Abstract
Background and aim Over the last decades, the length of time required for endoscopic procedures has
greatly expanded. The aim of the present decision analysis is to study the interactions
amongst various factors that have caused such delays and to compare the relative magnitude
of their influences.
Methods Performance of gastrointestinal endoscopy is influenced by the interaction of five
domains, that is, (1) patient discomfort and fear; (2) injury, disorder, and disruption;
(3) rituals to reduce fear, prevent disruption, and maintain order; (4) administrators
or various health providers carrying out a ritual; (5) information, knowledge, and
science, which influence fear, prevent disruption, and curtail unnecessary ritualistic
behavior. A Markov chain model is used to describe the interaction among the five
domains.
Results Overall, science exerts the strongest influence, followed by fear and ritual as distant
second and third most relevant influences, respectively. Disruption and administrator
exert only a minor influence on the system of mutual interactions.
Conclusions Studying patterns of ritualistic behavior during endoscopy and subjecting them to
means of scientific research could help eliminate redundancy, cutting unnecessary
rituals, and thus making gastrointestinal endoscopy overall more efficient.
