ORIGINAL ARTICLE: Will An Additional Observer Enhance Adenoma Detection During Colonoscopy?

Abstract

Background: Due to varied level of experience, the detection rate of adenoma on colonoscopy is different. In presence of both fellows and attending the incidence rates of adenoma are shown to increase in a small study reported by Rogart et al [4]. Based on similar hypothesis, a study was undertaken with much larger sample size to improve the power of the study. Aims and objective: To know if presence of additional observer will enhance adenoma detection during colonoscopy. Material and Methods: 2236 consecutive colonoscopies performed at Metro Health Medical Centre, Cleveland, Ohio were included in the study from July 2005 to August 2006. Cases with history of colorectal, surgical resection of colon, inflammatory bowel diseases and hereditary polyposis syndrome were excluded. Inpatient colonoscopies were also excluded. With all usual precautions for colonoscopy and after giving polyethylene glycol electrolyte (PEGEL) colonoscopies were performed by one of the nine experienced staff attending using an Olympus colonoscope and Evis Exera processors. All colonoscopies performed by fellows were supervised by an attending throughout the procedure. Advanced adenomas were defined as adenomas greater than 1 cm size. Statistical analysis was done using Tall hassee, FL software; Fisher’s exact test, unpaired t test and multiple logistic regression analysis were performed. p-value of <0.05 is considered as statistically significant. Results: Of the total 2236 colonoscopies included in the study, 1527 were performed by fellows under supervision of attending and 709 by the attending. There was no significant difference in patient demographics, caecal intubation or poor preparation colonoscopies. The mean age of the group was 55 years in both of the groups. There was no statistically significant different in the polyp detection rate (35% Vs 36.8%) as well as overall adenoma detection rate (28.4% Vs 27.7%) between these two groups of performers. However, increased rate of adenoma detection was seen for the adenomas of size 0.5 to 1.00 cm in the fellow and attending group (7.2%) as compared to attending alone group (4.0%). There was no difference in the number of colonoscopies aborted due to poor bowel preparations There was no statistically significant difference in the number of colonoscopies aborted due to poor bowel prep, 91(5.9%) Vs 32(4.5%). Conclusions: Our retrospective study has shown no improvement in the rate of adenoma detection when fellows performed colonoscopy with a supervising attending in comparison to procedures performed by attending alone. In fact, Adenoma Detection Rate (ADR) and caecal intubation rates are increasingly seen as important quality measure. We propose that ADR needs to be used as a tool to assess trainee competency and should be a marker to evaluate proper training. These could be evaluated in randomized prospective trials in future.