Adenoma detection rate is not influenced by full-day blocks, time, or modified queue position

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• 作者：Einar Lurix ; MD¹ ; Adrian V. Hernandez ; MD ; PhD² ; ³ ; Matthew Thoma ; MD⁴ ; Fernando Castro ; MD¹ ;
• 关键词：ADR ; adenoma detection rate ; BMI ; body mass index ; MAC ; monitored anesthesia care
• 刊名：Gastrointestinal Endoscopy
• 出版年：2012
• 出版时间：April, 2012
• 年：2012
• 卷：75
• 期：4
• 页码：827-834
• 全文大小：661 K

文摘

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Background

Recent studies have shown the adenoma detection rate (ADR) to decrease from endoscopist fatigue.

Objective

Our primary objective was to evaluate the afternoon ADR in half-day versus full-day blocks. Secondary objectives were to determine whether time or complexity of prior procedures (modified queue position) influence ADR.

Design

Retrospective chart review on consecutive colonoscopies.

Setting

Tertiary-care teaching hospital.

Patients

This study involved all patients in our database who were over age 45 and who underwent screening and surveillance colonoscopies.

Main Outcome Measurement

ADR.

Results

A total of 3085 patients were included in the study, with an overall 31 % ADR. Of these procedures, 2148 (70 % ) were done in the morning, and 937 (30 % ) were done in the afternoon (512 full-day block, 425 half-day block). By multivariate analysis, there was no difference in ADR between full-day blocks compared with afternoon-only blocks (35 % vs 32 % ; odds ratio [OR] 1.1; 95 % confidence interval [CI], 0.8-1.5; P = .2). For all afternoon colonoscopies, no decrease in ADR was noted with increasing queue position (P = .9) or time (P = .3). In addition, no difference was found comparing ADR between all afternoon colonoscopies versus morning colonoscopies (33 % vs 30 % ; OR 1.1; CI, 1.0-1.3; P = .1). No difference was found for advanced adenomas and number of adenomas between either afternoon-only blocks versus afternoon colonoscopy in full-day blocks or morning versus all afternoon cases.

Limitations

Retrospective study; not all withdrawal times were recorded; trainees performed some of the procedures.

Conclusion

Our data show that colonoscopy can be performed in full-day blocks and 30-minute slots without compromising ADR.