Document Detail

Fewer polyps detected by colonoscopy as the day progresses at a Veteran's Administration teaching hospital.
MedLine Citation:
PMID:  19631284     Owner:  NLM     Status:  MEDLINE    
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.
Michael Y Chan; Hartley Cohen; Brennan M R Spiegel
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, Non-P.H.S.     Date:  2009-07-22
Journal Detail:
Title:  Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association     Volume:  7     ISSN:  1542-7714     ISO Abbreviation:  Clin. Gastroenterol. Hepatol.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-11-05     Completed Date:  2010-01-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101160775     Medline TA:  Clin Gastroenterol Hepatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1217-23; quiz 1143     Citation Subset:  IM    
Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
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MeSH Terms
Adenoma / diagnosis*
Colonic Neoplasms / diagnosis*
Diagnostic Errors / statistics & numerical data*
Health Services Research*
Hospitals, Teaching
Hospitals, Veterans
Middle Aged
Polyps / diagnosis*
Prospective Studies
Time Factors*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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