title: Lack of impact on polyp detection by fellow involvement during colonoscopy: a meta-analysis.
abstract: BACKGROUND
  Conflicting data regarding the impact of fellow involvement during colonoscopy on the adenoma detection rate (ADR) and polyp detection rate (PDR) have been reported in the literature.
  
  
  OBJECTIVE
  Our aim was to perform a meta-analysis to determine the impact of fellow participation during colonoscopy on the ADR and PDR.
  
  
  METHODS
  Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, pertinent articles that reported ADR and/or PDR between attending physicians alone compared to gastroenterology fellows with attending physicians were obtained through database searches. Data was abstracted and pooled using a random effects model. The quality of each included study was ascertained using a modified version of the Quality Assessment of Diagnostic Accuracy Studies tool, and potential publication bias was assessed.
  
  
  RESULTS
  A total of 14 articles that included 21,504 colonoscopies met the inclusion criteria. The overall PDR and ADR were 44.4 and 30.8%, respectively. No significant differences were found between participant characteristics and colonoscopies performed with or without fellow participation. No significant differences were found in the relative rate of ADR (1.04, 95% CI 0.94-1.15) or PDR (1.03, 95% CI 0.93-1.14) with or without a fellow. An important limitation is that none of the included studies randomized fellow involvement.
  
  
  CONCLUSIONS
  Involvement of a fellow during colonoscopy did not affect adenoma and polyp detection rates.
authors.affiliation: Division of Gastroenterology and Hepatology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, 53226, USA, yoh@mcw.edu.
authors.forename: Young S
authors.initials: YS
authors.lastname: Oh
authors.forename: Chelsea L
authors.initials: CL
authors.lastname: Collins
authors.forename: Shamsuddin
authors.initials: S
authors.lastname: Virani
authors.forename: Min-Su
authors.initials: MS
authors.lastname: Kim
authors.forename: Julie A
authors.initials: JA
authors.lastname: Slicker
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Jackson
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003111:Colonic Polyps / Q000175:diagnosis*; D003113:Colonoscopy / Q000193:education / Q000592:standards*; D005257:Fellowships and Scholarships; D006801:Humans