Does Trainee Involvement in Colonoscopy Affect Cecal Intubation and Polyp Detection Rates?

Abstract

Purpose: There is an increased interest in endoscopic performance indicators. Currently cecal intubation rates along with adenoma detection rates and colonoscope withdrawal time are being viewed as such performance indictors. A number of studies have been done to assess factors that could potentially affect these indicators. Factors such as inpatient status, female sex, and immobility, among others, have been associated with decreased cecal intubation rates. Trainee involvement could be another factor affecting quality indicators. There are very few studies that evaluated performance indicators in relation to trainee involvement. AIM: To determine whether trainee involvement affect cecal intubationand polyp detection rates. Methods: We retrospectively reviewed 6,027 consecutive colonoscopies that were performed on adults by six full-time gastroenterologists between mid-2003 and 2007 at a high-volume endoscopy unit in a large urban hospital. All colonoscopies by trainees were supervised by teaching attendings. For each colonoscopic procedure, trainee involvement, polyp findings, extent of the exam, type of anesthesia, patients age, sex, inpatient or outpatient status, were summarized and analyzed using Student t-test and Fischer's exact tests as indicated. P < 0.05 was considered to be significant. Results: Overallcecal intubation rate was 93%. Trainees participated in 28% of all colonoscopies. Colonoscopies with trainees' involvement had 94% cecal intubation rate compared with colonoscopies performed by attending gastroenterologists alone, 93%. The difference was statistically insignificant, P= 0.4. Trainees had 42% polyp detection rate compared with attending gastroenterologists, who had 41% detection rate, P= 0.5. Mean age of the patients undergoing colonoscopy with trainee involvement was older as compared to colonoscopies done by attending gastroenterologists alone, 60 (SD 13) and 58 (SD 14) respectively, P= 0.0005. Female patients constituted 63% of both groups. The percentage of outpatient colonoscopies was the same for trainees and attendings (88%). Conclusion: Results of this study do not suggest a significant effect of trainees' participation on cecal intubation andpolyp detection rates.