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Original Investigation
April 17, 2019

Association of Adenoma and Proximal Sessile Serrated Polyp Detection Rates With Endoscopist Characteristics

Author Affiliations
  • 1Department of Hospital Medicine, Cleveland Clinic, Cleveland, Ohio
  • 2Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio
  • 3Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
  • 4Department of Value Based Care, Cleveland Clinic, Cleveland, Ohio
  • 5Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
JAMA Surg. 2019;154(7):627-635. doi:10.1001/jamasurg.2019.0564
Key Points

Question  Do adenoma and proximal sessile serrated polyp detection rates differ based on endoscopist characteristics?

Findings  This cohort study demonstrated differences in the adenoma and proximal sessile serrated polyp detection rates through replication of analyses of previous studies that have examined this question. However, after adjusting for additional factors, no difference in detection based on endoscopist characteristics was found.

Meaning  Differences in the adenoma and proximal sessile serrated polyp detection rates by endoscopist characteristics found by previous studies may be owing to residual confounding; per this analysis, patients or health systems need not select endoscopists based on the examined characteristics for the purposes of colorectal cancer screening.


Importance  Research demonstrates adenoma detection rate (ADR) and proximal sessile serrated polyp detection rate (pSSPDR) are associated with endoscopist characteristics including sex, specialty, and years in practice. However, many studies have not adjusted for other risk factors associated with colonic neoplasia.

Objective  To assess the association between endoscopist characteristics and polyp detection after adjusting the factors included in previous studies as well as other factors.

Design, Setting, and Participants  This cohort study was conducted in the Cleveland Clinic health system with data from individuals undergoing screening colonoscopies between January 2015 and June 2017. The study analyzed data using methods from previous studies that have demonstrated significant associations between endoscopist characteristics and ADR or pSSPDR. Multilevel mixed-effects logistic regression was performed to examine 7 endoscopist characteristics associated with ADRs and pSSPDRs after controlling for patient demographic, clinical, and colonoscopy-associated factors.

Exposures  Seven characteristics of endoscopists performing colonoscopy.

Main Outcomes and Measures  The ADR and pSSPDR, with a hypothesis created after data collection began.

Results  A total of 16 089 colonoscopies were performed in 16 089 patients by 56 clinicians. Of these, 8339 patients were male (51.8%), and the median (range) age of the cohort was 59 (52-66) years. Analyzing the data by the methods used in 4 previous studies yielded an association between endoscopist and polyp detection; surgeons (OR, 0.49 [95% CI, 0.28-0.83]) and nongastroenterologists (OR, 0.50 [95% CI 0.29-0.85]) had reduced odds of pSSPDR, which was similar to results in previous studies. In a multilevel mixed-effects logistic regression analysis, ADR was not significantly associated with any endoscopist characteristic, and pSSPDR was only associated with years in practice (odds ratio, 0.86 [95% CI, 0.83-0.89] per increment of 10 years; P < .001) and number of annual colonoscopies performed (odds ratio, 1.05 [95% CI, 1.01-1.09] per 50 colonoscopies/year; P = .02).

Conclusions and Relevance  The differences in ADRs that were associated with 7 of 7 endoscopist characteristics and differences in pSSPDRs that were associated with 5 of 7 endoscopist characteristics in previous studies may have been associated with residual confounding, because they were not replicated in this analysis. Therefore, these characteristics should not influence the choice of endoscopist for colorectal cancer screening. However, clinicians further from their training and those with lower colonoscopy volumes have lower adjusted pSSPDRs and may need additional training to help increase pSSPDRs.

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