Endoscopist Fatigue Estimates and Colonoscopic Adenoma Detection in a Large Community-Based Setting.Lee A, Jensen CD, Marks AR, Zhao WK, Doubeni CA, Zauber AG, Quinn VP, Levin TR, Corley DA. Gastrointest Endosc. 2016 Oct 1. [Epub ahead of print]

BACKGROUND AND AIMS:Endoscopist fatigue may impact colonoscopy quality, but prior studies conflict, and minimal data exist from community-based practices where most colonoscopies are performed.

METHODS:Within a large, community-based integrated healthcare system, we evaluated the associations among 4 measures of endoscopist fatigue and colonoscopic adenoma detection during the years 2010 to 2013. Fatigue measures included afternoon versus morning colonoscopy and the number of GI procedures performed before a given colonoscopy, including consideration of prior procedure complexity. Analyses were adjusted for potential confounders using multivariate logistic regression.RESULTS:We identified 126 gastroenterologists who performed 259,064 total GI procedures (median: 6/day, range: 1-24), including 76,445 screening and surveillance colonoscopies. Compared with morning examinations, colonoscopies in the afternoon were not associated with lower adenoma detection for screening examinations, surveillance examinations, or their combination (odds ratio (OR) for combination 0.99; 95% confidence interval (CI), 0.96-1.03). The number of procedures performed before a given colonoscopy, with or without consideration of prior procedure complexity, was also not inversely associated with adenoma detection (OR for adenoma detection for colonoscopies in the fourth quartile of fatigue based on the number of prior procedures performed versus colonoscopies performed as the first procedure of the day 0.99; 95% CI, 0.94-1.04).CONCLUSIONS:In a large community-based setting, adenoma detection for screening and surveillance colonoscopies was not associated with either time of day or the number of prior procedures performed by the endoscopist, within the range of procedure volumes evaluated. The lack of association persisted after accounting for prior procedure complexity.

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