Trainee participation during screening colonoscopy does not affect ADR at subsequent surveillance, but may result in early follow-up

Abstract

Background and study aims Training future endoscopists is essential to meet rising demands for screening and surveillance colonoscopies. Studies have shown conflicting results regarding the influence of trainees on adenoma detection rates (ADR). It is unclear whether trainee participation during screening adversely affects ADR at subsequent surveillance and whether it alters surveillance recommendations. Patients and methods A retrospective analysis of average-risk screening colonoscopies and surveillance exams over a subsequent 10-year period was performed. The initial inclusion criteria were met by 5208 screening and 2285 surveillance exams. Patients with poor preparation were excluded. The final analysis included 7106 procedures, including 4922 screening colonoscopies and 2184 surveillance exams. Data were collected from pathology and endoscopy electronic databases. The primary outcome was the ADR with and without trainee participation. Surveillance recommendations were analyzed as a secondary outcome. Results Trainees participated in 1131 (23 %) screening 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 higher at surveillance exams with (22.4 %) and without (27.5 %) trainee participation. ADR at surveillance was not adversely affected by trainee participation during the previous colonoscopy. Shorter surveillance intervals were given more frequently if trainees participated during the initial screening procedure (P = 0.0001). Conclusions ADR did not significantly differ in screening or surveillance colonoscopies with or without trainee participation. ADR at surveillance was not adversely affected by trainee participation during the previous screening exam. However, trainee participation may result in shorter surveillance recommendations.

You are not lab rats at teaching hospitals: A systematic review of resident and fellow participation leads to improved colonoscopy

“…Seventeen articles with 18 datasets 8,9,19–33 (the study by Chalifoux et al 22 . contained two sets of data) regarding the association between fellow/trainee involvement and the detection rate of adenoma were included for meta‐analysis.…”

“…There were 13 studies 8,19–27,29–31 comprising 14 datasets (the study by Chalifoux et al 22 . contained two sets of data) for investigating the association between fellow involvement and the detection rate of advanced adenoma.…”

“…As for other outcomes, including cecum intubation rate (CIR) and adverse events rate (AER), the analysis was not performed because the newly included articles did not provide original data to update the result from the previous meta‐analysis, which found no change of CIR and AER when fellows were involved 7 . Notably, some of the findings in this updated meta‐analysis were inconsistent with the previous meta‐analysis, 7 as there were four additional articles 8,9,19,24 included for a more comprehensive analysis. Additionally, several previously included articles were excluded for the following reasons.…”

“…Seventeen studies 8,9,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] involving colonoscopy outcomes were included in this meta-analysis. These articles were published between 2009 and 2022 and included 16 observational studies, and one RCT.…”

Effectiveness of switching endoscopists for repeat surveillance colonoscopy: a retrospective study

“…In the present study, colonoscopy experience was not significantly associated with missed lesions. Previous studies have indicated that trainee participation in screening colonoscopy does not affect the ADR [ 30 , 31 ]; therefore, the same could be applied to missed lesion detection rates. Furthermore, an attending endoscopist should always perform follow up when trainees perform colonoscopy at our institution.…”