Sex discordance between patients and endoscopists and colonoscopy outcome: a database analysis

Sex disparities in medicine have been shown to have clinical implications for patient outcomes. Previous studies have highlighted worse outcomes for female patients treated by male physicians in cardiology and surgery. This study aims to assess the effect of sex discordance between patients and endoscopists on colonoscopy outcomes.

Data from a gastrointestinal (GI) endoscopy database was used. All colorectal cancer (CRC) screening colonoscopies performed between January 2016 and December 2020 in 17 Dutch hospitals were analyzed. Primary outcomes included cecal intubation rate (CIR), adenoma detection rate (ADR), polyp detection rate (PDR) and patient discomfort measured by the Gloucester Comfort Scale (GCS). Associations between sex discordance (male-male, male-female, female-female and female-male) and outcomes were estimated using logistic mixed-effects models, accounting for various covariates and random effects.

We included 44,944 CRC-screening colonoscopies performed by 115 endoscopists, 53.4% were sex-concordant procedures. Predicted probabilities for CIR, ADR, PDR and discomfort were in male patients with male endoscopists 0.98, 0.65, 0.75, 0.01 vs. 0.98, 0.67, 0.77, 0.02, respectively, in male patients with female endoscopists. In female patients with female endoscopists these outcomes were 0.98, 0.54, 0.67, 0.04 vs. 0.98, 0.55, 0.66, 0.03, respectively, in female patients with male endoscopists.

Although subjective discomfort scores were slightly higher for female endoscopists, both for male and female patients, our results show that endoscopist sex has a negligible impact on CRC-screening colonoscopy outcomes.