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Adenoma Detected More Often on Morning Than Afternoon Colonoscopy: Presented at ACG
By Danny Kucharsky
PHILADELPHIA, PA -- October 17, 2007 -- Day-part timing of colonoscopy is an independent predictor for increased adenoma detection, according to a prospective study presented here at the American College of Gastroenterology (ACG) 2007 Annual Scientific Meeting. Colonoscopy performed in the morning compared with the afternoon detected more patients at risk.
Adenomas were detected in 29% of morning colonoscopies and 25% of afternoon colonoscopies (P =.008) in this study, which was presented here October 16. The study analysed 3,621 colonoscopies performed at Cleveland Clinic, Cleveland, Ohio, United States in 2006, according to lead investigator, Madhusudhan Sanaka, MD, Gastroenterology and Hepatology Staff, Cleveland Clinic.
There were more women, and patients with increased risk of neoplasia and diverticulosis in the morning group compared to the afternoon group. There was no significant difference, however, in the size (P =.4), number (P =.8), location (P =.4) or pathology (P =.4) of adenomas between the two groups.
A slight majority of colonoscopies were done in the afternoon (51.7%) compared to morning (48.3%), P =.4.
Dr. Sanaka speculated that physician fatigue may be a factor that explains the difference in adenoma detection between morning and afternoon colonoscopies. "Another factor is that physicians may be less vigilant in the afternoon," he theorised, "but we don't know."
A patient factor that could explain the difference is related to bowel preparation for the procedure. "There might be more excellent preps in the morning," said Dr. Sanaka, which could be explained by the fact that in afternoon procedures there is a longer duration between the time when patients take the preparation until the procedure is actually done. (Patients take the preparation the night before, whether or not their colonoscopies are scheduled for the morning or afternoon.)
Dr. Sanaka said he plans to investigate further the reasons and implications for this study's findings.
Patients excluded from this study included 5,442 patients with incomplete colonoscopy or inadequate bowel preparation, as well as those with prior colonic resection, inpatient status and colonoscopies done for indications other than asymptomatic ones.
[Presentation title: Adenomas are Detected More Often on Morning Than Afternoon Colonoscopy. Abstract 1003]
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