Impact of fellow participation on colon adenoma detection rates: a multicenter randomized trial

Abstract

There are limited and conflicting data on the impact of fellow participation in improving the colon adenoma detection rate. We performed a multicenter randomized controlled trial to evaluate whether fellow involvement might have a beneficial effect on adenoma detection rate. The trial was conducted at 4 tertiary hospitals between April and December 2019. Eight hundred twelve patients were randomized to undergo colonoscopy performed by a fellow under the supervision of a staff endoscopist or by an attending physician alone. No significant differences in demographic or adenoma risk factors were detected between the 2 groups. The adenoma detection rate in the intervention group was 44.8% versus 37.1% in the control arm (P= .02). The mean number of adenomas per colonoscopy was significantly higher in the intervention group (0.65 ± 0.3 vs 0.53± 0.2 in the control arm, P< .001). The polyp detection rate was 69.7% in the intervention group and 62.5% in the control arm (P= .03), whereas rates of advanced and sessile/serrated adenoma detection were not different between the trial arms (P= .50 and .42, respectively). In the subgroup of more experienced fellows, the adenoma detection rate and polyp detection rate were 49.5% and 75.7%, respectively. No difference was observed between less-experienced fellows and attending physicians alone (P= .53 and 0.86, respectively). The level of bowel preparation and fellow involvement were significant predictors of increased adenoma detectionrate in a multivariate analysis. Our multicenter trial represents the first prospective validation of the beneficial role of fellow involvement in colonoscopy procedures. (Clinical trial registration number: NCT03908229.).