Trainee participation and adenoma detection rates during screening colonoscopies.
OBJECTIVE
To evaluate whether participation of a gastroenterology trainee had an impact on adenoma detection rate (ADR) during screening colonoscopies performed with standard-definition colonoscopes (SD-C) versus high-definition colonoscopes (HD-C).


BACKGROUND
ADR is an established quality indicator of colonoscopy and efforts to improve ADR have led to technological advancements including HD-C that have a greater angle of view and produce an image with higher pixel density compared with SD-C. Moreover, other factors like trainee participation have been shown to improve adenoma detection.


METHODS
This is a retrospective review of screening colonoscopies performed during 2 different time periods by 4 experienced endoscopists with or without trainee participation. There are 2 arms of this study, based on whether screening colonoscopy was performed using SD-C or HD-C. Detailed review of endoscopy and histopathologic reports was conducted. Statistical analysis was performed and odds ratio and incidence rate ratios were calculated to adjust for numerous factors.


RESULTS
No significant differences were seen with trainee participation in the SD-C arm of the study. In the HD-C arm, the total number, and the proportion of subjects with: adenomas, diminutive adenomas, and right-sided adenomas were significantly higher with trainee participation.


CONCLUSIONS
Trainee participation significantly improved the overall adenoma detection, specifically diminutive adenoma and right-sided adenoma detection, but only when colonoscopies were performed with HD-C. The improved image quality and resolution provided by HD-C, coupled with enhanced visual scanning an additional pair of eyes provides, may account for the differential impact of trainee participation on ADR.
*Department of Gastroenterology, Kansas City Veterans Affairs Medical Center, Kansas City, MO Departments of †Pathology §Gastroenterology, University of Kansas Medical Center, Kansas City, KS ‡Department of Gastroenterology, University of Denver, Denver, CO ∥Department of Gastroenterology, Loyola University Medical Center, Maywood, IL.
Sara L
SL
Chalifoux
Deepthi S
DS
Rao
Sachin B
SB
Wani
Prateek
P
Sharma
Ajay
A
Bansal
Neil
N
Gupta
Amit
A
Rastogi
D000236:Adenoma / Q000175:diagnosis* / Q000473:pathology; D000368:Aged; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D003111:Colonic Polyps / Q000175:diagnosis; D020685:Colonoscopes; D003113:Colonoscopy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005762:Gastroenterology / Q000193:education*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies