"Running late" and adenoma detection - is there an association?

BACKGROUND: The efficacy of screening colonoscopy depends on adequate adenoma detection. Operating behind schedule (i. e. "running late") might impose time pressure and affect adenoma detection. The aim of the study was to examine whether there is an association between procedural delay and adenoma detection rate (ADR).

METHODS: We retrospectively identified individuals who underwent an elective outpatient colonoscopy at an academic medical center between October 2011 and March 2012.  We extracted information regarding procedure details, and patient and polyp characteristics. Procedure delay was defined as the time elapsed between the scheduled and actual procedure start times. We calculated the ADR for each 15-minute delay interval and for each quartile of procedure delay for individual endoscopists.

RESULTS: In total 1505 patients (mean age 61.3, 49 % men) were examined by 11 endoscopists. At least one adenomatous polyp was found in 507 patients (34 %), with a mean of 0.63 adenomas per patient. Colonoscopies started at a median 18 minutes late (IQR 3 - 36) and median delay times varied broadly between endoscopists from 4 minutes to 45 minutes. ADR was not affected by procedure delay and was similar across 15-minute delay intervals (P = 0.101). The ADR also remained similar across quartiles of the endoscopists' delay times (from lowest to highest delay quartile: 34 %, 32 %, 32 %, and 37 %; P = 0.397). Independent factors associated with increased adenoma detection included being a man, older age, surveillance colonoscopy, and the endoscopist.

CONCLUSION: In this large multiendoscopist study we did not find that procedure delay affected adenoma detection. Even when endoscopists are behind schedule, they still perform a meticulous examination with no impact on adenoma detection.