Impact of Endoscopist Experience on Adenoma Detection Rate: A Prospective Cohort Study

Aims Adequate adenoma detection during colonoscopy is crucial for effective colorectal cancer prevention. This study aimed to investigate the association between endoscopist experience and adenoma detection rates in a real-world clinical setting.

Methods A prospective cohort study was conducted among 2,359 patients undergoing outpatient colonoscopy at a tertiary care center. Endoscopists were categorized into three experience levels:<5 years, 5-30 years, and≥30 years of experience. Adenoma detection rates were compared between the experience groups, and multivariate analysis was performed to adjust for potential confounding factors, including quality of bowel preparation and use of high-definition colonoscopes.

Results The overall adenoma detection rate was 15.2%. Univariate analysis showed a significant association between endoscopist experience and adenoma detection rates (p<0.001). Endoscopists with≥30 years of experience had the highest adenoma detection rate at 28.1%, followed by those with 5-30 years of experience at 11.4%, and those with<5 years of experience at 7.0%. The differences remained statistically significant after adjusting for confounders in the multivariate analysis. Endoscopists with≥30 years of experience had a 4.6-fold higher odds of detecting adenomas compared to those with<5 years of experience (OR 4.6, 95% CI 3.3-6.6). Further subgroup analysis revealed that the impact of endoscopist experience was most pronounced for detecting larger (≥ 10 mm) and advanced adenomas. Endoscopists with≥30 years of experience had a 6.1% rate of detecting large adenomas, compared to 3.2% and 1.4% for the 5-30 years and<5 years experience groups, respectively (p<0.001). Similarly, the advanced adenoma detection rate was 8.5% for the≥30 years group, 3.8% for the 5-30 years group, and 2.0% for the<5 years group (p<0.001). Interestingly, the mean withdrawal time during colonoscopy was also significantly longer for the most experienced endoscopists (16.2±5.4 minutes) compared to the intermediate (14.0±6.1 minutes) and least experienced (12.8±6.8 minutes) groups (p<0.001). This suggests that longer examination time may be one of the factors contributing to the higher adenoma detection rates observed with greater endoscopist experience.

Conclusions Our findings demonstrate a strong and independent association between endoscopist experience and adenoma detection rates, particularly for larger and advanced adenomas. Endoscopists with greater experience are significantly more likely to detect clinically relevant adenomas during colonoscopy. These results highlight the importance of endoscopist experience in ensuring optimal quality of colorectal cancer screening and prevention. Strategies to enhance training and maintain the skills of experienced endoscopists may be crucial for improving adenoma detection and ultimately reducing the burden of colorectal cancer.

Conflicts of Interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
27 March 2025