Seemeen Hassan, MD, MS1, Zaheer Ahmed, MD2, Rajiv Chhabra, MD, MRCP (UK), FACG3, Esmat Sadeddin, MD4, Osama Yousef, MD5
1University of Missouri Kansas City School of Medicine, Kansas City, MO; 2University of Missouri, Kansas City, MO; 3University of Missouri Kansas City School of Medicine / Saint Luke's Hospital of Kansas City, Kansas City, MO; 4Truman Medical Center, University of Missouri Kansas City School of Medicine, Kansas City, MO; 5Cleveland Clinic, Abu Dhabi, Abu Dhabi, United Arab Emirates
Introduction: Screening colonoscopies are performed by gastroenterologists & surgeons, sometimes with trainees. The aim was to compare the adenoma detection rate (ADR) & sessile serrated adenoma/polyp detection rate (SDR) between surgeons, gastroenterologists & gastroenterologists with fellows.
Methods: The Clinical Outcomes Research Initiative (CORI) V4 was queried for adult average risk screening colonoscopies from 2009-2014. Data on self-reported specialty of the endoscopists was collected. The number of fellows were counted by the number of procedures signed by fellows. ADR & SDR were compared between 3 groups (gastroenterologists, gastroenterologists with trainees & surgeons). Sites with ≥ 95% polyp pathology submission to CORI were included. 13 sites were included which were community-based sites and/or Veterans Affairs sites(VA). SAS was used.
Results: 31467 screening average risk colonoscopies met the inclusion criteria. Most of them were performed by gastroenterologists without fellows (n=31035, 98.6%). Gastroenterologist with fellows & surgeons performed 355 & 77 procedures respectively. ADR of gastroenterologists was the highest (31.2%) & met the quality benchmark of ≥ 25% (Table 1). The ADR of gastroenterologists with fellows was lower (23.1%). Surgeons had a low ADR of 7.8%. The SDR of gastroenterologists, gastroenterologists with fellows & surgeons were 4.7%, 0.6% & 0% respectively. Rectal retroflexion, cecal intubation rate & total procedure time were comparable between gastroenterologists & surgeons but they all were much lower when gastroenterologists were with fellows. The complication rates were low. No deaths were reported. The rates of abdominal pain, gastrointestinal bleeding and perforation were 1.6%, 0.04% & 0.01% respectively. The adverse effects were not reported for gastroenterologists with fellows & surgeons in CORI for procedures included in this study.
Discussion: Community-based and VA gastroenterologists meet the quality benchmark of ADR ≥ 25%. Gastroenterologists had a lower ADR & SDR when they were with fellows. Gastroenterologists with fellows had longer procedure times & lower cecal intubation rates than gastroenterologists alone. There was under-reporting of colonoscopic procedural and outcome data to CORI by surgeons and those gastroenterologists who worked with fellows. University-based gastroenterology fellowship programs that participated in CORI under-reported post polypectomy pathology results to CORI nationwide & hence could not be included in this analysis.
Citation: Seemeen Hassan, MD, MS; Zaheer Ahmed, MD; Rajiv Chhabra, MD, MRCP (UK), FACG; Esmat Sadeddin, MD; Osama Yousef, MD. P1266 - GASTROENTEROLOGISTS VERSUS GASTROENTEROLOGISTS WITH FELLOWS VERSUS SURGEONS: A COMPARISON OF THE DETECTION RATES OF ADENOMA AND SESSILE SERRATED ADENOMA/POLYP. Program No. P1266. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.