Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Nov 16, 2017; 9(11): 540-551
Published online Nov 16, 2017. doi: 10.4253/wjge.v9.i11.540
Colonoscopy procedural volume increases adenoma and polyp detection rates in gastroenterologytrainees
Emad Qayed, Ravi Vora, Sara Levy, Roberd M Bostick
Emad Qayed, Ravi Vora, Sara Levy, Department of Medicine, Division of Digestive diseases, Emory University School of Medicine, Atlanta, GA 30303, United States
Emad Qayed, Grady Memorial Hospital, Atlanta, GA 30303, United States
Roberd M Bostick, Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA 30303, United States
Roberd M Bostick, Emory University, Winship Cancer Institute Atlanta, GA 30303, United States
Author contributions: Qayed E designed the research, collected and analyzed the data, drafted, and revised the manuscript; Vora R collected the data and revised the manuscript; Levy S collected the data and revised the manuscript; Bostick RM designed the research and revised the manuscript for important intellectual content; all authors read and approved the final version of the manuscript.
Supported by (in part) National Center for Advancing Translational Sciences of the National Institutes of Health, No. UL1TR000454.
Institutional review board statement: The study was reviewed and approved by Emory University Institutional Review Board.
Informed consent statement: Informed consent was waived by the Institutional Review Board due to the large sample size, retrospective study design, and the fact that this study does not affect the welfare of the patients.
Conflict-of-interest statement: The authors report no conflict of interest.
Data sharing statement: Statistical code is available from the corresponding author at eqayed@emory.edu. The presented data are anonymized with no risk of identification. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Emad Qayed, MD, MPH, FACG, Chief of Gastroenterology, Grady Memorial Hospital, 49 Jesse Hill Junior Drive, Atlanta, GA 30303, United States. eqayed@emory.edu
Telephone: +1-404-7781685 Fax: +1-404-7781681
Received: June 12, 2017
Peer-review started: June 12, 2017
First decision: July 13, 2017
Revised: July 20, 2017
Accepted: August 15, 2017
Article in press: August 16, 2017
Published online: November 16, 2017
Processing time: 158 Days and 7.1 Hours
Abstract
AIM

To investigate changes in polyp detection throughout fellowship training, and estimate colonoscopy volume required to achieve the adenoma detection rate (ADRs) and polyp detection rate (PDRs) of attending gastroenterologists.

METHODS

We reviewed colonoscopies from July 1, 2009 to June 30, 2014. Fellows’ procedural logs were used to retrieve colonoscopy procedural volumes, and these were treated as the time variable. Findings from screening colonoscopies were used to calculate colonoscopy outcomes for each fellow for the prior 50 colonoscopies at each time point. ADR and PDR were plotted against colonoscopy procedural volumes to produce individual longitudinal graphs. Repeated measures linear mixed effects models were used to study the change of ADR and PDR with increasing procedural volume.

RESULTS

During the study period, 12 fellows completed full three years of training and were included in the analysis. The average ADR and PDR were, respectively, 31.5% and 41.9% for all fellows, and 28.9% and 38.2% for attendings alone. There was a statistically significant increase in ADR with increasing procedural volume (1.8%/100 colonoscopies, P = 0.002). Similarly, PDR increased 2.8%/100 colonoscopies (P = 0.0001), while there was no significant change in advanced ADR (0.04%/100 colonoscopies, P = 0.92). The ADR increase was limited to the right side of the colon, while the PDR increased in both the right and left colon. The adenoma per colon and polyp per colon also increased throughout training. Fellows reached the attendings’ ADR and PDR after 265 and 292 colonoscopies, respectively.

CONCLUSION

We found that the ADR and PDR increase with increasing colonoscopy volume throughout fellowship. Our findings support recent recommendations of ≥ 275 colonoscopies for colonoscopy credentialing.

Keywords: Screening colonoscopy; Colorectal cancer; Polyp detection rate; Colonoscopy volumes; Adenoma detection rate; Gastroenterology training

Core tip: Adenoma and polyp detection rates are important colonoscopy quality indicators. Competence in colonoscopy is measured by motor skills and not adenoma detection rate (ADR) and polyp detection rate (PDR). Recent guidelines recommend at least 275 colonoscopies to achieve competence. In this study, we found that ADR, PDR, adenoma per colon, and polyp per colon significantly increase throughout fellowship training. Fellows achieve the ADR and PDR of attendings after 262 and 292 colonoscopies. The variability of polyp detection among fellows suggests that ADR and PDR could be used during fellowship as part of periodic feedback.