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Time of day variation in polyp detection rate for colonoscopies performed on a 3-hour shift schedule

  • Gregory W. Munson
    Affiliations
    Current affiliations: Department of Gastroenterology, Mayo Clinic (G.W.M., D.L.F.), Rochester, Minnesota, USA; Department of Gastroenterology and Hepatology, Beaumont Hospital (G.C.H.), Dublin, Ireland
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  • Gavin C. Harewood
    Affiliations
    Current affiliations: Department of Gastroenterology, Mayo Clinic (G.W.M., D.L.F.), Rochester, Minnesota, USA; Department of Gastroenterology and Hepatology, Beaumont Hospital (G.C.H.), Dublin, Ireland
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  • Dawn L. Francis
    Correspondence
    Reprint requests: Dawn L. Francis, MD, MHS, Mayo Clinic, Division of Gastroenterology, 200 First Street SW, Rochester, MN 55905
    Affiliations
    Current affiliations: Department of Gastroenterology, Mayo Clinic (G.W.M., D.L.F.), Rochester, Minnesota, USA; Department of Gastroenterology and Hepatology, Beaumont Hospital (G.C.H.), Dublin, Ireland
    Search for articles by this author
Published:October 08, 2010DOI:https://doi.org/10.1016/j.gie.2010.07.025

      Background

      Recent research suggests that the colonoscopy polyp detection rate (PDR) varies by time of day, possibly because of endoscopist fatigue. Mayo Clinic Rochester (MCR) schedules colonoscopies on 3-hour shifts, which should minimize fatigue.

      Objective

      To examine PDR variation with the MCR shift schedule.

      Design

      Retrospective cohort.

      Setting

      Outpatient tertiary-care center.

      Patients

      This study involved completed outpatient colonoscopies in 2008. Procedures were excluded for lack of withdrawal time stamps, indications other than average-risk screening, inadequate bowel preparation, fellow participation, or performance by endoscopists with a low number of endoscopies performed.

      Intervention

      None.

      Main Outcome Measurements

      PDR (colonoscopies with ≥1 polyp divided by total number of colonoscopies) by shift of day.

      Results

      We analyzed 3846 colonoscopies. PDR varied significantly by shift (P = .008) on univariate analysis; results for shifts 1 and 3 were similar (39.0% vs 38.7%, respectively) whereas shift 2 had the highest PDR (44.7%). Mean withdrawal times were stable (P = .92). PDR also varied significantly (P < .0001) by month of year on univariate analysis. On multivariate analysis, patient age (P < .0001), patient gender (P < .0001), endoscopist mean withdrawal time (P < .0001), month of year (P = .0002), endoscopist experience (P = .04), and shift of day (P = .048) significantly predicted PDR.

      Limitations

      Retrospective study.

      Conclusion

      MCR's 3-hour shift schedule does not show a decrease in PDR as the day progresses, as seen in other recent studies. Intervention trials at other institutions could determine whether alterations in shift length lead to PDR improvements.

      Abbreviations:

      ADR (adenoma detection rate), MCR (Mayo Clinic Rochester), MERGE (Mayo Electronic Record for Gastrointestinal Endoscopy), PDR (polyp detection rate), WT (withdrawal time)
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