Colonoscopies with trainee involvement yield lower sessile serrated polyp detection rate
Sessile serrated polyp detection rate was the only quality metric reduced when trainees participated in colonoscopy, highlighting the importance of careful examination of the right colon when trainees are present, according to new data.
“We wanted to better understand whether training a resident physician affected the quality of the colonoscopy procedure. This is of particular interest to us as we are a major endoscopy teaching center for both gastroenterology and general surgery,” Michael Sey, MD, MPH, FRCPC, a gastroenterologist at London Health Sciences Centre-Victoria Hospital in Ontario, Canada, told Healio.
“Furthermore, we felt it would be important to training centers and patients around the globe, given that there are tens of thousands of procedures performed with trainees each year in Canada alone, and an even higher number in the United States,” Sey, who also is an associated professor of medicine at Western University and a scientist at the Lawson Health Research Institute, noted.
In a multicenter, population-based cohort study published in JAMA Network Open, Sey and colleagues assessed the association between colonoscopy quality metrics and participation of a trainee, defined as a resident or fellow in a gastroenterology or general surgery training program.
The researchers identified 35,499 colonoscopies performed by 71 physicians at 21 academic and community hospitals between April 1, 2017, and Oct. 31, 2018. Of these, 5,941 (16.7%) involved trainees.
The study’s primary outcome was adenoma detection rate. Secondary outcomes included the sessile serrated polyp detection rate (ssPDR), polyp detection rate (PDR), cecal intubation rate (CIR) and perforation rate.
When trainees participated vs. did not participate in colonoscopies, the researchers did not report significant differences in the ADR (26.4% vs. 27.3%), CIR (96.7% vs. 97.2%) and perforation rate (0.05% vs. 0.06%). The researchers did report significantly lower ssPDR (4.4% vs. 5.2%; P = .009) and PDR (39.2% vs. 42%; P < .001).
In adjusted analyses, there was no association with trainee participation for ADR (RR = 0.97; 95% CI, 0.91-1.03), PDR (RR = 0.98; 95% CI, 0.93-1.04) and CIR (RR = 0.93; 95% CI, 0.78-1.1), although researchers continued to report significantly lower ssPDR (RR = 0.79; 95% CI, 0.64-0.98). The perforation rates were too low for multivariable regression.
Sey said, given the paucity of research in this area, he and his colleagues found all the results surprising.
“In the beginning, we were not sure whether trainee involvement would be negatively or positively associated with colonoscopy quality related outcomes. People may worry that having a trainee involved might negatively impact the quality of the procedure, although data from our study did not show this,” Sey said.
“We found that the procedure completion rate (eg, cecal intubation rate), detection rate of precancerous polyps (eg, adenoma detection rate) and perforation (a very serious complication of colonoscopy) were similar between procedures involving trainees and not involving trainees,” Sey continued. “When trainees were involved, sessile serrated polyp detection was lower, which makes intuitive sense. This is because they are often subtle and difficult to see, even by board-certified endoscopists.”
Based on this finding, the researchers recommended particular attention be given to the recognition of lesions when trainees are involved in colonoscopy, especially since one-third of colon cancers are suspected to arise from sessile serrated polyps.
“This finding highlights the need to pay meticulous attention to the right colon, especially when a trainee is present, as this is where sessile serrated polyps typically grow,” Sey said. “Doctors can use this finding to focus their teaching and guide the development of teaching strategies to continuously improve patient care.”
Collapse
Read more about