| Popis: |
Background: The quality of colonoscopy is sometimes questioned by the patient, the family and even the endoscopist when a trainee is involved in the procedure. The adenoma detection rate (ADR) has emerged as the main quality measure for colonoscopy due to its inverse correlation with colorectal cancer (CRC) incidence. Few studies have evaluated the impact of involvement of trainees on the quality of colonoscopy, with conflicting results.Aims: We aimed to evaluate the effect of fellow involvement on ADR and polyp detection.Methods: A retrospective chart review was conducted for outpatient colonoscopies (December 2013 to April 2015) done for patients 40-85 years old which were complete and were performed by academic gastroenterologists. Colonoscopies with inadequate bowel preparation were excluded.Results: 1100 patients were included. Indication was screening or surveillance in 60%. Most were males (93%), and 50% were African American. Mean age was 62.1 years. A gastroenterology fellow participated in 54.7% of the procedures.Fellow involvement resulted in a significant increase in the ADR (55.2% to 64.6%, P=0.001). There was also a substantial increase in mean number of polyps (2.59 to 3.27; P < 0.001), adenoma per patient (1.56 to 2.06; P = 0.001) as well as detection of at least three adenomas (21.7% to 29.2%; P = 0.004). Conclusions: Participation of trainees in colonoscopy is associated with a higher ADR and a higher number of polyps per patient, providing reassurance to patients and healthcare providers about the quality of the colonoscopy. |
