Fewer Polyps Detected by Colonoscopy as the Day Progresses at a Veteran's Administration Teaching Hospital

published online 23 July 2009.

Refers to article:

Exam 1: Timing of Myelosuppression During Thiopurine Therapy for Inflammatory Bowel Disease: Implications for Monitoring Recommendations , 27 September 2009
C. Mel Wilcox
Clinical Gastroenterology and Hepatology
November 2009 (Vol. 7, Issue 11, Pages 1141-1142)
Full-Text PDF (88 KB)

Background & Aims

One objective of colonoscopy is to identify and remove polyps—this process requires attention to detail and prolonged concentration. Providers are predisposed to cognitive errors because the procedure is often performed repetitively throughout the day. We measured the adjusted relationship between colonoscopy start time and polyp yield.

Methods

We performed a prospective study of 477 patients that received screening, surveillance, or diagnostic colonoscopies at a Veteran's Administration (VA) teaching hospital. The primary outcome measure was polyp yield. We collected data on colonoscopy start times, which were analyzed both as a dichotomous time period (“early-morning case” vs “later case”) and as a continuous variable (start time). We identified significant risk factors using univariate analysis and performed Poisson multivariable regression to measure the independent effect of colonoscopy start time on polyp yield. We evaluated evidence of decreasing polyp yield as the day progressed throughout pre-specified time intervals.

Results

In univariate analysis, early-morning cases yielded 27% more polyps per patient than later cases (95% confidence interval, 11%–45%; P < .001). The total numbers of, hyperplastic and adenomatous polyps found decreased hour-by-hour as the day progressed. Multivariable analysis demonstrated that early-morning cases yielded 20% more polyps per patient than later cases (95% confidence interval, 5%–38%; P = .007).

Conclusions

At a VA medical center, more polyps were detected in patients that received colonoscopies early in the morning compared with later in the day. Moreover, adenoma detection reduced as the day progressed. Providers might be most adept at detecting polyps at the beginning of the day; further validation in other practice settings is required.

Abbreviations used in this paper: VA, Veteran's Administration

‡ Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California

⁎ Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California

§ Department of Health Services, UCLA School of Public Health, Los Angeles, California

∥ CURE Digestive Diseases Research Center, Los Angeles, California

¶ UCLA/VA Center for Outcomes Research and Education, Los Angeles, California

Reprint requests Address requests for reprints to: Brennan M. R. Spiegel, MD, MSHS, 11301 Wilshire Boulevard, Building 115, Room 215, Los Angeles, California 90073. fax: (310) 268-4510

This article has an accompanying continuing medical education activity on page 1143. Learning Objectives—At the end of this activity the learner should appreciate the many factors associated with the identification of colorectal polyps and understand the potential reasons why fewer polpys may be identified later in the day.

Conflicts of interest The authors disclose no conflicts.

Funding Dr Spiegel is supported by a Veteran's Affairs Health Services Research and Development (HSR&D) Career Development Transition Award (RCD 03-179-2).

Disclaimer: The opinions and assertions contained herein are the sole views of the authors and are not to be construed as official or as reflecting the views of the Department of Veteran Affairs. Presented in the American Gastroenterology Association Research Plenary Session, Digestive Disease Week 2008, San Diego, California.

PII: S1542-3565(09)00669-7

doi:10.1016/j.cgh.2009.07.013

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