Abstract
Background
Current guidelines suggest that a gastroenterology fellow in training needs to perform 140 colonoscopies to achieve competency. Data are limited regarding adenoma detection rate (ADR) in fellowship.
Aims
To assess how fellow ADR correlates with number of colonoscopies performed.
Methods
We performed a retrospective study examining consecutive colonoscopies performed by gastroenterology fellows. Fellow ADR before and after the 140 procedure benchmark was compared to colonoscopies performed by attending only with whom these fellows trained. A threshold for ideal procedure count was performed using ROC analysis.
Results
We analyzed 2021 average-risk colonoscopies performed by 10 gastroenterology fellows under the supervision of an attending physician. When fellows had performed <140 colonoscopies, the ADR was 27 % compared with an ADR of 36 % when fellows had performed >140 colonoscopies under attending supervision (p = 0.02). The ADR of fellows who had performed >140 colonoscopies under attending supervision was greater than that of attending-only colonoscopies (36 vs. 25 %, p < 0.0001). A threshold of >325 (male patients) and 539 (female patients) colonoscopies was determined to be ideal for achieving adequate ADR based on ROC analysis.
Conclusions
Our data suggest that ADR increases after fellows perform >140 colonoscopies under attending supervision, and thereafter surpasses the ADR of attending-only colonoscopies. Some of the differences may be driven by detection of small adenomas. The findings of this study suggest that a higher threshold for number of colonoscopies performed under attending supervision may be needed to achieve adequate ADR during fellowship prior to independent practice.
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Author’s contribution
Gianotti and Shah involved in writing. Tapper, Gianotti, Kothari, and Sheth involved in critical revision. Gianotti, Kothari, and Shah involved in data acquisition. Tapper involved in analysis. Shah and Sheth involved in supervision/concept. All authors approved manuscript.
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Robert J. Gianotti and Sveta Shah Oza have contributed equally to this manuscript.
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Gianotti, R.J., Oza, S.S., Tapper, E.B. et al. A Longitudinal Study of Adenoma Detection Rate in Gastroenterology Fellowship Training. Dig Dis Sci 61, 2831–2837 (2016). https://doi.org/10.1007/s10620-016-4228-9
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DOI: https://doi.org/10.1007/s10620-016-4228-9