Another Possible Fix for Low Adenoma Detection Rates

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Another Possible Fix for Low Adenoma Detection Rates

Having an experienced nurse act as a second observer during colonoscopies performed by fellows could improve detection rates.

Previous studies have suggested that adenoma detection rates (ADRs) might increase when two observers are present, as when a fellow is involved in colonoscopy. Now, researchers have conducted a multicenter randomized trial to evaluate the effect of having an endoscopy nurse serve as a second observer.

Patients aged $≥$ 50 who were undergoing screening colonoscopy were randomized to have the entire exam done by a colonoscopist alone or to have both the colonoscopist and an endoscopy nurse watching the monitor during withdrawal. The colonoscopists were a mix of attendings and fellows, and the nurses also varied in their experience. The nurses were considered experienced if they had worked in the gastrointestinal endoscopy unit for at least 2 years.

Nearly 800 colonoscopies were performed during the study period. Overall, having a second observer did not affect the polyp detection rate (PDR) or the ADR. However, in the procedures performed by fellows, having an experienced nurse as a second observer led to a significant increase in the PDR (from 47% to 67%) and a nearly significant increase in the ADR (from 40% to 54%).

Comment: These results suggest that an experienced nurse can improve polyp and adenoma detection during procedures performed by an endoscopist in training. Additional study is warranted — both to validate this finding (given that it is from a subset analysis) and to determine whether the same approach could benefit experienced colonoscopists with low detection rates.

— Douglas K. Rex, MD

Published in Journal Watch Gastroenterology January 13, 2012

Citation(s):

Lee CK et al. Participation by experienced endoscopy nurses increases the detection rate of colon polyps during a screening colonoscopy: A multicenter, prospective, randomized study. Gastrointest Endosc 2011 Nov; 74:1094.

Medline abstract (Free)

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