The role of endoscopist adenoma detection rate in in sex differences in colonoscopy findings: cross-sectional analysis of the SCREESCO randomized controlled trial

Fewer adenomas are detected at colonoscopy in women compared to men and failure to detect adenomas and sessile serrated polyps is associated with an increased risk of post-colonoscopy colorectal cancer. The aim of this study was to investigate whether this was in part due to the greater difficulty of conducting colonoscopy in women, with the difference being more apparent in colonoscopies conducted by less skilled endoscopists. Cross-sectional exploratory analysis of data on 16,551 individuals undergoing a primary colonoscopy (PCOL group) or colonoscopy after positive faecal immunochemical test (FIT group) within the randomized controlled trial SCREESCO. Endoscopist adenoma detection rate (ADR; low or high) was determined based on each endoscopist’s colonoscopies performed in SCREESCO. In each study group, the relationship between the sex difference in colonoscopy outcome and endoscopist ADR was assessed using multiplicative interaction tests. Endoscopists performed equally many colonoscopies in men and women (median 52% men). There were no signs of effect modification of the risk ratio of any finding (men vs women) by endoscopist ADR in the PCOL group (<i>p</i> = 0.33) or the FIT group (<i>p</i> = 0.30). The proportion of incomplete index colonoscopies was lower in men than in women in both groups and there was no effect modification by endoscopist ADR in either the PCOL group (<i>p</i> = 0.41) or the FIT group (<i>p</i> = 0.96). This study provides no evidence that endoscopist skill measured by ADR underlies the sex difference in adenoma detection at colonoscopy. This study has trial number NCT02078804 and is registered with ClinicalTrials.gov.

与男性相比，女性在结肠镜检查中检出的腺瘤更少，而腺瘤及无蒂锯齿状息肉（sessile serrated polyps）的漏检与结肠镜检查后结直肠癌风险升高相关。本研究旨在探究这一现象是否部分源于女性结肠镜检查操作难度更大，且该差异在操作技能较低的内镜医师实施的检查中更为显著。本研究对随机对照试验SCREESCO中的数据开展横断面探索性分析，纳入16551名接受首次结肠镜检查的受试者（PCOL组）或粪便免疫化学试验（faecal immunochemical test, FIT）阳性后接受结肠镜检查的受试者（FIT组）。内镜医师腺瘤检出率（adenoma detection rate, ADR）根据其在SCREESCO试验中完成的结肠镜检查情况分为高、低两组。在每个研究亚组中，采用乘积交互检验评估结肠镜检查结局的性别差异与内镜医师ADR之间的关联。内镜医师对男性和女性实施的结肠镜检查数量相当（男性占比中位数为52%）。无论是PCOL组（p=0.33）还是FIT组（p=0.30），均未发现内镜医师ADR对各类检出结局的性别相关风险比存在效应修饰迹象。两组中男性的首次结肠镜检查未完成比例均低于女性，且无论是PCOL组（p=0.41）还是FIT组（p=0.96），均未观察到内镜医师ADR对该比例存在效应修饰作用。本研究未发现以ADR衡量的内镜医师技能差异是导致结肠镜检查中腺瘤检出率存在性别差异的原因。本研究试验编号为NCT02078804，已在ClinicalTrials.gov注册。