Influence of Fellow Participation and Level of Fellowship Training on Adenoma Detection Rate of One Staff Endoscopist

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Introduction: Adenoma detection rate (ADR) is the proportion of screening colonoscopies that detect at least one histologically confirmed tubular adenoma. In a study done with multiple endoscopists, we had shown that fellow participation did not influence ADR. To remove the influence of fellow participation with multiple endoscopists, we evaluated the influence of fellow participation on the ADR of a single endoscopist. We also assessed correlation between level of fellowship training and ADR. Methods: This was a retrospective chart review of screening colonoscopies done in a large medical center, performed/staffed by a single endoscopist, between April 2016 and June 2017. Fellows were classified based on year of training into first, second, and third. Those procedures with no documented cecal intubation, poor/ undocumented bowel preparation quality, ones with unrecovered tissue, were excluded. Data was analyzed using JMP 13 software. Results: 284 screening colonoscopies were analyzed, 206 (73%) done with fellow assistance, 78 (27%) without. 85.6 % of patients (n=243) were African American (AA) with a mean age of 58.3 vs. 59.6 in non-AA. Gender distribution by race was similar. The mean ages of patients were similar in both assisted and unassisted groups. ADR in AA was 57.8 % and 62.5 % in non-AA (p = 0.5). In the fellow-assisted group, ADR was 59.7%. ADR was 56.4 % in the unassisted group (p = 0.614). ADRs trended up with the year of fellowship training: Year 1 - 51%, Year 2 - 57.1%, Year 3 - 68.6% (p Conclusion: The mean age of our patients is considerably higher than recommended age of 50, which may partly explain the high ADR noted in the study. No significant difference was seen in ADR for AA vs. non-AA, probably due to the small number of non-AA. Involvement of a fellow does not impact the ADR of the staff endoscopist. Involvement of a Year 1 fellow, however, does increase the procedure duration. As fellows progress through levels of fellowship training the expected trend towards improvement in the ADR and decrease in the total colonoscopy time is confirmed.2757 Figure 1. Showing the duration of colonoscopies for assisted (divided into fellow year 1, 2 and 3) and the unassisted procedures.