Mohammad Alomari, MD1, Laith Al Momani, MD2, Hunter Bratton3, Bara El Kurdi, MD2, Shrouq Khazaaleh, MD4, Vaibhav Wadhwa, MD5, Prashanthi N. Thota, MD6, Madhusudhan R. Sanaka, MD, FACG6
1Cleveland Clinic Foundation, Cleveland, OH; 2East Tennessee State University, Johnson City, TN; 3Quillen College of Medicine, Johnson City, TN; 4King Abdullah University Hospital, Ar Ramtha, Irbid, Jordan; 5Cleveland Clinic, Weston, FL; 6Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH
Introduction: High-risk adenomas (HRA) have been associated with a significant risk of interval colorectal cancer development. Recent literature suggests that high-risk adenoma detection rate (HRADR) can be used as a complementary screening colonoscopy quality metric. Being dependent upon the experience- and skill-level of the provider, we aimed in this study to investigate the impact of gastroenterologists’ gender on HRADR among screened patients.
Methods: A retrospective review of all screening colonoscopies in patients ≥50 years of age performed at our center between 2012 and 2014 was done. Average risk patients who had a complete colonoscopy with excellent, good, and fair bowel preparation were included. Overall, gender-specific, and segment-specific adenoma detection rates (ADR), large adenoma detection rate and high-risk adenoma detection rates (HRADR) were calculated and compared using t-tests. HRADR defined as either ≥ 3 adenomas or at least one adenoma of ≥ 10 mm (big adenoma) or at least one tubule-villous adenoma, high grade dysplasia or cancerous polyp.
Results: A total of 2641 patients were included in the analysis. Average patient age was 58±7.6 years and 53.2% were females. (Table 1) Compared to female gastroenterologists, male gastroenterologists had better overall HRADR (9.8±6.6 vs. 5.0±4.0; p< 0.012) and overall Distal HRADR (4.6±5.0 vs. 1.2±2.2, 0.019). In male patients, male gastroenterologists had better proximal and distal HRADR (6.4±7.0 vs. 1.8±2.7; p< 0.021 and 6.3±7.4 vs. 1.2±3; p< 0.016, respectively). In female patients there was a non-significant trend toward better overall and segment-specific HRADR (p-value= 0.97, 0.56 and 0.30). Also, male gastroenterologists were better at detecting large adenomas ( >1 cm) in male patients (7.4±8.3 vs.1.7±3.3; p< 0.016). All endoscopists met the nationally recommended ADR thresholds (25% overall, 20% for females and 30% for males).
Discussion: In this study, male gastroenterologists had better overall HRADR and overall Distal HRADR among all screened patients. In male patients, male gastroenterologists had better proximal and distal HRADR and were better at detecting large adenomas. This association was consistent across patient age, race, and level of colon preparation. These findings suggest that the differences in screening colonoscopy training and/or volume between male and female gastroenterologists may have important clinical implications in the detection of colon cancer and patient outcomes.
Citation: Mohammad Alomari, MD; Laith Al Momani, MD; Hunter Bratton; Bara El Kurdi, MD; Shrouq Khazaaleh, MD; Vaibhav Wadhwa, MD; Prashanthi N. Thota, MD; Madhusudhan R. Sanaka, MD, FACG. P0235 - MALE GASTROENTEROLOGISTS HAVE BETTER HIGH-RISK ADENOMA DETECTION RATE (HRADR) IN MALE PATIENTS. Program No. P0235. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.