Comparison of Adenoma Detection Rates in Screening Colonoscopy Between Therapeutic Gastroenterologists and General Gastroenterologists: A Retrospective Single Center Study

Introduction: Adenoma detection rate (ADR) is a critical quality metric in colonoscopy as it directly correlates with the prevention of colorectal cancer. The aim of this study is to compare the ADRs between therapeutic gastroenterologists (TG) and general gastroenterologists (GG) to identify potential differences in polyp detection and their implications for patient outcomes. Methods: A retrospective analysis was conducted on screening colonoscopies performed from January 2020 through January 2023 at a tertiary medical center by TG and GG. TG were defined as gastroenterologists performing therapeutic endoscopies including ERCPs. The study cohort consisted of patients aged 45-75 with a complete screening colonoscopy with adequate bowel preparation (Boston bowel preparation score of 6 or more). Patient characteristics and ADRs were summarized and compared for GG and TG using t-tests and chi-squared tests as appropriate. Multivariable regression was used to assess the difference in ADR between TG and GG while controlling for patient age, sex, race, previous colonoscopy, family history of adenocarcinoma, fellow involvement, and sedation type (Table 1). Results: A total of 9,755 colonoscopy procedures were included in the analysis, of which 407 were performed by 15 TG and 9,348 by 41 GG. The ADR for the TE was 46.9% overall, while the ADR for GG was 41.5% ( χ2 = 4.55, p = 0.033). This difference was no longer statistically significant after controlling for the above covariates; the odds ratio for TG compared to GG was 0.99 (95% CI: 0.80 – 1.22, p = 0.919). 98.2% of the procedures performed by GG had a withdrawal time of at least 6 minutes compared to 95.6% for TE ( χ2 = 13.56, p < 0.001) (Figure 1). Conclusion: This study reveals no significant difference in ADRs between therapeutic gastroenterologists and general gastroenterologists after controlling for patient characteristics. The results of this study are reassuring in that TG who may perform lower volume screening colonoscopies achieve a satisfactory ADR and advocate for the inclusion of TG into CRC screening practices. Further research is warranted to explore the long-term implications of these findings on colorectal cancer prevention and patient outcomes.Figure 1.: Patient and case characteristics for screening colonoscopies performed by General Gastroenterologists (GG) vs Therapeutic Gastroenterologists (TG). Table 1. - Multivariable Logistic Regression Results to Predict Adenoma and Adenocarcinoma Detection for Therapeutic Gastroenterologists Compared to General Gastroenterologists Odds Ratio 95% CI P-value Therapeutic Gastroenterologists 0.99 0.80 – 1.22 0.919 Age (years) 1.04 1.03 – 1.04 < 0.001 Female Sex 0.56 0.52 – 0.61 < 0.001 Race: Black or African American* 0.99 0.89 – 1.11 0.901 Race: Asian* 0.79 0.58 – 1.06 0.123 Race: Other* 1.06 0.87 – 1.29 0.576 Race: Declined/Unknown* 1.08 0.92 – 1.28 0.354 Family History of Adenocarcinoma 0.99 0.79– 1.25 0.960 Previous Colonoscopy 0.69 0.59 – 0.81 < 0.001 Fellow Involved 1.14 1.03 – 1.27 0.012 Sedation: None** 0.94 0.60 – 1.48 0.786 Sedation: Moderate** 0.48 0.44 – 0.53 < 0.001 *Reference category for comparison is White.**Reference category is Monitored Anesthesia Care.