S3119 Detection Rates of Adenoma, Clinically Significant Serrated Polyp, Proximal Serrated Polyp, and Laterally Spreading Tumors in Gastrointestinal Medicine (GI) Fellows

Abstract

INTRODUCTION: Adenoma detection rate (ADR) is a widely accepted benchmark on quality for screening colonoscopy with studies suggesting 25% goal detection rates. Newer quality metrics like clinically significant serrated polyp detection rates (CSSDR) and proximal serrated polyp detection rates (PSDR) are being evaluated with suggested benchmarks of 7% and 11% respectively. CSSDR is defined as ≥1 sessile serrated adenoma or polyp, traditional serrated adenoma, hyperplastic polyp (HP) ≥ 1cm anywhere in the colon or any HP ≥ 5mm proximal to the sigmoid. PSDR is defined as a serrated polyp of any size proximal to the sigmoid colon. Another emerging milestone is the detection rate of laterally spreading tumors (LSTs). In this study, we evaluated the ADR, CSSDR, PSDR, and LSTs detection rates among GI fellows. METHODS: A retrospective analysis of 795 screening colonoscopy reports was performed at an urban academic hospital. The demographic data, GI fellow training years, and pathology results were collected by chart review. Statistical analysis using multiple linear regression models were used to evaluate effects of categorized covariates and logistic regression models to examine factors associated with ADR, CSSDR, PSDR, and LSTs. RESULTS: For our patient population, median age was 58, 49.8% were males, 46.3% Caucasians and 48.6% African Americans. 27.3% colonoscopies were done by first year fellows (F1s) and the rest by upper level fellows (ULs). Overall detection was 42.1% for ADR, 4.4% for CSSDR, 10.5% for PSDR, and 3.2% for LSTs. Between F1s and ULs, there was no statistical significance in ADR, CSSDR and PSDR. Detection of LSTs, however, showed trend toward significance with 0.9% detection rate in F1s and 4.0% in ULs (P = 0.05). The odds of detecting LSTs are expected to be 4 times higher for ULs compared to F1s (OR = 4.37, P = 0.048). CONCLUSION: In our study, GI fellows met the quality measure with an ADR of 42.1%. PSDR of 10.5% was comparable to the reported 11% in previous studies. CSSDR of 4.4% did not meet the 7% suggested by previous studies. The ability to detect ADR, CSSDR and PSDR did not significantly change between levels of training. The borderline significance of training level on LST detection rate could be attributed to more awareness of these lesions and higher volume of colonoscopies performed by upper levels. Similar studies in the future can help GI programs prioritize education in detecting these subtypes of polyps to improve screening.