“Running late” and adenoma detection – is there an association?

Background: The efficacy of screening colonoscopy depends on adequate adenoma detection. Operating behind schedule (i. e. “running late”) might impose time pressure and affect adenoma detection. The aim of the study was to examine whether there is an association between procedural delay and adenoma detection rate (ADR).

Methods: We retrospectively identified individuals who underwent an elective outpatient colonoscopy at an academic medical center between October 2011 and March 2012.  We extracted information regarding procedure details, and patient and polyp characteristics. Procedure delay was defined as the time elapsed between the scheduled and actual procedure start times. We calculated the ADR for each 15-minute delay interval and for each quartile of procedure delay for individual endoscopists.

Results: In total 1505 patients (mean age 61.3, 49 % men) were examined by 11 endoscopists. At least one adenomatous polyp was found in 507 patients (34 %), with a mean of 0.63 adenomas per patient. Colonoscopies started at a median 18 minutes late (IQR 3 – 36) and median delay times varied broadly between endoscopists from 4 minutes to 45 minutes. ADR was not affected by procedure delay and was similar across 15-minute delay intervals (P = 0.101). The ADR also remained similar across quartiles of the endoscopists’ delay times (from lowest to highest delay quartile: 34 %, 32 %, 32 %, and 37 %; P = 0.397). Independent factors associated with increased adenoma detection included being a man, older age, surveillance colonoscopy, and the endoscopist.

Conclusion: In this large multiendoscopist study we did not find that procedure delay affected adenoma detection. Even when endoscopists are behind schedule, they still perform a meticulous examination with no impact on adenoma detection.

• References

• 1 van Rijn JC, Reitsma JB, Stoker J et al. Polyp miss rate determined by tandem colonoscopy: a systematic review. Am J Gastroenterol 2006; 101: 343-350
• 2 Pohl H, Robertson DJ. Colorectal cancers detected after colonoscopy frequently result from missed lesions. Clin Gastroenterol Hepatol 2010; 8: 858-864
• 3 Kahi CJ, Hewett DG, Norton DL et al. Prevalence and variable detection of proximal colon serrated polyps during screening colonoscopy. Clin Gastroenterol Hepatol 2011; 9: 42-46
• 4 Imperiale TF, Glowinski EA, Juliar BE et al. Variation in polyp detection rates at screening colonoscopy. Gastrointest Endosc 2009; 69: 1288-1295
• 5 Barclay RL, Vicari JJ, Doughty AS et al. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. NEJM 2006; 355: 2533-2541
• 6 Chen SC, Rex DK. Endoscopist can be more powerful than age and male gender in predicting adenoma detection at colonoscopy. Am J Gastroenterol 2007; 102: 856-861
• 7 Abeysekera A, Bergman IJ, Kluger MT et al. Drug error in anaesthetic practice: a review of 896 reports from the Australian Incident Monitoring Study database. Anaesthesia 2005; 60: 220-227
• 8 Moorthy K, Munz Y, Dosis A et al. The effect of stress-inducing conditions on the performance of a laparoscopic task. Surg Endosc 2003; 17: 1481-1484
• 9 Kaminski MF, Regula J, Kraszewska E et al. Quality indicators for colonoscopy and the risk of interval cancer. NEJM 2010; 362: 1795-1803
• 10 Aslanian HR, Shieh FK, Chan FW et al. Nurse observation during colonoscopy increases polyp detection: a randomized prospective study. Am J Gastroenterol 2013; 108: 166-172
• 11 Sanaka MR, Deepinder F, Thota PN et al. Adenomas are detected more often in morning than in afternoon colonoscopy. Am J Gastroenterol 2009; 104: 1659-1664 ; quiz 1665
• 12 Lee A, Iskander JM, Gupta N et al. Queue position in the endoscopic schedule impacts effectiveness of colonoscopy. Am J Gastroenterol 2011; 106: 1457-1465
• 13 Kaneshiro M, Ho A, Chan M et al. Colonoscopy yields fewer polyps as the day progresses despite using social influence theory to reverse the trend. Gastrointest Endosc 2010; 72: 1233-1240
• 14 Long MD, Martin C, Sandler RS et al. Reduced polyp detection as endoscopy shift progresses: experience with screening colonoscopy at a tertiary-care hospital. J Clin Gastroenterol 2011; 45: 253-258
• 15 Leffler DA, Kheraj R, Bhansali A et al. Adenoma detection rates vary minimally with time of day and case rank: a prospective study of 2139 first screening colonoscopies. Gastrointest Endosc 2012; 75: 554-560
• 16 Lurix E, Hernandez AV, Thoma M et al. Adenoma detection rate is not influenced by full-day blocks, time, or modified queue position. Gastrointest Endosc 2012; 75: 827-834
• 17 Freedman JS, Harari DY, Bamji ND et al. The detection of premalignant colon polyps during colonoscopy is stable throughout the workday. Gastrointest Endosc 2011; 73: 1197-206
• 18 Munson GW, Harewood GC, Francis DL. Time of day variation in polyp detection rate for colonoscopies performed on a 3-hour shift schedule. Gastrointest Endosc 2011; 73: 467-475
• 19 Gurudu SR, Ratuapli SK, Leighton JA et al. Adenoma detection rate is not influenced by the timing of colonoscopy when performed in half-day blocks. Am J Gastroenterol 2011; 106: 1466-1471
• 20 Chan MY, Cohen H, Spiegel BM. Fewer polyps detected by colonoscopy as the day progresses at a Veteran’s Administration teaching hospital. Clin Gastroenterol Hepatol 2009; 7: 1217-1223 ; quiz 1143
• 21 Peters SL, Hasan AG, Jacobson NB et al. Level of fellowship training increases adenoma detection rates. Clin Gastroenterol Hepatol 2010; 8: 439-442