Trainees need to conduct an estimated 450 colonoscopies to achieve a miss rate of <25% in 60-year-old patients.

An important issue in colonoscopy training is how to measure the detection abilities of trainees. In a recent study conducted at a single hospital in California, trainees had their adenoma miss rates measured by tandem colonoscopy. A total of 218 patients underwent a colonoscopy performed by a trainee and then a second colonoscopy performed by an attending endoscopist.


The unassisted cecal intubation rate for the trainees was 70% overall, ranging from 43% for those who had conducted fewer than 100 colonoscopies to ?90% after 250 examinations. The overall adenoma detection rate was 54%. For the 147 patients who had complete withdrawals performed by both the trainee and the attending physician, the trainees had an overall adenoma miss rate of 27% and an overall advanced adenoma miss rate of 9%. Increased experience of the trainee and older age of the patient were independent predictors of a lower adenoma miss rate. To achieve an adenoma miss rate of <25% in 60-year-old patients, approximately 450 exams would be needed.


Citation(s):

Munroe CA et al. A tandem colonoscopy study of adenoma miss rates during endoscopic training: A venture into uncharted territory. Gastrointest Endosc 2012 Mar; 75:561.