Comparison of Morning Versus Afternoon Cecal Intubation Rates
Background: Many factors impacting cecal intubation rates have been examined in detail; however, little information exists regarding the effect of the timing of the procedure. We sought to examine any difference in cecal intubation rates between morning and afternoon colonoscopies and identify factors contributing to a discrepancy.
Methods: Retrospective, single-center study comparing cecal intubation rates for colonoscopies performed in the morning (begun prior to 12 noon) and colonoscopies performed in the afternoon (begun after 12 noon) over an approximately 12 month period. Univariate and multivariate analyses were performed evaluating patient demographics, procedure indication(s), endoscopist, bowel preparation type and quality, and participation by a gastroenterology fellow.
Results: 6087 colonoscopies were evaluated in this study. Colonoscopies (n = 3729) performed in the morning were compared to colonoscopies performed in the afternoon (n = 2358). The crude completion rate to the cecum was 95.0% in the morning group while the completion rate to the cecum was 93.6% of the afternoon exams (p = 0.02). The morning colonoscopies had better bowel preparation quality (p < 0.001). The multivariate analyses demonstrated that gender, age, and bowel preparation quality impacted completion rates. After correcting for these factors, there was no significant difference in completion rates in the morning versus afternoon.
Conclusion: Uncorrected cecal intubation rates were lower in the afternoon compared to the morning in outpatients undergoing colonoscopy. Bowel preparation quality was worse in the afternoon compared with the morning. Efforts at improving afternoon bowel preparation may improve the outcome of afternoon colonoscopies.
Examination of the entire colon is necessary to detect and remove as many polyps as possible to maximize the effectiveness of colorectal cancer screening. A number of factors such as gender, age, prior hysterectomy, body mass index and endoscopist's experience have been identified in the literature as impacting cecal intubation rates. Additionally, age, gender, bowel preparation quality, history of constipation, body mass index and endoscopist's experience have been reported to affect procedure duration. Cecal intubation rates have been used as a one measure of quality of colonoscopic examination. While any single measure of quality is imperfect, it is generally accepted that cecal intubation rates for both diagnostic and screening colonoscopies should be > 90% for individuals and institutions. However, this target is not always achieved. While many of these factors have been studied in depth, the timing of colonoscopy (ie morning versus afternoon) has not been studied in detail. Sanaka, et al, recently reported a lower cecal intubation rate in a retrospective study of 2087 colonoscopies comparing morning and afternoon colonoscopies. They reported a statistically significant difference in cecal intubation rates between morning and afternoon exams after excluding cases limited by poor bowel preparation. The aim of our study was to evaluate the relationship of cecal intubation rates between colonoscopies performed in the morning and afternoon and identify factors contributing to a difference in between the groups using multiple logistic regression analysis.
Background: Many factors impacting cecal intubation rates have been examined in detail; however, little information exists regarding the effect of the timing of the procedure. We sought to examine any difference in cecal intubation rates between morning and afternoon colonoscopies and identify factors contributing to a discrepancy.
Methods: Retrospective, single-center study comparing cecal intubation rates for colonoscopies performed in the morning (begun prior to 12 noon) and colonoscopies performed in the afternoon (begun after 12 noon) over an approximately 12 month period. Univariate and multivariate analyses were performed evaluating patient demographics, procedure indication(s), endoscopist, bowel preparation type and quality, and participation by a gastroenterology fellow.
Results: 6087 colonoscopies were evaluated in this study. Colonoscopies (n = 3729) performed in the morning were compared to colonoscopies performed in the afternoon (n = 2358). The crude completion rate to the cecum was 95.0% in the morning group while the completion rate to the cecum was 93.6% of the afternoon exams (p = 0.02). The morning colonoscopies had better bowel preparation quality (p < 0.001). The multivariate analyses demonstrated that gender, age, and bowel preparation quality impacted completion rates. After correcting for these factors, there was no significant difference in completion rates in the morning versus afternoon.
Conclusion: Uncorrected cecal intubation rates were lower in the afternoon compared to the morning in outpatients undergoing colonoscopy. Bowel preparation quality was worse in the afternoon compared with the morning. Efforts at improving afternoon bowel preparation may improve the outcome of afternoon colonoscopies.
Examination of the entire colon is necessary to detect and remove as many polyps as possible to maximize the effectiveness of colorectal cancer screening. A number of factors such as gender, age, prior hysterectomy, body mass index and endoscopist's experience have been identified in the literature as impacting cecal intubation rates. Additionally, age, gender, bowel preparation quality, history of constipation, body mass index and endoscopist's experience have been reported to affect procedure duration. Cecal intubation rates have been used as a one measure of quality of colonoscopic examination. While any single measure of quality is imperfect, it is generally accepted that cecal intubation rates for both diagnostic and screening colonoscopies should be > 90% for individuals and institutions. However, this target is not always achieved. While many of these factors have been studied in depth, the timing of colonoscopy (ie morning versus afternoon) has not been studied in detail. Sanaka, et al, recently reported a lower cecal intubation rate in a retrospective study of 2087 colonoscopies comparing morning and afternoon colonoscopies. They reported a statistically significant difference in cecal intubation rates between morning and afternoon exams after excluding cases limited by poor bowel preparation. The aim of our study was to evaluate the relationship of cecal intubation rates between colonoscopies performed in the morning and afternoon and identify factors contributing to a difference in between the groups using multiple logistic regression analysis.
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