Limits...
Colonoscopy performance is stable during the course of an extended three-session working day.

Subramanian S, Psarelli EE, Collins P, Haslam N, O'Toole P, Lombard M, Sarkar S - Endosc Int Open (2015)

Bottom Line: The CIR was reduced in female patients and those with poor bowel preparation (P < 0.05).The ADR was significantly higher in patients older than 60 years and in men (P < 0.001).Queue position did not independently influence the CIR or ADR.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Royal Liverpool University Hospital, United Kingdom.

ABSTRACT

Background: Three-session days were introduced in our endoscopy unit to accommodate the increased demand resulting from the introduction of the National Health Service Bowel Cancer Screening Programme (BCSP). Cecal intubation rate (CIR) and adenoma detection rate (ADR) may decline with time during a standard working day, but data are lacking for an extended three-session day. We assessed colonoscopy performance in an extended three-session day.

Methods: Colonoscopies performed during the year 2011 were retrospectively analyzed. The CIR and ADR were analyzed according to the time of day when procedures were done: morning (AM), afternoon (PM), or evening (EVE). Because of an expected higher incidence of adenomas in the BCSP patients, ADR was analyzed according to indication (BCSP or non-BCSP).

Results: Of the 2574 colonoscopies, 1328 (51.7 %) were in male patients and 1239 (48.3 %) in female patients with a median age of 63 years (interquartile range [IQR], 51 - 70). Of the 2574 colonoscopies, 1091 (42.4 %) were performed in AM lists, 994 (38.6 %) in PM lists, and 489 (19 %) in EVE lists. Time of day did not affect the CIRs for the AM, PM, and EVE lists (90.5 %, 90.1 %, and 89.9 %, respectively; χ (2) [2, N = 2540] = 0.15, P = 0.927). The CIR was reduced in female patients and those with poor bowel preparation (P < 0.05). After exclusion of the BCSP patients, the ADR was lower in the EVE lists than in the AM and PM lists on univariate analysis, but on multivariate analysis, this difference was not significant (P > 0.05). The ADR was significantly higher in patients older than 60 years and in men (P < 0.001). Queue position did not independently influence the CIR or ADR.

Conclusions: Colonoscopy quality does not appear to depend on time of day or queue position in an extended three-session day.

No MeSH data available.


Related in: MedlinePlus

Adenoma detection rate by time of day with inclusion of all cases (n = 2574) and with exclusion of Bowel Cancer Screening Programme (BCSP) cases (n = 2117). b Adenoma detection rate by queue position with inclusion of all cases (n = 2574) and with exclusion of BCSP cases (n = 2117). AM, morning; PM, afternoon; EVE, evening.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4612239&req=5

FI181-3: Adenoma detection rate by time of day with inclusion of all cases (n = 2574) and with exclusion of Bowel Cancer Screening Programme (BCSP) cases (n = 2117). b Adenoma detection rate by queue position with inclusion of all cases (n = 2574) and with exclusion of BCSP cases (n = 2117). AM, morning; PM, afternoon; EVE, evening.

Mentions: Overall, adenomas were detected in 702 patients (27.6 %). After exclusion of the BCSP cases, adenomas were detected in 476 cases (22.5 %). A statistically significant relationship was found between the ADR and time of day (23.6 % AM, 25.7 % PM, and 15.4 % EVE; χ2 [2, N = 2117] = 18.827, P < 0.0001; Fig. 3 a), whereas queue position was not associated with the probability of adenoma detection (χ2 [3, N = 2095] = 1.80, P = 0.615; Fig. 3 b and Table 3 a). A multivariate logistic regression analysis was performed that included the following variables: age, sex, time of day, quality of bowel preparation, and intera ction of bowel preparation quality with time of day (Table 3 b). Time of day and quality of bowel preparation were collapsed into two categories in order to allow a direct interpretation of the interaction term. Age, gender, and quality of bowel preparation were significantly associated with adenoma detection. More specifically, the odds of adenoma presence for female patients was decreased by 41 % in comparison with the odds for male patients after adjustment for all other variables in the model (OR 0.59, 95 %CI 0.45 – 0.76, P < 0.001). The odds of adenoma presence in patients older than 60 years was 2.4 times greater than that in patients younger than 60 years after adjustment for all the other variables in the model (OR 2.43, 95 %CI 1.42 – 3.75, P = 0.001). The odds of adenoma detection were 2.3-fold greater with a satisfactory bowel preparation than with a poor preparation (OR 2.31, 95 %CI 1.31 – 3.44, P = 0.002). Interestingly, the probability of adenoma detection increased with improved quality of bowel preparation for the AM and PM sessions, but the probability of adenoma detection for the EVE session was not affected by the quality of bowel preparation.


Colonoscopy performance is stable during the course of an extended three-session working day.

Subramanian S, Psarelli EE, Collins P, Haslam N, O'Toole P, Lombard M, Sarkar S - Endosc Int Open (2015)

Adenoma detection rate by time of day with inclusion of all cases (n = 2574) and with exclusion of Bowel Cancer Screening Programme (BCSP) cases (n = 2117). b Adenoma detection rate by queue position with inclusion of all cases (n = 2574) and with exclusion of BCSP cases (n = 2117). AM, morning; PM, afternoon; EVE, evening.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4612239&req=5

FI181-3: Adenoma detection rate by time of day with inclusion of all cases (n = 2574) and with exclusion of Bowel Cancer Screening Programme (BCSP) cases (n = 2117). b Adenoma detection rate by queue position with inclusion of all cases (n = 2574) and with exclusion of BCSP cases (n = 2117). AM, morning; PM, afternoon; EVE, evening.
Mentions: Overall, adenomas were detected in 702 patients (27.6 %). After exclusion of the BCSP cases, adenomas were detected in 476 cases (22.5 %). A statistically significant relationship was found between the ADR and time of day (23.6 % AM, 25.7 % PM, and 15.4 % EVE; χ2 [2, N = 2117] = 18.827, P < 0.0001; Fig. 3 a), whereas queue position was not associated with the probability of adenoma detection (χ2 [3, N = 2095] = 1.80, P = 0.615; Fig. 3 b and Table 3 a). A multivariate logistic regression analysis was performed that included the following variables: age, sex, time of day, quality of bowel preparation, and intera ction of bowel preparation quality with time of day (Table 3 b). Time of day and quality of bowel preparation were collapsed into two categories in order to allow a direct interpretation of the interaction term. Age, gender, and quality of bowel preparation were significantly associated with adenoma detection. More specifically, the odds of adenoma presence for female patients was decreased by 41 % in comparison with the odds for male patients after adjustment for all other variables in the model (OR 0.59, 95 %CI 0.45 – 0.76, P < 0.001). The odds of adenoma presence in patients older than 60 years was 2.4 times greater than that in patients younger than 60 years after adjustment for all the other variables in the model (OR 2.43, 95 %CI 1.42 – 3.75, P = 0.001). The odds of adenoma detection were 2.3-fold greater with a satisfactory bowel preparation than with a poor preparation (OR 2.31, 95 %CI 1.31 – 3.44, P = 0.002). Interestingly, the probability of adenoma detection increased with improved quality of bowel preparation for the AM and PM sessions, but the probability of adenoma detection for the EVE session was not affected by the quality of bowel preparation.

Bottom Line: The CIR was reduced in female patients and those with poor bowel preparation (P < 0.05).The ADR was significantly higher in patients older than 60 years and in men (P < 0.001).Queue position did not independently influence the CIR or ADR.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Royal Liverpool University Hospital, United Kingdom.

ABSTRACT

Background: Three-session days were introduced in our endoscopy unit to accommodate the increased demand resulting from the introduction of the National Health Service Bowel Cancer Screening Programme (BCSP). Cecal intubation rate (CIR) and adenoma detection rate (ADR) may decline with time during a standard working day, but data are lacking for an extended three-session day. We assessed colonoscopy performance in an extended three-session day.

Methods: Colonoscopies performed during the year 2011 were retrospectively analyzed. The CIR and ADR were analyzed according to the time of day when procedures were done: morning (AM), afternoon (PM), or evening (EVE). Because of an expected higher incidence of adenomas in the BCSP patients, ADR was analyzed according to indication (BCSP or non-BCSP).

Results: Of the 2574 colonoscopies, 1328 (51.7 %) were in male patients and 1239 (48.3 %) in female patients with a median age of 63 years (interquartile range [IQR], 51 - 70). Of the 2574 colonoscopies, 1091 (42.4 %) were performed in AM lists, 994 (38.6 %) in PM lists, and 489 (19 %) in EVE lists. Time of day did not affect the CIRs for the AM, PM, and EVE lists (90.5 %, 90.1 %, and 89.9 %, respectively; χ (2) [2, N = 2540] = 0.15, P = 0.927). The CIR was reduced in female patients and those with poor bowel preparation (P < 0.05). After exclusion of the BCSP patients, the ADR was lower in the EVE lists than in the AM and PM lists on univariate analysis, but on multivariate analysis, this difference was not significant (P > 0.05). The ADR was significantly higher in patients older than 60 years and in men (P < 0.001). Queue position did not independently influence the CIR or ADR.

Conclusions: Colonoscopy quality does not appear to depend on time of day or queue position in an extended three-session day.

No MeSH data available.


Related in: MedlinePlus