Trainees‘ Influence on Adenoma Detection and Follow-Up Recommendations at Screening and Surveillance Colonoscopies

Abstract

Introduction: Background: Colonoscopy has emerged as the main diagnostic and therapeutic tool in the detection of colonic adenomas. Training future endoscopists is essential to meet future demands. Objectives: Studies have shown some what conflicting results regarding the influence of trainee-participation on adenoma detection rates (ADR), mostly showing positive or indifferent effects of trainee participation. A previous prospective study by our group showed no adverse effect of trainee participation on ADR. However, this study did not include first year trainees or subsequent surveillance exams. The aim of the current investigation was to see, whether the inclusion of first year trainees magnifies the noted difference and whether trainee participation affects ADRs or the timing of subsequent surveillance exams Methods: A retrospective analysis of average-risk screening colonoscopies over a 3-year interval was performed.Patients with poor preparation were excluded.The final analysis included 4922 screening colonoscopies between the years 2004-2006, as well as 2184 subsequent surveillance exams. Data were collected from pathologic and endoscopic electronic data bases. The primary outcome was the ADR at colonoscopies with and without trainee participation Results: Trainees participated in 1131 (23%) screening exams and in 232 (11%) surveillance exams. ADR did not significantly differ (P=0.19) for screening exams with trainee participation (19.5%) or those without (21.4%). ADRs were generally higher at surveillance exams, both with (22.4%) and without (27.5%) trainee participation. The noted difference of ADRs at surveillance colonoscopies with or without trainee participation did not reach statistical significance (P=0.1). Multivariate analysis showed no influence of first year fellow participation on the outcome. When surveillance recommendations differed from guidelines, shorter surveillance intervals were given more frequently if trainees participated during the initial screening procedure (P=0.0001). Conclusion: Limitations: Single-center, retrospective study. Conclusions: ADR did not significantly differ at screening or surveillance colonoscopies with or without trainee participation. There was a trend towards higher ADR at surveillance exams in both groups. The inclusion of first year trainees had no adverse effect on the outcome. However, trainee participation may result in shortened surveillance recommendations after initial screening exams.305_A Figure 1. Pre-Test and Post-Test