UMMS Affiliation

Department of Population and Quantitative Health Sciences; Department of Medicine, Division of Gastroenterology; Division of Gastroenterology and Hepatology, UMass Memorial Medical Center

Publication Date


Document Type



Gastroenterology | Health Services Administration | Medical Education | Neoplasms


Background and study aims: Training future endoscopists is essential to meet rising demands for screening and surveillance colonoscopies. Studies have shown conflicting results regarding the influence of trainees on adenoma detection rates (ADR). It is unclear whether trainee participation during screening adversely affects ADR at subsequent surveillance and whether it alters surveillance recommendations.

Patients and methods: A retrospective analysis of average-risk screening colonoscopies and surveillance exams over a subsequent 10-year period was performed. The initial inclusion criteria were met by 5208 screening and 2285 surveillance exams. Patients with poor preparation were excluded. The final analysis included 7106 procedures, including 4922 screening colonoscopies and 2184 surveillance exams. Data were collected from pathology and endoscopy electronic databases. The primary outcome was the ADR with and without trainee participation. Surveillance recommendations were analyzed as a secondary outcome.

Results: Trainees participated in 1131 (23 %) screening and in 232 (11 %) surveillance exams. ADR did not significantly differ ( P = 0.19) for screening exams with trainee participation (19.5 %) or those without (21.4 %). ADRs were higher at surveillance exams with (22.4 %) and without (27.5 %) trainee participation. ADR at surveillance was not adversely affected by trainee participation during the previous colonoscopy. Shorter surveillance intervals were given more frequently if trainees participated during the initial screening procedure ( P = 0.0001).

Conclusions: ADR did not significantly differ in screening or surveillance colonoscopies with or without trainee participation. ADR at surveillance was not adversely affected by trainee participation during the previous screening exam. However, trainee participation may result in shorter surveillance recommendations.


endoscopy, trainees, colonoscopy

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© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (

DOI of Published Version



Eckardt AJ, Kheder J, Basil A, Silverstein T, Patel K, Mahmoud M, Al-Azzawi Y, Ellis D, Gillespie W, Carrasquillo Vega Y, Person SD, Levey JM. Trainee participation during screening colonoscopy does not affect ADR at subsequent surveillance, but may result in early follow-up. Endosc Int Open. 2020 Dec;8(12):E1732-E1740. doi: 10.1055/a-1244-1859. Epub 2020 Nov 17. PMID: 33269304; PMCID: PMC7676994. Link to article on publisher's site

Journal/Book/Conference Title

Endoscopy international open

PubMed ID


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Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.