Gastrointestinal Endoscopy
Volume 73, Issue 6 , Pages 1197-1206, June 2011

The detection of premalignant colon polyps during colonoscopy is stable throughout the workday

  • Joseph S. Freedman, BS

      Affiliations

    • Department of Medicine, Division of Gastroenterology, Mount Sinai Medical Center, New York, New York, USA
    • ,
  • David Y. Harari, BS

      Affiliations

    • Department of Medicine, Division of Gastroenterology, Mount Sinai Medical Center, New York, New York, USA
    • ,
  • Neville D. Bamji, MD

      Affiliations

    • Department of Medicine, Division of Gastroenterology, Mount Sinai Medical Center, New York, New York, USA
    • ,
  • Carol A. Bodian, PhD

      Affiliations

    • Department of Anesthesiology, Division of Biostatistics, Mount Sinai Medical Center, New York, New York, USA
    • ,
  • Susan Kornacki, MD

      Affiliations

    • Department of Pathology, New York University School of Medicine, New York, New York, USA
    • ,
  • Lawrence B. Cohen, MD

      Affiliations

    • Department of Medicine, Division of Gastroenterology, Mount Sinai Medical Center, New York, New York, USA
    • ,
  • Kenneth M. Miller, MD

      Affiliations

    • Department of Medicine, Division of Gastroenterology, Mount Sinai Medical Center, New York, New York, USA
    • ,
  • James Aisenberg, MD

      Affiliations

    • Department of Medicine, Division of Gastroenterology, Mount Sinai Medical Center, New York, New York, USA
    • Corresponding Author InformationReprint requests: Dr James Aisenberg, Mount Sinai Medical Center, Department of Medicine, 311 East 79th Street, New York, NY 10075

Received 4 August 2010; accepted 10 January 2011. published online 14 March 2011.

Background

Recent studies have shown that colonoscopic polyp detection decreases as the workday progresses. This may reflect time-dependent factors such as colonoscopist fatigue and decreased colon cleanliness, which can be addressed through adaptations in colonoscopy practice.

Objective

To test for time-of-day differences in adenomatous polyp (AP) and sessile serrated polyp (SSP) detection in a practice that uses split-dose bowel preparation and moderated daily colonoscopist procedure loads.

Design

Retrospective chart review.

Setting

Community-based, group gastroenterology practice.

Patients

This study involved 2439 patients undergoing surveillance or screening colonoscopy.

Intervention

Colonoscopy.

Main Outcome Measurements

Detection rate of all premalignant polyps (PMPs), and of APs and SSPs, individually.

Results

A total of 1183 PMPs were identified in 1486 eligible patients (mean PMP/colonoscopy = 0.80; PMP detection rate = 47%). In univariate and multivariate analyses, PMP detection as well as detection of APs or SSPs individually did not vary significantly in relation to the hour of the day. In a binary comparison of morning (am) versus afternoon (pm) procedures, the total polyp detection rate was 67% and 66%, respectively. For PMPs, APs, SSPs, and hyperplastic polyps (HPs), the am and pm detection rates were 46% and 47%, 41% and 44%, 8% and 8%, and 27% and 24%, respectively. Bowel preparation quality was independent of time of day and was rated excellent or good in 86% to 87% of cases.

Limitations

Retrospective, nonrandomized study.

Conclusion

Stable PMP, AP, SSP, and HP detection rates throughout the workday occur under certain practice conditions, including the use of split-dose bowel preparation and/or moderated daily colonoscopist procedure loads.

Abbreviations: AP, adenomatous polyp, HP, hyperplastic polyp, PMP, premalignant polyp, SSP, sessile serrated polyp, SSPDR, sessile serrated polyp detection rate

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 DISCLOSURE: This study was funded by grants from the Digestive Disease Research Foundation to J.S. Freedman and D.Y. Harari. L.B. Cohen has performed consulting and sponsored clinical research for Salix, Inc. No other financial relationships relevant to this publication were disclosed.

 If you would like to chat with an author of this article, you may contact Dr Aisenberg at j.aisenberg@nyga.md.

PII: S0016-5107(11)00021-6

doi:10.1016/j.gie.2011.01.019

Gastrointestinal Endoscopy
Volume 73, Issue 6 , Pages 1197-1206, June 2011

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