BACKGROUND AND AIMS The use of anesthesia assistance (AA) for screening colonoscopy has been increasing substantially over the past decade, raising concerns about procedure safety and cost without demonstrating a proven improvement in overall quality indicators such as adenoma detection rate (ADR). The effect of AA on ADR has not been extensively studied among trainees learning colonoscopy. We aimed to determine whether type of sedation used during screening colonoscopy affects trainee ADR. METHODS Using the electronic endoscopy databases of two hospitals in our medical center, we identified colonoscopies performed by 15 trainees from 2014 through 2018, including all screening examinations in which the cecum was reached. Multivariable logistic regression was used to determine factors associated with adenoma detection. RESULTS We identified 1420 unique patients who underwent screening colonoscopy by a trainee meeting the inclusion criteria. Of these, 459 (32.3%) were performed with AA. Overall trainee ADR was 39.6%, with ADR increasing from 35.0% in year one of training to 42.8% in year three (p = 0.047). ADR for cases with AA was 37.9%, while ADR for conscious sedation cases was 32.0% (p = 0.374). Despite this 5.9% absolute difference, the use of AA was not associated with finding an adenoma on multivariable analysis when controlling for patient age, sex, smoking status, body mass index, trainee year of training, mean withdrawal time, supervising attending ADR, and bowel preparation quality (OR 0.85; 95% CI 0.67-1.09). CONCLUSIONS Despite providing the ability to more consistently sedate patients, the use of AA did not affect trainee ADR. These results on trainee ADR and sedation type suggest that the overall lack of association between AA use and ADR is applicable to the trainee setting.

中文翻译：

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学员在结肠镜检查和腺瘤检出率筛查中的麻醉协助。

背景和目的在过去的十年中，用于筛查结肠镜检查的麻醉辅助（AA）的使用已大大增加，这引起了对手术安全性和成本的担忧，但并未证明已证实腺瘤检出率（ADR）等总体质量指标得到了改善。AA对ADR的影响尚未在学习结肠镜检查的学员中广泛研究。我们旨在确定结肠镜检查期间使用的镇静剂类型是否会影响学员的ADR。方法使用我们医疗中心两家医院的电子内窥镜数据库，我们确定了15名受训者从2014年至2018年进行的结肠镜检查，包括所有盲肠检查筛查。多变量logistic回归用于确定与腺瘤检测相关的因素。结果我们确定了1420名由符合入选标准的受训医师进行结肠镜检查的独特患者。其中有459例（占32.3％）使用AA进行。总体受训人员的ADR为39.6％，而ADR从培训的第一年的35.0％增加到第三年的42.8％（p = 0.047）。AA病例的ADR为37.9％，清醒镇静病例的ADR为32.0％（p = 0.374）。尽管有5.9％的绝对差异，但在控制患者年龄，性别，吸烟状况，体重指数，受训者接受培训的年限，平均停药时间，监督参加ADR的时间以及对ADR的控制时，AA的使用与在多变量分析中发现腺瘤并不相关。肠道准备质量（OR 0.85； 95％CI 0.67-1.09）。结论尽管有能力使患者更稳定地离开，但使用AA不会影响学员的ADR。