Abstract
Background and study aims Endoscopic mucosal resection (EMR) is an effective way to remove large (> 2 cm) colon
adenomas. Training about it has not been standardized in fellowship programs. This
study was aimed at evaluating the education and knowledge of gastroenterology fellows
about EMR of colorectal adenomas.
Methods Participation in this survey was offered to 1730 gastroenterology fellows in the United
States during the academic year 2019 to 2020. The survey assessed endoscopic mucosal
resection training and knowledge and was approved and administered by the American
College of Gastroenterology.
Results A total of 163 fellows (9.4 %) completed the survey. Only 85 fellows (52.1 %) reported
receiving formal education in endoscopic mucosal resection. Fellow confidence was
lowest regarding knowing electrosurgery unit settings. Fewer fellows correctly identified
Paris 0-IIb (79, 48.5 %; P < 0.0001) or NICE I (114, 69.9 %; P < 0.01) lesions as compared to other Paris and NICE III lesions, respectively. Only
73 (44.8 %) and 93 fellows (57.1 %) arranged steps of EMR in the correct order and
identified the correct type of current used for resection, respectively. Training
year, male sex, and provision of advanced endoscopy rotations during fellowship were
associated with a higher knowledge score for EMR.
Conclusions Nearly half of all fellows reported no formal education in EMR and incorrectly ordered
its steps. Adenoma assessment by Paris and NICE classifications and electrosurgery
unit settings were the most prominent knowledge deficiencies. Incorporation of standardized
training about EMR with inclusion of advanced endoscopy rotations appears to be an
important educational opportunity during gastroenterology fellowship.
