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Delayed Start Times Associated With Reduced Adenoma Detection

Douglas K. Rex, MD, MASGE, reviewing Laszkowska M, et al. Digest Liver Dis 2020 Jul 2.

Previous studies have shown that the adenoma detection rate (ADR) is sometimes lower in colonoscopies performed in the afternoon versus the morning, though the results have been mixed. Further, significant results in individual studies can usually be attributed to a subset of the endoscopists. These results suggest that for some physicians, fatigue or rushing toward the end of the day influenced performance. There are few data on the association of delayed start times with detection, which would seem to investigate the rushing component. 

In a study of 7905 screening colonoscopies, there were 5390 morning and 2515 afternoon cases. A total of 2503 (32%) cases were delayed by at least 1 hour. Overall, the ADR was 25% for both morning and afternoon cases. The ADR in cases delayed less than 1 hour was 26% versus 23% with cases delayed more than 1 hour (P=.028). Delayed starts were associated with shorter withdrawal times in morning but not afternoon cases. Compared to cases with a delay of less than 1 hour, ADR was reduced by 12% in those with a delay of 1 to 2 hours and 19% with those delayed more than 2 hours.

Douglas K. Rex, MD, FASGE

COMMENT

These results suggest that rushing or distraction in colonoscopies with delayed starts or, perhaps, simply ignoring small lesions when starts are substantially delayed, can affect colonoscopy detection.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Laszkowska M, Mahadev S, Hur C, Green PHR, Lebwohl B. Delays in colonoscopy start time are associated with reductions in adenoma detection rates. Digest Liver Dis 2020 Jul 2. (Epub ahead of print) (https://doi.org/10.1016/j.dld.2020.06.011)

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