Does Mandatory Documentation of Colonoscopy Duration Enhance Adenoma Detection Rate?

Abstract

Listen

Translate article

Introduction: Our institution has recently mandated documentation of duration of all colonoscopies by endoscopists as a quality improvement initiative. Adenoma detection rate (ADR), an important quality indicator of colonoscopy, is known to be improved with a withdrawal time of at least 6 minutes. However, there is sparse data on influence of mandatory documentation of total colonoscopy times on ADR. Aims of this study were to determine if mandatory documentation of colonoscopy duration enhances ADR and the number of adenomas detected per patient. Methods: Chart review of screening colonoscopies performed at our institution for 6 months in premandatory period (PRE; January 2013 to June 2013) and for 9 months in post-mandatory period (POST; July 2013 to March 2014). Patients over age 50 years undergoing screening or surveillance colonoscopy with adequate bowel preparation and complete colonoscopy were included. Patient demographics and colonoscopy findings such as indication, quality of bowel preparation, and type and amount of sedation were reviewed. Patients with IBD, polyposis syndromes, prior colonic resection, and poor bowel preparation were excluded. ADR was defined as proportion of colonoscopies with at least 1 adenoma detected. Procedure duration was defined as time from endoscope insertion to removal out of the patient. Data is presented as mean plus standard deviation, median (25th, 75th percentiles), or N (%). Univariate analysis, analysis of variance, Kruskal-Wallis tests, Pearson’s Chi-square tests and Wilcoxon rank sum tests were performed, and SAS (version 9.3, SAS institute, Cary, NC) was used for statistical analysis. Results: A total of 578 subjects were included in the analysis (254 in PRE and 324 in POST). Average age at time of colonoscopy was 64±9 years, and 52% were male. Patient demographics and colonoscopy findings were similar in PRE and POST. Mean procedure duration was 25.9+16.8 minutes in POST. ADR was 41.7% in PRE compared to 46.6% in POST (p=0.24). The findings were similar in the subgroup of average risk subjects. There was a trend suggesting that a higher number of adenomas per patient, particularly in the distal colon, were likely to be found in the POST. This trend was not observed in the subgroup of average risk patients (p=0.88). There was only trivial correlation between procedure duration and number of adenomas detected per patient (rho 0.27; 95% CI 0.017, 0.38). Conclusion: Mandatory documentation of colonoscopy duration does not seem to impact ADR. It might increase the number of adenomas detected per patient, mainly in the distal colon. Further studies are needed to evaluate these findings.