Trainee participation is associated with increased small adenoma detection

Area of Science:

• Gastroenterology
• Endoscopy
• Cancer Screening

Background:

• Conflicting results exist regarding fellow participation and adenoma detection rate (ADR) in colonoscopy.
• Previous studies have not rigorously evaluated adenoma size and location effects.

Purpose of the Study:

• To determine if fellow participation during colonoscopy impacts adenoma or polyp detection rates.
• To analyze the effect of fellow involvement on size-specific and location-specific detection rates.

Main Methods:

• Retrospective analysis of 2430 colonoscopies (Sept 2006 - Dec 2007).
• Comparison of ADR between colonoscopies performed by fellows with supervision versus staff endoscopists alone.
• Logistic regression used to assess the association between fellow participation and detection rates.

Main Results:

• Higher detection rate of small adenomas (<5 mm) when fellows were present (25% vs. 17%, P=.001).
• A trend towards increased overall adenoma detection was observed with fellow participation (30% vs. 26%, P=.11).
• Findings remained significant after multiple-testing and multivariable adjustments.

Conclusions:

• Fellow involvement is associated with improved detection rates of small adenomas during colonoscopy.
• The presence of a fellow may enhance the diagnostic yield of colonoscopic examinations.
• Further research could explore optimal fellow involvement strategies to maximize adenoma detection.