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Complete Resection of Colorectal Adenomas: What Are the Important Factors in Fellow Training?

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Abstract

Background

The complete removal of adenomatous polyps is important for reducing interval cancer after colonoscopy.

Aims

To identify factors affecting the completeness of colonoscopic polypectomies and to evaluate the experience level of fellows who achieve competence compared with that of experts.

Methods

Medical records of 1,860 patients who underwent at least one polypectomy for an adenomatous polyp at Seoul National University Hospital between March 2011 and February 2013 were retrospectively reviewed. A total of 3,469 adenomatous polyps were included. The lateral and deep margins of the resected polyps were evaluated to check the resection completeness.

Results

Of the 3,469 adenomatous polyps, 1,389 (40.0 %) were removed by two experts and 2,080 (60.0 %) were removed by seven fellows. In the expert-treated group, larger size [odds ratio (OR) 2.81 for ≥20 mm, 95 % confidence interval (CI) 1.64–4.84, P < 0.001] and right-sided location (OR 1.31, 95 % CI 1.05–1.63, P = 0.019) were associated with incomplete resection. In the fellow-treated group, not only polyp characteristics [right-sided location (OR 1.41, 95 % CI 1.18–1.69, P < 0.001)], but also the cumulative number of procedures was also related to resection completeness. After 300 polypectomies, the complete resection rate of the fellows was comparable to that of the experts.

Conclusions

In the fellow-treated group, the level of procedure experience was closely associated with the polypectomy outcomes. Meticulous attention is critical to ensure the completeness of polypectomies performed by trainee endoscopists during the training program.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Daehak-Road 101, Jongno-gu, Seoul, 110-744, Republic of Korea

    Ji Min Choi, Sung Wook Hwang, Jaeyoung Chun, Jong Pil Im & Joo Sung Kim

  2. Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Gangnam Finance Center 152, Teheran-ro, Gangnam-gu, Seoul, 135-984, Republic of Korea

    Changhyun Lee

  3. Department of Pathology, Seoul National University College of Medicine, Daehak-Road 101, Jongno-gu, Seoul, 110-744, Republic of Korea

    Jeong Hwan Park & Hyeon Jeong Oh

  4. Division of Gastroenterology, Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul National University College of Medicine, 5 Gil 20, Boramae-Road, Dongjak-gu, Seoul, 156-707, Republic of Korea

    Seong-Joon Koh, Ji Won Kim, Byeong Gwan Kim & Kook Lae Lee

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  1. Ji Min Choi
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  2. Changhyun Lee
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  9. Ji Won Kim
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Corresponding author

Correspondence to Byeong Gwan Kim.

Additional information

Ji Min Choi and Changhyun Lee have contributed equally to this work.

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Choi, J.M., Lee, C., Park, J.H. et al. Complete Resection of Colorectal Adenomas: What Are the Important Factors in Fellow Training?. Dig Dis Sci 60, 1579–1588 (2015). https://doi.org/10.1007/s10620-014-3500-0

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  • DOI: https://doi.org/10.1007/s10620-014-3500-0

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