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Carol A. Burke - One of the best experts on this subject based on the ideXlab platform.
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Association of Adenoma and Proximal Sessile Serrated Polyp Detection Rates With Endoscopist Characteristics
JAMA surgery, 2019Co-Authors: Shashank Sarvepalli, Ari Garber, Michael B. Rothberg, Gautam Mankaney, John Mcmichael, Gareth Morris-stiff, John J. Vargo, Maged Rizk, Carol A. BurkeAbstract:Importance Research demonstrates adenoma detection rate (ADR) and proximal sessile serrated polyp detection rate (pSSPDR) are associated with Endoscopist characteristics including sex, specialty, and years in practice. However, many studies have not adjusted for other risk factors associated with colonic neoplasia. Objective To assess the association between Endoscopist characteristics and polyp detection after adjusting the factors included in previous studies as well as other factors. Design, Setting, and Participants This cohort study was conducted in the Cleveland Clinic health system with data from individuals undergoing screening colonoscopies between January 2015 and June 2017. The study analyzed data using methods from previous studies that have demonstrated significant associations between Endoscopist characteristics and ADR or pSSPDR. Multilevel mixed-effects logistic regression was performed to examine 7 Endoscopist characteristics associated with ADRs and pSSPDRs after controlling for patient demographic, clinical, and colonoscopy-associated factors. Exposures Seven characteristics of Endoscopists performing colonoscopy. Main Outcomes and Measures The ADR and pSSPDR, with a hypothesis created after data collection began. Results A total of 16 089 colonoscopies were performed in 16 089 patients by 56 clinicians. Of these, 8339 patients were male (51.8%), and the median (range) age of the cohort was 59 (52-66) years. Analyzing the data by the methods used in 4 previous studies yielded an association between Endoscopist and polyp detection; surgeons (OR, 0.49 [95% CI, 0.28-0.83]) and nongastroenterologists (OR, 0.50 [95% CI 0.29-0.85]) had reduced odds of pSSPDR, which was similar to results in previous studies. In a multilevel mixed-effects logistic regression analysis, ADR was not significantly associated with any Endoscopist characteristic, and pSSPDR was only associated with years in practice (odds ratio, 0.86 [95% CI, 0.83-0.89] per increment of 10 years;P Conclusions and Relevance The differences in ADRs that were associated with 7 of 7 Endoscopist characteristics and differences in pSSPDRs that were associated with 5 of 7 Endoscopist characteristics in previous studies may have been associated with residual confounding, because they were not replicated in this analysis. Therefore, these characteristics should not influence the choice of Endoscopist for colorectal cancer screening. However, clinicians further from their training and those with lower colonoscopy volumes have lower adjusted pSSPDRs and may need additional training to help increase pSSPDRs.
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association of adenoma and proximal sessile serrated polyp detection rates with Endoscopist characteristics
JAMA Surgery, 2019Co-Authors: Shashank Sarvepalli, Ari Garber, Michael B. Rothberg, Gautam Mankaney, John Mcmichael, John J. Vargo, Maged Rizk, Gareth Morrisstiff, Carol A. BurkeAbstract:Importance: Research demonstrates adenoma detection rate (ADR) and proximal sessile serrated polyp detection rate (pSSPDR) are associated with Endoscopist characteristics including sex, specialty, and years in practice. However, many studies have not adjusted for other risk factors associated with colonic neoplasia. Objective: To assess the association between Endoscopist characteristics and polyp detection after adjusting the factors included in previous studies as well as other factors. Design, Setting, and Participants: This cohort study was conducted in the Cleveland Clinic health system with data from individuals undergoing screening colonoscopies between January 2015 and June 2017. The study analyzed data using methods from previous studies that have demonstrated significant associations between Endoscopist characteristics and ADR or pSSPDR. Multilevel mixed-effects logistic regression was performed to examine 7 Endoscopist characteristics associated with ADRs and pSSPDRs after controlling for patient demographic, clinical, and colonoscopy-associated factors. Exposures: Seven characteristics of Endoscopists performing colonoscopy. Main Outcomes and Measures: The ADR and pSSPDR, with a hypothesis created after data collection began. Results: A total of 16 089 colonoscopies were performed in 16 089 patients by 56 clinicians. Of these, 8339 patients were male (51.8%), and the median (range) age of the cohort was 59 (52-66) years. Analyzing the data by the methods used in 4 previous studies yielded an association between Endoscopist and polyp detection; surgeons (OR, 0.49 [95% CI, 0.28-0.83]) and nongastroenterologists (OR, 0.50 [95% CI 0.29-0.85]) had reduced odds of pSSPDR, which was similar to results in previous studies. In a multilevel mixed-effects logistic regression analysis, ADR was not significantly associated with any Endoscopist characteristic, and pSSPDR was only associated with years in practice (odds ratio, 0.86 [95% CI, 0.83-0.89] per increment of 10 years; P < .001) and number of annual colonoscopies performed (odds ratio, 1.05 [95% CI, 1.01-1.09] per 50 colonoscopies/year; P = .02). Conclusions and Relevance: The differences in ADRs that were associated with 7 of 7 Endoscopist characteristics and differences in pSSPDRs that were associated with 5 of 7 Endoscopist characteristics in previous studies may have been associated with residual confounding, because they were not replicated in this analysis. Therefore, these characteristics should not influence the choice of Endoscopist for colorectal cancer screening. However, clinicians further from their training and those with lower colonoscopy volumes have lower adjusted pSSPDRs and may need additional training to help increase pSSPDRs.
Evelien Dekker - One of the best experts on this subject based on the ideXlab platform.
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differences in proximal serrated polyp detection among Endoscopists are associated with variability in withdrawal time
Gastrointestinal Endoscopy, 2013Co-Authors: Thomas R De Wijkerslooth, Ernst J. Kuipers, Esther M Stoop, Patrick M Bossuyt, Kristien M A J Tytgat, Jan Dees, Elisabeth M H Mathusvliegen, Paul Fockens, Monique E Van Leerdam, Evelien DekkerAbstract:Background Insufficient detection of proximal serrated polyps (PSP) might explain the occurrence of a proportion of interval carcinomas in colonoscopy surveillance programs. Objective To compare PSP detection among Endoscopists and to identify patient-related and Endoscopist-related factors associated with PSP detection. Design Prospective study in unselected patients. Setting Colonoscopy screening program for colorectal cancer at two academic medical centers. Patients Asymptomatic consecutive screening participants (aged 50-75 years). Intervention Colonoscopies were performed by 5 experienced Endoscopists. All detected polyps were removed. Multiple colonoscopy quality indicators were prospectively recorded. Main Outcome Measurements We compared PSP detection among Endoscopists by calculating odds ratios (OR) with logistic regression analysis. Logistic regression also was used to identify patient features and colonoscopy factors associated with PSP detection. Results A total of 1354 patients underwent a complete screening colonoscopy: 1635 polyps were detected, of which 707 (43%) were adenomas and 685 (42%) were serrated polyps, including 215 PSPs. In 167 patients (12%) 1 or more PSPs were detected. The PSP detection rate differed significantly among Endoscopists, ranging from 6% to 22% ( P Limitations Limited number of highly experienced Endoscopists. Conclusion The PSP detection rate differs among Endoscopists. Longer withdrawal times are associated with better PSP detection, but patient features are not. (Clinical trial registration number: NTR1888.)
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Discrepancies Between Endoscopists' and Patients' View on the Adequacy of Sedation During Colonoscopy
Gastroenterology, 2011Co-Authors: Maaike Denters, Paul Fockens, Marthe Schreuder, Annekatrien C.t.m. Depla, Rosalie C. Mallant-hent, Mariëtte C.a. Van Kouwen, Marije Deutekom, Patrick M.m. Bossuyt, Evelien DekkerAbstract:Background and aims: Colonoscopy is generally perceived as invasive and burdensome. Patients frequently express dissatisfaction with the level of sedation. We aimed to compare Endoscopists' and patients' views on adequacy of sedation during colonoscopy. Methods: Data were collected in the IMPROVE-study, a multicenter clinical trial assessing patients' experience during colonoscopy. A total of 1,157 consecutive patients scheduled for colonoscopy in 2 academic and 2 non-academic centers were asked to complete a questionnaire directly after the procedure. Depth of sedation and memory about the procedure were also assessed. Procedural data were collected by a questionnaire offered to the Endoscopist. Adequacy of sedation could be scored on a 3-point scale (too little adequate too much). Results: Data on adequacy of sedation from both Endoscopists and patients were available for 677 persons (40% male, median age 54, range 17 to 94). Midazolam was given in 664 (98%) procedures (mean dose 4.86mg), fentanyl or alfentanil in 470 (69%) (mean dose 0.06mg for fentanyl and 0.54mg for alfentanil)). In 468 (69%) colonoscopies both midazolam and fentanyl were administered. Depth of sedation was scored as “awake and responding to all instructions” or “responding to the majority of instructions (>50%)” in 547 procedures (81%). In 18 (3%) procedures sedation depth was scored as “responding to hardly any instruction (
Shashank Sarvepalli - One of the best experts on this subject based on the ideXlab platform.
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Association of Adenoma and Proximal Sessile Serrated Polyp Detection Rates With Endoscopist Characteristics
JAMA surgery, 2019Co-Authors: Shashank Sarvepalli, Ari Garber, Michael B. Rothberg, Gautam Mankaney, John Mcmichael, Gareth Morris-stiff, John J. Vargo, Maged Rizk, Carol A. BurkeAbstract:Importance Research demonstrates adenoma detection rate (ADR) and proximal sessile serrated polyp detection rate (pSSPDR) are associated with Endoscopist characteristics including sex, specialty, and years in practice. However, many studies have not adjusted for other risk factors associated with colonic neoplasia. Objective To assess the association between Endoscopist characteristics and polyp detection after adjusting the factors included in previous studies as well as other factors. Design, Setting, and Participants This cohort study was conducted in the Cleveland Clinic health system with data from individuals undergoing screening colonoscopies between January 2015 and June 2017. The study analyzed data using methods from previous studies that have demonstrated significant associations between Endoscopist characteristics and ADR or pSSPDR. Multilevel mixed-effects logistic regression was performed to examine 7 Endoscopist characteristics associated with ADRs and pSSPDRs after controlling for patient demographic, clinical, and colonoscopy-associated factors. Exposures Seven characteristics of Endoscopists performing colonoscopy. Main Outcomes and Measures The ADR and pSSPDR, with a hypothesis created after data collection began. Results A total of 16 089 colonoscopies were performed in 16 089 patients by 56 clinicians. Of these, 8339 patients were male (51.8%), and the median (range) age of the cohort was 59 (52-66) years. Analyzing the data by the methods used in 4 previous studies yielded an association between Endoscopist and polyp detection; surgeons (OR, 0.49 [95% CI, 0.28-0.83]) and nongastroenterologists (OR, 0.50 [95% CI 0.29-0.85]) had reduced odds of pSSPDR, which was similar to results in previous studies. In a multilevel mixed-effects logistic regression analysis, ADR was not significantly associated with any Endoscopist characteristic, and pSSPDR was only associated with years in practice (odds ratio, 0.86 [95% CI, 0.83-0.89] per increment of 10 years;P Conclusions and Relevance The differences in ADRs that were associated with 7 of 7 Endoscopist characteristics and differences in pSSPDRs that were associated with 5 of 7 Endoscopist characteristics in previous studies may have been associated with residual confounding, because they were not replicated in this analysis. Therefore, these characteristics should not influence the choice of Endoscopist for colorectal cancer screening. However, clinicians further from their training and those with lower colonoscopy volumes have lower adjusted pSSPDRs and may need additional training to help increase pSSPDRs.
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association of adenoma and proximal sessile serrated polyp detection rates with Endoscopist characteristics
JAMA Surgery, 2019Co-Authors: Shashank Sarvepalli, Ari Garber, Michael B. Rothberg, Gautam Mankaney, John Mcmichael, John J. Vargo, Maged Rizk, Gareth Morrisstiff, Carol A. BurkeAbstract:Importance: Research demonstrates adenoma detection rate (ADR) and proximal sessile serrated polyp detection rate (pSSPDR) are associated with Endoscopist characteristics including sex, specialty, and years in practice. However, many studies have not adjusted for other risk factors associated with colonic neoplasia. Objective: To assess the association between Endoscopist characteristics and polyp detection after adjusting the factors included in previous studies as well as other factors. Design, Setting, and Participants: This cohort study was conducted in the Cleveland Clinic health system with data from individuals undergoing screening colonoscopies between January 2015 and June 2017. The study analyzed data using methods from previous studies that have demonstrated significant associations between Endoscopist characteristics and ADR or pSSPDR. Multilevel mixed-effects logistic regression was performed to examine 7 Endoscopist characteristics associated with ADRs and pSSPDRs after controlling for patient demographic, clinical, and colonoscopy-associated factors. Exposures: Seven characteristics of Endoscopists performing colonoscopy. Main Outcomes and Measures: The ADR and pSSPDR, with a hypothesis created after data collection began. Results: A total of 16 089 colonoscopies were performed in 16 089 patients by 56 clinicians. Of these, 8339 patients were male (51.8%), and the median (range) age of the cohort was 59 (52-66) years. Analyzing the data by the methods used in 4 previous studies yielded an association between Endoscopist and polyp detection; surgeons (OR, 0.49 [95% CI, 0.28-0.83]) and nongastroenterologists (OR, 0.50 [95% CI 0.29-0.85]) had reduced odds of pSSPDR, which was similar to results in previous studies. In a multilevel mixed-effects logistic regression analysis, ADR was not significantly associated with any Endoscopist characteristic, and pSSPDR was only associated with years in practice (odds ratio, 0.86 [95% CI, 0.83-0.89] per increment of 10 years; P < .001) and number of annual colonoscopies performed (odds ratio, 1.05 [95% CI, 1.01-1.09] per 50 colonoscopies/year; P = .02). Conclusions and Relevance: The differences in ADRs that were associated with 7 of 7 Endoscopist characteristics and differences in pSSPDRs that were associated with 5 of 7 Endoscopist characteristics in previous studies may have been associated with residual confounding, because they were not replicated in this analysis. Therefore, these characteristics should not influence the choice of Endoscopist for colorectal cancer screening. However, clinicians further from their training and those with lower colonoscopy volumes have lower adjusted pSSPDRs and may need additional training to help increase pSSPDRs.
Maged Rizk - One of the best experts on this subject based on the ideXlab platform.
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Association of Adenoma and Proximal Sessile Serrated Polyp Detection Rates With Endoscopist Characteristics
JAMA surgery, 2019Co-Authors: Shashank Sarvepalli, Ari Garber, Michael B. Rothberg, Gautam Mankaney, John Mcmichael, Gareth Morris-stiff, John J. Vargo, Maged Rizk, Carol A. BurkeAbstract:Importance Research demonstrates adenoma detection rate (ADR) and proximal sessile serrated polyp detection rate (pSSPDR) are associated with Endoscopist characteristics including sex, specialty, and years in practice. However, many studies have not adjusted for other risk factors associated with colonic neoplasia. Objective To assess the association between Endoscopist characteristics and polyp detection after adjusting the factors included in previous studies as well as other factors. Design, Setting, and Participants This cohort study was conducted in the Cleveland Clinic health system with data from individuals undergoing screening colonoscopies between January 2015 and June 2017. The study analyzed data using methods from previous studies that have demonstrated significant associations between Endoscopist characteristics and ADR or pSSPDR. Multilevel mixed-effects logistic regression was performed to examine 7 Endoscopist characteristics associated with ADRs and pSSPDRs after controlling for patient demographic, clinical, and colonoscopy-associated factors. Exposures Seven characteristics of Endoscopists performing colonoscopy. Main Outcomes and Measures The ADR and pSSPDR, with a hypothesis created after data collection began. Results A total of 16 089 colonoscopies were performed in 16 089 patients by 56 clinicians. Of these, 8339 patients were male (51.8%), and the median (range) age of the cohort was 59 (52-66) years. Analyzing the data by the methods used in 4 previous studies yielded an association between Endoscopist and polyp detection; surgeons (OR, 0.49 [95% CI, 0.28-0.83]) and nongastroenterologists (OR, 0.50 [95% CI 0.29-0.85]) had reduced odds of pSSPDR, which was similar to results in previous studies. In a multilevel mixed-effects logistic regression analysis, ADR was not significantly associated with any Endoscopist characteristic, and pSSPDR was only associated with years in practice (odds ratio, 0.86 [95% CI, 0.83-0.89] per increment of 10 years;P Conclusions and Relevance The differences in ADRs that were associated with 7 of 7 Endoscopist characteristics and differences in pSSPDRs that were associated with 5 of 7 Endoscopist characteristics in previous studies may have been associated with residual confounding, because they were not replicated in this analysis. Therefore, these characteristics should not influence the choice of Endoscopist for colorectal cancer screening. However, clinicians further from their training and those with lower colonoscopy volumes have lower adjusted pSSPDRs and may need additional training to help increase pSSPDRs.
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association of adenoma and proximal sessile serrated polyp detection rates with Endoscopist characteristics
JAMA Surgery, 2019Co-Authors: Shashank Sarvepalli, Ari Garber, Michael B. Rothberg, Gautam Mankaney, John Mcmichael, John J. Vargo, Maged Rizk, Gareth Morrisstiff, Carol A. BurkeAbstract:Importance: Research demonstrates adenoma detection rate (ADR) and proximal sessile serrated polyp detection rate (pSSPDR) are associated with Endoscopist characteristics including sex, specialty, and years in practice. However, many studies have not adjusted for other risk factors associated with colonic neoplasia. Objective: To assess the association between Endoscopist characteristics and polyp detection after adjusting the factors included in previous studies as well as other factors. Design, Setting, and Participants: This cohort study was conducted in the Cleveland Clinic health system with data from individuals undergoing screening colonoscopies between January 2015 and June 2017. The study analyzed data using methods from previous studies that have demonstrated significant associations between Endoscopist characteristics and ADR or pSSPDR. Multilevel mixed-effects logistic regression was performed to examine 7 Endoscopist characteristics associated with ADRs and pSSPDRs after controlling for patient demographic, clinical, and colonoscopy-associated factors. Exposures: Seven characteristics of Endoscopists performing colonoscopy. Main Outcomes and Measures: The ADR and pSSPDR, with a hypothesis created after data collection began. Results: A total of 16 089 colonoscopies were performed in 16 089 patients by 56 clinicians. Of these, 8339 patients were male (51.8%), and the median (range) age of the cohort was 59 (52-66) years. Analyzing the data by the methods used in 4 previous studies yielded an association between Endoscopist and polyp detection; surgeons (OR, 0.49 [95% CI, 0.28-0.83]) and nongastroenterologists (OR, 0.50 [95% CI 0.29-0.85]) had reduced odds of pSSPDR, which was similar to results in previous studies. In a multilevel mixed-effects logistic regression analysis, ADR was not significantly associated with any Endoscopist characteristic, and pSSPDR was only associated with years in practice (odds ratio, 0.86 [95% CI, 0.83-0.89] per increment of 10 years; P < .001) and number of annual colonoscopies performed (odds ratio, 1.05 [95% CI, 1.01-1.09] per 50 colonoscopies/year; P = .02). Conclusions and Relevance: The differences in ADRs that were associated with 7 of 7 Endoscopist characteristics and differences in pSSPDRs that were associated with 5 of 7 Endoscopist characteristics in previous studies may have been associated with residual confounding, because they were not replicated in this analysis. Therefore, these characteristics should not influence the choice of Endoscopist for colorectal cancer screening. However, clinicians further from their training and those with lower colonoscopy volumes have lower adjusted pSSPDRs and may need additional training to help increase pSSPDRs.
John J. Vargo - One of the best experts on this subject based on the ideXlab platform.
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Association of Adenoma and Proximal Sessile Serrated Polyp Detection Rates With Endoscopist Characteristics
JAMA surgery, 2019Co-Authors: Shashank Sarvepalli, Ari Garber, Michael B. Rothberg, Gautam Mankaney, John Mcmichael, Gareth Morris-stiff, John J. Vargo, Maged Rizk, Carol A. BurkeAbstract:Importance Research demonstrates adenoma detection rate (ADR) and proximal sessile serrated polyp detection rate (pSSPDR) are associated with Endoscopist characteristics including sex, specialty, and years in practice. However, many studies have not adjusted for other risk factors associated with colonic neoplasia. Objective To assess the association between Endoscopist characteristics and polyp detection after adjusting the factors included in previous studies as well as other factors. Design, Setting, and Participants This cohort study was conducted in the Cleveland Clinic health system with data from individuals undergoing screening colonoscopies between January 2015 and June 2017. The study analyzed data using methods from previous studies that have demonstrated significant associations between Endoscopist characteristics and ADR or pSSPDR. Multilevel mixed-effects logistic regression was performed to examine 7 Endoscopist characteristics associated with ADRs and pSSPDRs after controlling for patient demographic, clinical, and colonoscopy-associated factors. Exposures Seven characteristics of Endoscopists performing colonoscopy. Main Outcomes and Measures The ADR and pSSPDR, with a hypothesis created after data collection began. Results A total of 16 089 colonoscopies were performed in 16 089 patients by 56 clinicians. Of these, 8339 patients were male (51.8%), and the median (range) age of the cohort was 59 (52-66) years. Analyzing the data by the methods used in 4 previous studies yielded an association between Endoscopist and polyp detection; surgeons (OR, 0.49 [95% CI, 0.28-0.83]) and nongastroenterologists (OR, 0.50 [95% CI 0.29-0.85]) had reduced odds of pSSPDR, which was similar to results in previous studies. In a multilevel mixed-effects logistic regression analysis, ADR was not significantly associated with any Endoscopist characteristic, and pSSPDR was only associated with years in practice (odds ratio, 0.86 [95% CI, 0.83-0.89] per increment of 10 years;P Conclusions and Relevance The differences in ADRs that were associated with 7 of 7 Endoscopist characteristics and differences in pSSPDRs that were associated with 5 of 7 Endoscopist characteristics in previous studies may have been associated with residual confounding, because they were not replicated in this analysis. Therefore, these characteristics should not influence the choice of Endoscopist for colorectal cancer screening. However, clinicians further from their training and those with lower colonoscopy volumes have lower adjusted pSSPDRs and may need additional training to help increase pSSPDRs.
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association of adenoma and proximal sessile serrated polyp detection rates with Endoscopist characteristics
JAMA Surgery, 2019Co-Authors: Shashank Sarvepalli, Ari Garber, Michael B. Rothberg, Gautam Mankaney, John Mcmichael, John J. Vargo, Maged Rizk, Gareth Morrisstiff, Carol A. BurkeAbstract:Importance: Research demonstrates adenoma detection rate (ADR) and proximal sessile serrated polyp detection rate (pSSPDR) are associated with Endoscopist characteristics including sex, specialty, and years in practice. However, many studies have not adjusted for other risk factors associated with colonic neoplasia. Objective: To assess the association between Endoscopist characteristics and polyp detection after adjusting the factors included in previous studies as well as other factors. Design, Setting, and Participants: This cohort study was conducted in the Cleveland Clinic health system with data from individuals undergoing screening colonoscopies between January 2015 and June 2017. The study analyzed data using methods from previous studies that have demonstrated significant associations between Endoscopist characteristics and ADR or pSSPDR. Multilevel mixed-effects logistic regression was performed to examine 7 Endoscopist characteristics associated with ADRs and pSSPDRs after controlling for patient demographic, clinical, and colonoscopy-associated factors. Exposures: Seven characteristics of Endoscopists performing colonoscopy. Main Outcomes and Measures: The ADR and pSSPDR, with a hypothesis created after data collection began. Results: A total of 16 089 colonoscopies were performed in 16 089 patients by 56 clinicians. Of these, 8339 patients were male (51.8%), and the median (range) age of the cohort was 59 (52-66) years. Analyzing the data by the methods used in 4 previous studies yielded an association between Endoscopist and polyp detection; surgeons (OR, 0.49 [95% CI, 0.28-0.83]) and nongastroenterologists (OR, 0.50 [95% CI 0.29-0.85]) had reduced odds of pSSPDR, which was similar to results in previous studies. In a multilevel mixed-effects logistic regression analysis, ADR was not significantly associated with any Endoscopist characteristic, and pSSPDR was only associated with years in practice (odds ratio, 0.86 [95% CI, 0.83-0.89] per increment of 10 years; P < .001) and number of annual colonoscopies performed (odds ratio, 1.05 [95% CI, 1.01-1.09] per 50 colonoscopies/year; P = .02). Conclusions and Relevance: The differences in ADRs that were associated with 7 of 7 Endoscopist characteristics and differences in pSSPDRs that were associated with 5 of 7 Endoscopist characteristics in previous studies may have been associated with residual confounding, because they were not replicated in this analysis. Therefore, these characteristics should not influence the choice of Endoscopist for colorectal cancer screening. However, clinicians further from their training and those with lower colonoscopy volumes have lower adjusted pSSPDRs and may need additional training to help increase pSSPDRs.