Fredy Nehme, MD1, Ahmed ElKafrawy, MD1, Harris Zamir, MD1, Daniel Merrill, MD1, Hasan Bader, MD1, Laith Al Momani, MD1, Mohammad Alomari, MD2, Tejas V. Joshi, MD3, Wendell Clarkston, MD1; 1University of Missouri, Kansas City, MO; 2East Tennessee State University, Johnson City, TN; 3LSUHSC, New Orleans, LA
Introduction: Polypectomy techniques vary widely in clinical practice and are often driven by physician preference due to the lack of standardized training. Recent evidence showed superiority of certain polypectomy techniques over others in terms of safety and rates of complete and efficient resection. Recent USMSTF guidelines recommend cold snare polypectomy for diminutive and small lesions < 1 cm while cold forceps resection should be limited to lesions ≤ 2 mm. Selection of polypectomy technique is affected by several factors. It remains unclear whether participation of GI fellows affects the polypectomy quality of colorectal lesions. We aim to investigate whether the participation of GI fellows at different stages of training affect the selection of polypectomy technique compared to screening colonoscopies performed by attendings without fellows. Methods: We performed a retrospective review of all patients who underwent a screening colonoscopy at our institution between January 2018 and June 2019. Descriptive statistics were reported as proportions. Categorical variables were compared using Chi-Square test of association with a 95% confidence interval. Results: A total of 895 colonoscopies were reviewed. From 950 polyps resected during the study period, 43.8% were performed with a GI fellow. 96.3% of diminutive polyps ≤ 2 mm and 39.7% of polyps 3-5 mm were resected using cold biopsy forceps. In addition, 51.1% of small polyps 6-9 mm were removed using a hot snare. Fellow participation lead to significantly less utilization of hot snare polypectomy for 6-9 mm polyps (55.3% vs 44.7%, p< 0.001) but significantly more use of cold forceps polypectomy for 3-9 mm polyps. Cold snare polypectomy rates were comparable between the 2 groups regardless of polyp size. More senior fellows were significantly more likely to use a cold snare for 3-9 mm polyps (p=0.004). Discussion: Adherence to recent evidence on appropriate polypectomy techniques remains suboptimal in clinical practice regardless of fellow participation. Selection of polypectomy technique by GI fellows appears to be related to endoscopy skill level given more frequent use of cold forceps polypectomy and less frequent use of hot snare polypectomy compared to GI attendings. Standardized training with adherence to USMSTF recommendations should be emphasized during fellowship training for complete and safe removal of colorectal lesions in order to optimize prevention of colorectal cancer in the future.
Disclosures: Fredy Nehme indicated no relevant financial relationships. Ahmed ElKafrawy indicated no relevant financial relationships. Harris Zamir indicated no relevant financial relationships. Daniel Merrill indicated no relevant financial relationships. Hasan Bader indicated no relevant financial relationships. Laith Al Momani indicated no relevant financial relationships. Mohammad Alomari indicated no relevant financial relationships. Tejas Joshi indicated no relevant financial relationships. Wendell Clarkston indicated no relevant financial relationships.