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Fellow involvement may increase adenoma detection rates during colonoscopy
Jason N Rogart1, Uzma D Siddiqui, Priya A Jamidar
1Department of Medicine, Section of Digestive Diseases, Yale University School of Medicine, Yale University, New Haven, Connecticut 06520-8019, USA.
The American Journal of Gastroenterology
|September 2, 2008
Summary
Gastroenterology fellow participation during colonoscopy significantly increases adenoma detection rate (ADR). This involvement also leads to detecting more subtle adenomas, suggesting improved quality in colonoscopy screening.
Area of Science:
- Gastroenterology
- Endoscopy
- Quality Improvement in Medicine
Background:
- Adenoma detection rate (ADR) is a key quality metric for colonoscopy.
- Research on ADR factors often focuses on technical aspects.
- The impact of trainee involvement on ADR requires further study.
Purpose of the Study:
- To evaluate if gastroenterology (GI) fellow participation during colonoscopy influences the adenoma detection rate (ADR).
Main Methods:
- Retrospective analysis of prospectively collected data from 309 patients.
- Comparison of ADR between colonoscopies performed by attending physicians alone (126) and those with supervised GI fellow involvement (183).
Main Results:
- Fellow involvement was associated with a significantly higher ADR (37% vs. 23%) and more adenomas detected per patient (0.56 vs. 0.30).
- Fellows detected a higher percentage of patients with multiple adenomas, though advanced adenoma detection rates were similar.
- Adenomas detected with fellow participation were smaller and more likely to be sessile.
Conclusions:
- Fellow involvement in colonoscopy may enhance ADR and the detection of subtle adenomas.
- Further research is needed to determine if this is a "fellow effect" or a result of enhanced visual scanning.
- This finding has implications for quality assurance and training in colonoscopy procedures.
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