Fatigue of physician, not timing, affects colonoscopy quality
The time of day does not appear to have a significant effect on colonoscopy adenoma detection rates (ADR), when the procedure is performed by endoscopists working block shifts, according to a recent meta-analysis. However, those working full-day blocks may show significantly lower detection rates in the afternoon.
Pooled analysis of 16 studies, including 38,063 participants, showed that there was no significant difference in ADR between colonoscopies performed in the morning and in the afternoon (relative risk [RR], 1.08; 95 percent CI, 1.00–1.16; p=0.06).
In contrast, polyp detection rates (PDR) were significantly lower in procedures performed in the afternoon than in the morning (RR, 1.12; 1.04–1.20; p=0.002). The same was true for coecal intubation rates (CIR; RR, 1.01; 1.00–1.02; p=0.004). In all cases, heterogeneity of the findings was high.
In subgroup analyses, physicians who worked full-day block shifts showed significantly lower ADR (RR, 1.18; 1.09–1.28), CIR (RR, 1.08; 1.02–1.13) and PDR (RR, 1.17; 1.07–1.29) in colonoscopies performed in the afternoon than those performed in the mornings.
The quality of colonoscopy was not significantly influenced by the participation and help of staff members.
“The key finding of our study is that colonoscopies of the afternoon and morning do not differ in quality, and therefore schedule alone is not a risk factor,” said researchers, however noting that in full-day shifts, colonoscopy quality suffers in the afternoon.
“A half-day shift may prevent endoscopist fatigue, and split-dose bowel preparation could improve bowel preparation for colonoscopies scheduled in the afternoon,” they added.
For the meta-analysis, researchers accessed the databases of Embase, Cochrane Library, Web of Science and Medline, and searched for studies that reported ADR, CIR and PDR for morning and afternoon colonoscopy schedules.