Are We Working too Much? Adenoma Detection Rate in Double Shift Endoscopists

Aims Colon cancer is the third most common neoplasm worldwide, with an incidence of approximately 2 million new cases each year [1]. In Spain, colorectal cancer is the most common of all cancers, making its diagnosis and prevention a major health concern [2]. Performing quality colonoscopies is a major goal in colorectal cancer screening strategies. We wondered whether colonoscopies performed by professionals who double shift might be affected by fatigue and, consequently, be of poorer quality. Some studies have compared this with mixed results [3] [4]. However, to our knowledge, none has compared quality of morning vs afternoon colonoscopies performed by the same professionals on double shifts.

Methods We designed a single-centre retrospective observational and cross-sectional study comparing morning colonoscopies (performed from 8-14h) with afternoon colonoscopies (14-20h) carried out at our centre (Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid) from 1 January 2021 to 31 December 2021. Eligible colonoscopies, were performed by an experienced endoscopist (> 7 years of experience and>300 colonoscopies/year) who performed a continuous work shift that day, from 8-20h in the Endoscopy service. All patients over 18 years of age who had undergone a colonoscopy in that period were included, irrespective of the reason for which the colonoscopy was requested. Exclusion criteria were admission, urgent colonoscopies and poor preparation (considered as Boston<2 at any section) as well as prior history of colorectal cancer. The primary objective was to compare the adenoma detection rate (ADR) between the two groups. Secondary objectives included the comparison of other quality measures, such as adenoma per colonoscopy (APC), cecal intubation rate (CIR) and colonoscopy preparation using Boston scale.

Results After reviewing the more than 5000 colonoscopies performed in our centre in 2021, only 310 met the inclusion criteria. They were carried out by 18 experienced endoscopists. Of these, 122 (39.3%) were performed in the morning, while 188 (60.6%) were performed in the afternoon, with no demographic differences between the two groups. Morning ADR was 41.8% (51/122), while in the afternoon group it was 31.3% (59/188) (OR 2.04 (CI 1.55-2.68) and p<0.001). Similarly, APC was significantly higher in the colonoscopies performed during the morning shift (0.90 compared to 0.61 in the afternoon OR 1.76 (CI 1.35-2.31) and p=0.005). There were no differences in CIR (100% in the morning vs 98.4% in the afternoon with p=0.161). On the other hand, preparation was significantly higher in the afternoon shift, with a mean Boston scale score of 7.18 in the morning and 7.71 in the afternoon. When comparing both means by Student's t-test, a p<0.001 was found.

Conclusions ADR and APC were higher in morning colonoscopies compared to afternoon colonoscopies in a continuous shift, even though the latter were significantly better prepared. These results may have future implications for the organisation of endoscopy shifts. However, further well-designed and powered studies are needed to improve the consistency of these results.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

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• 4 Barakat M, Panchal A, Abdelfatah MM. et al. “Morning versus afternoon adenoma detection rate: a systematic review and meta-analysis”. Eur J Gastroenterol Hepatol 2020; 32 (04): 467-474