1686
Letters to the Editor
Do Male Endoscopists have Better Adenoma Detection Rates than Female Endoscopists? Turki AlAmeel, MBBS, FRCPC, FACP1 and Sami AlMomen, MBBS, MRCP1 doi:10.1038/ajg.2014.244
To the Editor: Colonoscopy can reduce mortality from colorectal cancer through detection and removal of precancerous adenomatous polyps. One of the major quality indicators in screening colonoscopies is adenoma detection rate (1). We read with great interest the study by Butterly et al. (2) looking at the effect of longer withdrawal time on adenoma detection rate. They found that female endoscopist had lower adenoma detection rate than their male counterparts. This was attributed to the fact that female endoscopists had higher percentage of female patients compared with male endoscopists. We were surprised that the authors did not take into account other important factors that may have led to their findings. It was not clear from the study what were the subspecialties of the six participating female endoscopists. Higher number of non-gastroenterologists may explain the lower adenoma detection rate. In fact, the Board of Medicine in the state of New Hampshire, where the study was conducted, has currently only three female physicians statewide registered as gastroenterologists (3). It is not clear if there were more female gastroenterologists at the time when the study was conducted. Other potential confounders that could have affected the results include the percentage of colonoscopies performed by these female endoscopists for diagnostic or surveillance indications and those done for screening purposes. This has an impact on the adenoma detection rate. Other endoscopistrelated factors include the number of continuing medical education (CME) meetings attended in the preceding 5 years (4).
The American Journal of GASTROENTEROLOGY
nature publishing group
Gender differences already exist in the field of gastroenterology. Female gastroenterologists have significantly lower career satisfaction and less job advancement than male gastroenterologists (5). We believe that these potential confounders rather than the endoscopist gender may have led to lower adenoma detection rate among female endoscopists in this study. CONFLICT OF INTEREST The authors declare no conflict of interest.
REFERENCES 1. Rex DK, Petrini JL, Baron TH et al. ASGE/ ACG taskforce on quality in endoscopy. Quality indicators for colonoscopy. Am J Gastroenterol 2006;101:873–85. 2. Butterly L, Robinson CM, Anderson JC et al. Serrated and adenomatous polyp detection increases with longer withdrawal time: results from the New Hampshire colonoscopy registry. Am J Gastroenterol 2014;109:417–26. 3. New Hampshire Board of Medicine website, http://business.nh.gov/medicineboard/search. aspx. Accessed 12 April 2014. 4. Adler A, Wegscheider K, Lieberman D et al. Factors determining the quality of screening colonoscopy: a prospective study on adenoma detection rates, from 12,134 examinations (Berlin colonoscopy project 3, BECOP-3). Gut 2013;62:236–41. 5. Gerson LB, Twomey K, Hecht G et al. Does gender affect career satisfaction and advancement in gastroenterology? Results of an AGA institute-sponsored survey. Gastroenterology 2007;132:1598–606.
To the Editor: We thank AlAmeel et al. (1) for their interest in our article. As stated in their correspondence, there were six female endoscopists in our sample. There were three gastroenterologists and three surgeons in this group. As noted in our article, endoscopist gender affected the adenoma detection rate (ADR) but not the polyp or serrated polyp detection rates. Our regression analyses for ADR included endoscopist-estimated volume, age, gender, and subspecialty. We would like to clarify that diagnostic exams and surveillance exams for IBD or familial syndromes were excluded from our analysis (Figure 1). Although we indicated that lower ADR among female endoscopists may result from a higher percentage of female patients, we feel that six endoscopists may be too small a number on which to draw conclusions or perform additional analyses. There are currently 17 female endoscopists contributing data to the NHCR, and we anticipate that as our registry grows more female endoscopists will be added to our sample, increasing our ability to do meaningful analysis based on endoscopist gender. Thank you again for your interest in our article and for your contributions to the discussion.
CONFLICT OF INTEREST The authors declare no conflict of interest.
1
Division of Gastroenterology, Department of Medicine, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia. Correspondence: Turki AlAmeel, MBBS, FRCPC, FACP, Division of Gastroenterology, Department of Medicine, King Fahad Specialist Hospital Dammam, Dammam 31444, Saudi Arabia. E-mail: [email protected]
Response to AlAmeel et al. Lynn Butterly, MD1,2, Joseph Anderson, MD2, 3, Christina M. Robinson, MS4 and Julie Weiss, MS4 doi:10.1038/ajg.2014.255
REFERENCES 1. AlAmeel T, AlMomen S. Do male endoscopists have better adenoma detection rates than female endoscopists? Am J Gastroenterol 2014;109:1686 (this issue).
1 Dartmouth-Hitchcock Medical Center, Section of Gastroenterology, Lebanon, New Hampshire, USA; 2Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA; 3Department of Veterans Affairs Medical Center, White River Junction, Vermont, USA; 4Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA. Correspondence: Lynn Butterly, MD, Geisel School of Medicine at Dartmouth, Section of Gastroenterology, 46 Centerra Parkway, Evergreen Center, Suite 105, Lebanon, New Hampshire 03766, USA. E-mail: [email protected]
VOLUME 109 | OCTOBER 2014 www.amjgastro.com
Letters to the Editor
Do Male Endoscopists have Better Adenoma Detection Rates than Female Endoscopists? Turki AlAmeel, MBBS, FRCPC, FACP1 and Sami AlMomen, MBBS, MRCP1 doi:10.1038/ajg.2014.244
To the Editor: Colonoscopy can reduce mortality from colorectal cancer through detection and removal of precancerous adenomatous polyps. One of the major quality indicators in screening colonoscopies is adenoma detection rate (1). We read with great interest the study by Butterly et al. (2) looking at the effect of longer withdrawal time on adenoma detection rate. They found that female endoscopist had lower adenoma detection rate than their male counterparts. This was attributed to the fact that female endoscopists had higher percentage of female patients compared with male endoscopists. We were surprised that the authors did not take into account other important factors that may have led to their findings. It was not clear from the study what were the subspecialties of the six participating female endoscopists. Higher number of non-gastroenterologists may explain the lower adenoma detection rate. In fact, the Board of Medicine in the state of New Hampshire, where the study was conducted, has currently only three female physicians statewide registered as gastroenterologists (3). It is not clear if there were more female gastroenterologists at the time when the study was conducted. Other potential confounders that could have affected the results include the percentage of colonoscopies performed by these female endoscopists for diagnostic or surveillance indications and those done for screening purposes. This has an impact on the adenoma detection rate. Other endoscopistrelated factors include the number of continuing medical education (CME) meetings attended in the preceding 5 years (4).
The American Journal of GASTROENTEROLOGY
nature publishing group
Gender differences already exist in the field of gastroenterology. Female gastroenterologists have significantly lower career satisfaction and less job advancement than male gastroenterologists (5). We believe that these potential confounders rather than the endoscopist gender may have led to lower adenoma detection rate among female endoscopists in this study. CONFLICT OF INTEREST The authors declare no conflict of interest.
REFERENCES 1. Rex DK, Petrini JL, Baron TH et al. ASGE/ ACG taskforce on quality in endoscopy. Quality indicators for colonoscopy. Am J Gastroenterol 2006;101:873–85. 2. Butterly L, Robinson CM, Anderson JC et al. Serrated and adenomatous polyp detection increases with longer withdrawal time: results from the New Hampshire colonoscopy registry. Am J Gastroenterol 2014;109:417–26. 3. New Hampshire Board of Medicine website, http://business.nh.gov/medicineboard/search. aspx. Accessed 12 April 2014. 4. Adler A, Wegscheider K, Lieberman D et al. Factors determining the quality of screening colonoscopy: a prospective study on adenoma detection rates, from 12,134 examinations (Berlin colonoscopy project 3, BECOP-3). Gut 2013;62:236–41. 5. Gerson LB, Twomey K, Hecht G et al. Does gender affect career satisfaction and advancement in gastroenterology? Results of an AGA institute-sponsored survey. Gastroenterology 2007;132:1598–606.
To the Editor: We thank AlAmeel et al. (1) for their interest in our article. As stated in their correspondence, there were six female endoscopists in our sample. There were three gastroenterologists and three surgeons in this group. As noted in our article, endoscopist gender affected the adenoma detection rate (ADR) but not the polyp or serrated polyp detection rates. Our regression analyses for ADR included endoscopist-estimated volume, age, gender, and subspecialty. We would like to clarify that diagnostic exams and surveillance exams for IBD or familial syndromes were excluded from our analysis (Figure 1). Although we indicated that lower ADR among female endoscopists may result from a higher percentage of female patients, we feel that six endoscopists may be too small a number on which to draw conclusions or perform additional analyses. There are currently 17 female endoscopists contributing data to the NHCR, and we anticipate that as our registry grows more female endoscopists will be added to our sample, increasing our ability to do meaningful analysis based on endoscopist gender. Thank you again for your interest in our article and for your contributions to the discussion.
CONFLICT OF INTEREST The authors declare no conflict of interest.
1
Division of Gastroenterology, Department of Medicine, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia. Correspondence: Turki AlAmeel, MBBS, FRCPC, FACP, Division of Gastroenterology, Department of Medicine, King Fahad Specialist Hospital Dammam, Dammam 31444, Saudi Arabia. E-mail: [email protected]
Response to AlAmeel et al. Lynn Butterly, MD1,2, Joseph Anderson, MD2, 3, Christina M. Robinson, MS4 and Julie Weiss, MS4 doi:10.1038/ajg.2014.255
REFERENCES 1. AlAmeel T, AlMomen S. Do male endoscopists have better adenoma detection rates than female endoscopists? Am J Gastroenterol 2014;109:1686 (this issue).
1 Dartmouth-Hitchcock Medical Center, Section of Gastroenterology, Lebanon, New Hampshire, USA; 2Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA; 3Department of Veterans Affairs Medical Center, White River Junction, Vermont, USA; 4Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA. Correspondence: Lynn Butterly, MD, Geisel School of Medicine at Dartmouth, Section of Gastroenterology, 46 Centerra Parkway, Evergreen Center, Suite 105, Lebanon, New Hampshire 03766, USA. E-mail: [email protected]
VOLUME 109 | OCTOBER 2014 www.amjgastro.com
