Colonoscopy quality affected when endoscopist works full-day vs block shift

  • Wu J & al.
  • Dig Liver Dis
  • 9 Apr 2018

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • Colonoscopy quality is reduced in afternoon when the endoscopist works a full-day, but not half-day, block shift, according to a meta-analysis.

Why this matters

  • A half-day shift may prevent endoscopist fatigue.

Study design

  • Meta-analysis of 16 studies (n=38,063) that met inclusion criteria after search of MEDLINE, Web of Science, EMBASE, and the Cochrane Library.
  • Quality of colonoscopy was defined by adenoma detection rate (ADR), which was the primary outcome, or by polyp detection rate and cecal intubation rate (CIR), which were secondary outcomes.

Key results

  • When endoscopists worked half-day block shifts, no difference was seen in ADR between morning and afternoon (relative risk [RR], 1.08; 95% CI, 1.00-1.17) and CIR (RR, 1.01; 95% CI, 1.00-1.02).
  • When endoscopists worked full-day shifts, a significant reduction was seen in afternoon (vs morning) ADR (RR, 1.18; 95% CI, 1.09-1.28) and CIR (RR, 1.08; 95% CI, 1.02-1.13) in subgroup analysis.
  • When inferior bowel preparation was performed, a significant reduction was seen in afternoon (vs morning) ADR (RR, 1.12; 95% CI, 1.01-1.24) and CIR (RR, 1.02; 95% CI, 1.01-1.03) in subgroup analysis.

Limitations

  • Each of the studies was performed at a single center.
  • Heterogeneity across studies.

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