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Canadian Journal of Gastroenterology and Hepatology
Volume 29 (2015), Issue 6, Pages 304-308
Original Article

Adenoma Detection Rates Decline with Increasing Procedural Hours in an Endoscopist’s Workload

Majid A Almadi,1,2 Maida Sewitch,3 Alan N Barkun,1,3 Myriam Martel,1 and Lawrence Joseph3

1Division of Gastroenterology, The McGill University Health Centre, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
2Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
3Division of Clinical Epidemiology, The McGill University Health Centre, Montreal General Hospital, McGill University, Montreal, Quebec, Canada

Received 2 February 2015; Accepted 27 February 2015

Copyright © 2015 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


BACKGROUND: Operator fatigue may negatively influence adenoma detection (AD) during screening colonoscopy.

OBJECTIVE: To better characterize factors affecting AD, including the number of hours worked, and the number and type of procedures performed before an index screening colonoscopy.

METHODS: A retrospective cohort study was conducted involving individuals undergoing a screening colonoscopy at a major tertiary care hospital in Montreal, Quebec. Individuals were identified using an endoscopic reporting database; AD was identified by an electronic chart review. A hierarchical logistic regression analysis was performed to determine the association between patient- and endoscopist-related variables and AD.

RESULTS: A total of 430 consecutive colonoscopies performed by 10 gastroenterologists and two surgeons were included. Patient mean (± SD) age was 63.4±10.9 years, 56.3% were males, 27.7% had undergone a previous colonoscopy and the cecal intubation rate was 95.7%. The overall AD rate was 25.7%. Age was associated with AD (OR 1.06 [95% CI 1.03 to 1.08]), while female sex (OR 0.44 [95% CI 0.25 to 0.75]), an indication for average-risk screening (OR 0.47 [95% CI 0.27 to 0.80]) and an increase in the number of hours during which endoscopies were performed before the index colonoscopy (OR 0.87 [95% CI 0.76 to 0.99]) were associated with lower AD rates. On exploratory univariable analysis, a threshold of 3 h of endoscopy time performed before the index colonoscopy was associated with decreased AD.

CONCLUSION: The number of hours devoted to endoscopies before the index colonoscopy was inversely associated with AD rate, with decreased performance possibly as early as within 3 h. This metric should be confirmed in future studies and considered when optimizing scheduling practices.