0.40 (0.34-0.46)	0.30 (0.21-0.39)	0.03 (0.01-0.05)	0.01

¹From linear mixed effects regression models, controlling for age, sex, race, and inadequate procedure;

²Mean from all screening colonoscopies over all 3 years of training;

³P value associated with the rate of change;

⁴Mean attending values were: ADR 28.9%, PDR 38.2%, APC 0.57, and PPC 0.80. ADR: Adenoma detection rate; PDR: Polyp detection rate; AADR: Advanced ADR; APC: Mean adenoma per colon; PPC: Mean polyp per colon. Right colon included the cecum, ascending colon, hepatic flexure, and transverse colon. Left colon included splenic flexure, descending colon, sigmoid, and rectum.