Wayne State University, Detroit Medical Center Detroit, MI
Hajra Khan, MD1, Salina Faidhalla, MD1, Heba Habbal, MD2, Hamid-Reza Moein, MD1, Eskara Pervez, MD1, Anshu Wadehra, MD1, Mahvish Khalid, MD1, Diana Kakos, BS3, Paul Naylor, PhD4, Bashar Mohamad, MD5; 1Wayne State University, Detroit Medical Center, Detroit, MI; 2Oakwood Hospital and Medical Center, Dearborn, MI; 3Wayne State University, School of Medicine, Detroit, MI; 4WSU, Detroit, MI; 5WSUPG, Detroit, MI
Introduction: There is conflicting data on the impact of trainees on adenoma detection during screening and surveillance colonoscopies. The aim of our study was to determine whether the participation of a gastroenterology fellow during colonoscopy affects adenoma detection based on the first 6 months of the fellow year of training. Methods: In this retrospective cohort study, we extracted data of 575 screening colonoscopies by academic gastroenterologists in the last 6 months of 2017. There were 5 attending physicians and 7 fellows. Variables included patient demographics (age, gender, race), colonoscopy indication (surveillance vs. screening), bowel preparation quality (adequate vs. inadequate), cecum intubation, adenoma detection, presence and/or year of fellow in the last 6 months of 2017. Adenoma detection rate was defined as the presence of at least one adenoma /number of colonoscopies. Results: At our institution, academic physicians have a better ADR for screening (46%) as compared to non-Academic GI physicians (46%) and surgeons. Fellows were involved in 297 screening colonoscopies out of the 574 procedures performed by academic GI (57%) . The mean patient age was 58.4 years, and most patients were African American (88 %) and female (54%). There were no significant differences with respect to age, gender, race, indication for colonoscopy, or quality of bowel prep. There was a slight difference with cecum intubation between fellows and attendings (96% vs. 99%, p = 0.03). The overall adenoma detection was similar with fellow participation compared to non-fellow (45% vs. 40%, p = 0.19). Results by year of fellowship and screening colonoscopies are shown in figure 1. The only setting where fellow participation influenced the detection of adenoma was in the first 6 months of fellowship for screening colonoscopies which were lower with fellows compared to the other groups (p=0.048). Discussion: Fellow involvement had minimal impact on adenoma detection, although first year fellows appear to have a slightly lower detection rate than in later years. Our data accentuates the first-year fellow effect by using only the first 6 months of each fellow’s respective year. Patient demographics, colonoscopy indication and bowel prep did not contribute a significant role in these findings. The reasons for conflicting literature remain unknown.
Figure 1: The % of patients with an adenoma (ADR) as a function of the year of GI fellowship. Also presented on the graph is the ADR for attending faculty when no fellow was present.
Disclosures: Hajra Khan indicated no relevant financial relationships. Salina Faidhalla indicated no relevant financial relationships. Heba Habbal indicated no relevant financial relationships. Hamid-Reza Moein indicated no relevant financial relationships. Eskara Pervez indicated no relevant financial relationships. Anshu Wadehra indicated no relevant financial relationships. Mahvish Khalid indicated no relevant financial relationships. Diana Kakos indicated no relevant financial relationships. Paul Naylor indicated no relevant financial relationships. Bashar Mohamad indicated no relevant financial relationships.