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Published in: Digestive Diseases and Sciences 4/2018

01-04-2018 | Original Article

Adenoma Detection Rate Falls at the End of the Day in a Large Multi-site Sample

Authors: Felippe O. Marcondes, Rebecca A. Gourevitch, Robert E. Schoen, Seth D. Crockett, Michele Morris, Ateev Mehrotra

Published in: Digestive Diseases and Sciences | Issue 4/2018

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Abstract

Background

There is concern that mental and physical fatigue among endoscopists over the course of the day will lead to lower adenoma detection rate (ADR). There are mixed findings in the prior literature on whether such an association exists.

Aims

The aim of this study was to measure the association between the number of colonoscopies performed in a day and ADR and withdrawal time.

Methods

We analyzed 86,624 colonoscopy and associated pathology reports between October 2013 and September 2015 from 131 physicians at two medical centers. A previously validated natural language processing program was used to abstract relevant data. We identified the order of colonoscopies performed in the physicians’ schedule and calculated the ADR and withdrawal time for each colonoscopy position.

Results

The ADR for our overall sample was 29.9 (CI 29.6–30.2). The ADR for colonoscopies performed at the 9th + position was significantly lower than those at the 1st–4th or 5th–8th position, 27.2 (CI 25.8–28.6) versus 29.9 (CI 29.5–30.3), 30.2 (CI 29.6–30.9), respectively. Withdrawal time steadily decreased by colonoscopy position going from 11.6 (CI 11.4–11.9) min for the 1st colonoscopy to 9.6 (8.9–10.3) min for the 9th colonoscopy.

Conclusion

In our study population, ADR and withdrawal time decrease by roughly 7 and 20%, respectively, by the end of the day. Our results imply that rather than mental or physical fatigue, lower ADR at the end of the day might be driven by endoscopists rushing.
Literature
1.
2.
go back to reference Schoen RE, Pinsky PF, Weissfeld JL, et al. Colorectal-cancer incidence and mortality with screening flexible sigmoidoscopy. N Engl J Med. 2012;366:2345–2357.CrossRefPubMedPubMedCentral Schoen RE, Pinsky PF, Weissfeld JL, et al. Colorectal-cancer incidence and mortality with screening flexible sigmoidoscopy. N Engl J Med. 2012;366:2345–2357.CrossRefPubMedPubMedCentral
3.
go back to reference Nishihara R, Wu K, Lochhead P, et al. Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med. 2013;369:1095–1105.CrossRefPubMed Nishihara R, Wu K, Lochhead P, et al. Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med. 2013;369:1095–1105.CrossRefPubMed
6.
go back to reference Meester RGS, Doubeni CA, Zauber AG, van Ballegooijen M, Corley DA, Lansdorp-Vogelaar I. Impact of adenoma detection on the benefit of faecal testing versus colonoscopy for colorectal cancer. Int J Cancer. 2017;141:2359–2367.CrossRefPubMed Meester RGS, Doubeni CA, Zauber AG, van Ballegooijen M, Corley DA, Lansdorp-Vogelaar I. Impact of adenoma detection on the benefit of faecal testing versus colonoscopy for colorectal cancer. Int J Cancer. 2017;141:2359–2367.CrossRefPubMed
7.
go back to reference Sanaka MR, Deepinder F, Thota PN, Lopez R, Burke CA. Adenomas are detected more often in morning than in afternoon colonoscopy. Am J Gastroenterol. 2009;104:1659–1664; quiz 1665. Sanaka MR, Deepinder F, Thota PN, Lopez R, Burke CA. Adenomas are detected more often in morning than in afternoon colonoscopy. Am J Gastroenterol. 2009;104:1659–1664; quiz 1665.
8.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
9.
go back to reference Lee A, Jensen CD, Marks AR, et al. Endoscopist fatigue estimates and colonoscopic adenoma detection in a large community-based setting. Gastrointest Endosc. 2017;85(601–610):e602. Lee A, Jensen CD, Marks AR, et al. Endoscopist fatigue estimates and colonoscopic adenoma detection in a large community-based setting. Gastrointest Endosc. 2017;85(601–610):e602.
10.
go back to reference Freedman JS, Harari DY, Bamji ND, et al. The detection of premalignant colon polyps during colonoscopy is stable throughout the workday. Gastrointest Endosc. 2011;73:1197–1206.CrossRefPubMed Freedman JS, Harari DY, Bamji ND, et al. The detection of premalignant colon polyps during colonoscopy is stable throughout the workday. Gastrointest Endosc. 2011;73:1197–1206.CrossRefPubMed
11.
go back to reference 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. 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.
12.
go back to reference Almadi MA, Sewitch M, Barkun AN, Martel M, Joseph L. Adenoma detection rates decline with increasing procedural hours in an endoscopist’s workload. Can J Gastroenterol Hepatol. 2015;29:304–308.CrossRefPubMedPubMedCentral Almadi MA, Sewitch M, Barkun AN, Martel M, Joseph L. Adenoma detection rates decline with increasing procedural hours in an endoscopist’s workload. Can J Gastroenterol Hepatol. 2015;29:304–308.CrossRefPubMedPubMedCentral
13.
go back to reference Almario CV, Spiegel BMR. Does endoscopist fatigue impact adenoma detection rate? A review of the evidence to date. Gastrointest Endosc. 2017;85:611–613.CrossRefPubMed Almario CV, Spiegel BMR. Does endoscopist fatigue impact adenoma detection rate? A review of the evidence to date. Gastrointest Endosc. 2017;85:611–613.CrossRefPubMed
14.
go back to reference Lurix E, Hernandez AV, Thoma M, Castro F. Adenoma detection rate is not influenced by full-day blocks, time, or modified queue position. Gastrointest Endosc. 2012;75:827–834.CrossRefPubMed Lurix E, Hernandez AV, Thoma M, Castro F. Adenoma detection rate is not influenced by full-day blocks, time, or modified queue position. Gastrointest Endosc. 2012;75:827–834.CrossRefPubMed
16.
go back to reference Carrell DS, Schoen RE, Leffler DA, et al. Challenges in adapting existing clinical natural language processing systems to multiple, diverse healthcare settings. J Am Med Inform Assoc. 2017;24:986–991.CrossRefPubMed Carrell DS, Schoen RE, Leffler DA, et al. Challenges in adapting existing clinical natural language processing systems to multiple, diverse healthcare settings. J Am Med Inform Assoc. 2017;24:986–991.CrossRefPubMed
17.
go back to reference Mehrotra A, Dellon ES, Schoen RE, et al. Applying a natural language processing tool to electronic health records to assess performance on colonoscopy quality measures. Gastrointest Endosc. 2012;75:1233-1239; e1214. Mehrotra A, Dellon ES, Schoen RE, et al. Applying a natural language processing tool to electronic health records to assess performance on colonoscopy quality measures. Gastrointest Endosc. 2012;75:1233-1239; e1214.
18.
go back to reference Harkema H, Chapman WW, Saul M, Dellon ES, Schoen RE, Mehrotra A. Developing a natural language processing application for measuring the quality of colonoscopy procedures. J Am Med Inform Assoc.. 2011;18(Suppl 1):i150–i156.CrossRefPubMedPubMedCentral Harkema H, Chapman WW, Saul M, Dellon ES, Schoen RE, Mehrotra A. Developing a natural language processing application for measuring the quality of colonoscopy procedures. J Am Med Inform Assoc.. 2011;18(Suppl 1):i150–i156.CrossRefPubMedPubMedCentral
19.
go back to reference Mehrotra A, Morris M, Gourevitch RA, et al. Physician characteristics associated with higher adenoma detection rate. Gastrointest Endosc.. 2017;S0015-5107:32205–32208. Mehrotra A, Morris M, Gourevitch RA, et al. Physician characteristics associated with higher adenoma detection rate. Gastrointest Endosc.. 2017;S0015-5107:32205–32208.
20.
go back to reference Marcondes FO, Dean KM, Schoen RE, et al. The impact of exclusion criteria on a physician’s adenoma detection rate. Gastrointest Endosc.. 2015;82:668–675.CrossRefPubMedPubMedCentral Marcondes FO, Dean KM, Schoen RE, et al. The impact of exclusion criteria on a physician’s adenoma detection rate. Gastrointest Endosc.. 2015;82:668–675.CrossRefPubMedPubMedCentral
21.
go back to reference Long MD, Martin C, Sandler RS, Herfarth HH, Shaheen NJ, Dellon ES. Reduced polyp detection as endoscopy shift progresses: experience with screening colonoscopy at a tertiary-care hospital. J Clin Gastroenterol.. 2011;45:253–258.CrossRefPubMed Long MD, Martin C, Sandler RS, Herfarth HH, Shaheen NJ, Dellon ES. Reduced polyp detection as endoscopy shift progresses: experience with screening colonoscopy at a tertiary-care hospital. J Clin Gastroenterol.. 2011;45:253–258.CrossRefPubMed
22.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
Metadata
Title
Adenoma Detection Rate Falls at the End of the Day in a Large Multi-site Sample
Authors
Felippe O. Marcondes
Rebecca A. Gourevitch
Robert E. Schoen
Seth D. Crockett
Michele Morris
Ateev Mehrotra
Publication date
01-04-2018
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 4/2018
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-018-4947-1

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