Association Of Fellow Training Year And Sedative Use During Screening Colonoscopy

INTRODUCTION: Colonoscopy has become a key tool for colorectal cancer screening, but like any procedure, it is not without risk. The procedure can be done under conscious sedation. Risks of sedation include hypotension and hypoxia. Therefore, endoscopists aim to minimize the amount of sedation needed to reduce risk but keep the patient comfortable. At centers with gastroenterology fellowships, screening colonoscopies are performed by fellows in training. We sought to examine the relationship between the fellow’s level of training and the amount of sedation used during colonoscopy. METHODS: Data were collected on 640 patients undergoing screening colonoscopies at Louisville Veterans Affairs Medical Center, and 509 were excluded based on specific exclusion criteria, including known colonic disorders (e.g., IBD history, pre-existing malignancies) and lack of documented sedative use. Of 131 patients included, median age was 62, 86% patients were male, and 73% were white. Data were gathered by retrospective chart review of the fellow’s level of training (1st, 2nd, 3rdyear) at the time of colonoscopy and dosages of Midazolam, Fentanyl and Diphenhydramine used. Multiple Regression Model was used for analysis with corresponding P-values calculated. Statistical significance was set at P < 0.05. The total number of polyps detected was controlled for as this was thought to affect the duration of colonoscopy. RESULTS: Our study indicates that, although a fellow earlier into his/her training was hypothesized to be associated with increased sedative use, the association was not statistically significant for any of the three sedatives in this study. This is most likely due to the fact that there was little variability between the doses of each sedative and the small sample size. CONCLUSION: Data in literature is limited regarding the association between a fellow’s level of training and the amount of sedation used. Factors affecting sedation use include the experience of the endoscopist and possibly cecal intubation time. Larger studies are needed to further explore these findings, which may have future clinical implications regarding the introduction of specific guidelines for sedative use based on a fellow’s level of training.