Introduction

Adenoma and polyp detection rate (ADR and PDR) are important quality measurement indicator in colonoscopy.

Aims & Methods

We aimed to investigate the differences in polyp detection rate (PDR) in colonoscopy between morning and afternoon shifts.
A multi-center, large cohort, retrospective study included all colonoscopies performed between 2016 and 2021 in seven endoscopy departments. The PDR in colonoscopy was compared between the morning and afternoon shifts.

Results

277,203 colonoscopies were included in the study, with 160,095 (57.7%) performed during the morning shift and 117,108 (42.3%) performed during the afternoon shift. Patients undergoing colonoscopies in the morning shift were more frequently female (53.9% vs. 46.1%, p < 0.001) and tended to be older compared to those in the afternoon shift (average age of 57.35 ± 12.4 vs. 55.9 ± 13, p < 0.001). Colonoscopies conducted during the morning shift exhibited a higher cecum intubation rate (CIR) (96.7% vs. 95.7%, p < 0.001). During the morning shift, higher rates of PDR (31,575/100,000 vs. 27,837/100,000, p < 0.001) were observed compared to the afternoon shift. In the multivariate analysis, after adjusting for other variables, age, male gender, polyp's follow-up, FOBT, morning shift, FHCRC, and rectal bleeding demonstrated statistically significant associations (p < 0.001) for PDR.

Conclusion

A colonoscopy during the morning shift yields a higher PDR and cecum intubation rate than in the afternoon. It is essential to create the right conditions for the endoscopist working in the afternoon shift to improve PDR and cecum intubation rate and eventually the Adenoma detection rate (ADR)

Introduction

Differences between males and females were reported in digestive diseases and upper endoscopy.

Aims & Methods

The objective of the study was to investigate the similarities and differences in colonoscopy indications and findings between men and women. Multi-center, large cohort, retrospective study included all colonoscopies performed between 2016 and 2021. Multi-center study, data collected from seven Assuta endoscopy departments. All performed colonoscopies were included, and the indications and findings of the procedures were compared between men and women.

Results

287,930 were included, 151,411(52.5%) women and 136,519 men, aged 56.54±12.9 years and 56.59±12.7, with no difference in cecal intubation (95.6% vs 95.5%, p=0.251). 71.4% of the females had excellent or good bowel preparation, while 65.6% of the males had the same grade of quality. 22,650 (15%) of the females had Abdominal pain as the indication compared to 13,568 (9.9%) of males, while 11,846 (7.8%) had positive fecal occult testing compared to 12,955 (9.5), p<0.001.
Higher rates of change in Bowel habits, constipation, diarrhea, family history of colon cancer and Anemia were found among females compared to males (4.3% vs 3.7%, 3.9% vs 2.2%, 12.6% vs 11.4% and 7.6% vs 4.9%, p<0.001, respectively), while rectal bleeding, weight loss, polyp follow up and screening colonoscopy were more among males (10.7% vs 7.8%, 1.5% vs 1.3%, 10.8% vs 7.1% and 23.4% vs 20.6%, p<0.001, respectively. The colonoscopy findings showed that males had significantly higher rates of colon cancer, polyp detection rates, Crohn’s disease, ulcerative colitis and diverticulosis (0.5% vs 0.4%, 35.1% vs 24.6%, 1.5% vs 1.3%, 1.6% vs 1.5%, and 14.9% vs 12.8%.

Conclusion

We found significant differences between men and women regarding the indications and pathological findings of colonoscopy; these findings highlighted the need of the identification of factors contributing to these differences and the development of sex-specific approaches for the diagnosis and management of gastrointestinal diseases.

Introduction

Endoscopist performance may fluctuate throughout the day, potentially influencing adenoma detection during colonoscopy. Endoscopist fatigue has been proposed as contributing factor but few studies have rigorously examined its impact using precise quality metrics^1,2.

Aims & Methods

This study compared corrected withdrawal time (cWT) and lesion detection metrics between morning and afternoon procedures to assess the effect of procedural timing.
We conducted a prospective analysis of elective colonoscopies performed in adult patients (≥18 years) at the University of Montreal Hospital Center by 19 endoscopists. All procedures were video-recorded and annotated in real-time by trained research assistants. Procedures performed solely for polypectomy, those with incomplete examinations, technical failures, or performed by endoscopists with fewer than 10 colonoscopies were excluded. cWT was defined as the withdrawal time minus the duration of all therapeutic interventions. The primary outcome was the comparison of mean cWT between morning and afternoon colonoscopies. Secondary outcomes included the cWT required to reach ADR threshold ≥35%, adenoma detection rate (ADR), advanced ADR (AADR), sessile serrated lesion detection rate (SSLDR), adenomas per colonoscopy (APC), and the per-lesion intervention time, all stratified by time of day. The increase of all performance measures per additional cWT minute were further compared across time of day, adjusting for patient demographics, bowel preparation quality, indication for colonoscopy, computed-assisted detection use, and clustering by individual endoscopist using generalized estimated equations.

Results

A total of 1,437 colonoscopies were included, of which 665 were performed in the morning and 772 in the afternoon. Morning colonoscopies had significantly longer mean cWT than afternoon procedures (8'49'' vs. 8'11''; P=0.002), despite similar per-lesion intervention durations (1’32’’ vs 1’28’’, P=0.425). To achieve an ADR ≥35%, afternoon procedures required on average 1’42’’ more cWT than morning ones (10'02'' vs. 8'20''). Mean ADR and AADR were higher in the morning (ADR: 36.2% vs. 32.4%, P=0.138; AADR: 7.2% vs. 6.5%, P=0.652), although not statistically significant (Table 1). For each additional cWT minute, adenoma detection odds increased by 7.2% in the morning (P=0.003) and 5.9% in the afternoon (P=0.049), suggesting reduced detection efficiency later in the day despite comparable polyp intervention times. Also, the increases in the odds of detecting advanced adenoma dropped from 13.1% in the morning to 7.8% in the afternoon for each additional cWT minute. This reduction was not as steep for SSLDR and APC metrics.

Table 1. Metrics’ estimated summaries overall and by time of day.

Metrics	Overall Mean (95% CI)	Morning Mean (95% CI)	Afternoon Mean (95% CI)	Overall Increase/additional cWT minute (p-value)	Morning Increase/additional cWT minute (p-value)	Afternoon Increase/additional cWT minute (p-value)
ADR	34.2% (31.7-36.7)	36.2% (32.6-40.0)	32.4% (29.1-35.8)	6.6% (0.003)	7.2% (0.003)	5.9% (0.049)
AADR	6.8% (5.6-8.3)	7.2% (5.4-9.5)	6.5% (4.9-8.5)	10.6% (<0.001)	13.1% (<0.001)	7.8% (0.100)
SSLDR	4.8% (3.8-6.1)	4.7% (3.2-6.6)	4.9% (3.6-6.8)	12.4% (<0.001)	13.1% (0.001)	12.1% (<0.001)
APC	0.6 (0.6-0.7)	0.7 (0.6-0.8)	0.6 (0.5-0.7)	7.4% (<0.001)	7.4% (<0.001)	7.3% (<0.001)

ADR, adenoma detection rate; AADR, advanced adenoma detection rate; SSLDR, sessile serrated lesion detection rate; APC, adenoma per colonoscopy; cWT, corrected withdrawal time.

Conclusion

Colonoscopy outcomes were influenced by procedural timing, with morning examinations associated with higher adenoma detection and more efficient use of WT. Afternoon procedures required longer cWT to achieve comparable detection benchmark of ≥35%, indicating potential performance fatigue. These findings suggest that optimizing endoscopy scheduling may enhance diagnostic yield and overall quality of care.

References

1. Sanaka MR, Deepinder F, Thota PN, Lopez R, Burke CA. Adenomas are detected more often in morning than in afternoon colonoscopy. Am J Gastroenterol. 2009;104(7):1659–1665. doi:10.1038/ajg.2009.188

2. Lee CK, Cha JM, Kim WJ, et al. Endoscopist fatigue may contribute to a decline in the effectiveness of screening colonoscopy. J Clin Gastroenterol. 2015;49(7):e51–e56. doi:10.1097/MCG.0000000000000300

Disclosure

Daniel von Renteln has received research funding from ERBE Elektromedizin GmbH, Ventage, Pendopharm, Fujifilm, and Pentax, and has received consultant or speaker fees from Boston Scientific Inc., ERBE Elektromedizin GmbH, and Pendopharm. Roupen Djinbachian has received speaker fees from Fujifilm. The remaining authors declare that they have no conflict of interest.

Introduction

The high diagnostic accuracy of colon capsule endoscopy (CCE) for colorectal polyps makes it a valid alternative in colorectal screening compared to conventional colonoscopy [1, 2]. To achieve an acceptable adenoma detection rate (ADR) by colonoscopy the scope withdrawal time should be > 6 minutes (min) [3]. No guideline currently exists for the optimal colon transit time (CTT) in CCE. We aimed to investigate the impact of CCT on polyp detection rate (PDR) to establish a minimum CCT for an acceptable PDR.

Aims & Methods

Between August 2020 and December 2022, the trial CareForColon2015 was conducted in Denmark [4,5]. Complete CCE investigation was defined a study with visualization of the hemorrhoidal plexus or excreted capsule within battery lifetime and bowel preparation rated fair or better on the Leighton-Rex scale for all colonic segments. PDR was defined as number of CCEs in which at least one polyp was detected, divided by the total number of CCEs. Additionally, we calculated two PDRs limited to polyps > 5 and > 9 millimeter (mm), respectively. Statistical analyses were performed in Stata/BE 17.0 (StataCorp, Texas, USA). Logistic regression models adjusted for age, sex and bowel preparation were used to estimate odds ratios (OR) for polyp detection based on CTT as a categorical variable.

Results

Two thousand and thirty had CCE; 616 were excluded due to incomplete investigation (30.3%). For the complete CCEs, the total PDR was 79.4%. PDR was 68.8% for polyps > 5 mm and 46.5% for polyps > 9 mm. CTT > 60 min (n = 1,009) was set as reference in the analyses of PDR stratified by CTT ≤ 15 min (n = 74), CTT 16-30 min (n = 126) and CTT 31-60 min (n = 205). The OR of polyp detection was significantly lower for CTT ≤ 15 min (OR 0.334, p < 0.001) and CTT 31-60 min (OR 0.663, p = 0.013) (Table 1). Regarding PDR for polyps > 5 mm, the OR was significantly lower for investigations ≤ 15 min (OR 0.466, p = 0.003) and 31-60 min (OR 0.695, p = 0.027) (Table 1). No significant differences for PDR concerning polyps > 9 mm and CTT were observed (Table 1).

Table 1 Calculated odds ratio (OR), 95 % confidence interval, p value and forest plot for PDR overall, PDR > 5 mm and PDR > 9 mm stratified for colonic transit time (CTT). For all calculations, CTT > 60 minutes was set as baseline and OR are adjusted for sex and age.

	CTT (min)	n	OR	95% - CI	p-value
PDR	1-15	74	0.334	0.199 – 0.560	<0.001
	16-30	126	0.796	0.502 – 1.261	0.331
	31-60	205	0.633	0.442 – 0.906	0.013
PDR polyps > 5 mm	1-15	74	0.466	0.284 – 0.766	0.003
	16-30	126	1.016	0.669 – 1.545	0.940
	31-60	205	0.695	0.503 – 0.960	0.027
PDR polyps > 9 mm	1-15	74	0.790	0.487 – 1.282	0.422
	16-30	126	1.307	0.896 – 1.909	0.165
	31-60	205	0.747	0.548 – 1.012	0.065

*Aberrations: CTT; Colonic transit time, OR; Odds ratio, PDR; Polyp detection rate

Conclusion

Until now, expert opinion is used in evaluation of CCE investigation validity; Rex et al. suggests CTT < 40 min combined with poor preparation as a technically inadequate investigation for polyps [6]. Also, Pickhardt et al. have demonstrated the malignant potential of polyps > 9 mm to be significantly higher than of diminutive polyps [7], suggesting the impact of missed polyps ≤ 9 mm to be low. Thus, our results suggests CTT to have minor clinical impact on patient pathway in colorectal screening CCE although a CTT ≤ 60 min is significantly correlated with lower PDR compared to CTT > 60 min.

References

1. Kjølhede T, Ølholm AM, Kaalby L, et al. Diagnostic accuracy of capsule endoscopy compared with colonoscopy for polyp detection: systematic review and meta-analyses. Endoscopy. 2021;53(07):713-21.
2. Sulbaran M, Bustamante-Lopez L, Bernardo W, et al. Systematic review and meta-analysis of colon capsule endoscopy accuracy for colorectal cancer screening. An alternative during the Covid-19 pandemic? J Med Screen. 2022;29(3):148-55.
3. Barclay RL, Vicari JJ, Doughty AS, et al. Colonoscopic Withdrawal Times and Adenoma Detection during Screening Colonoscopy. New England Journal of Medicine. 2006;355(24):2533-41.
4. Kaalby L, Deding U, Kobaek-Larsen M, et al. Colon capsule endoscopy in colorectal cancer screening: a randomised controlled trial. BMJ Open Gastroenterol. 2020;7(1).
5. Deding U, Bjorsum-Meyer T, Kaalby L, et al. Colon capsule endoscopy in colorectal cancer screening: Interim analyses of randomized controlled trial CareForColon2015. Endosc Int Open. 2021;9(11):E1712-E9.
6. Rex DK, Adler SN, Aisenberg J, et al. Accuracy of Capsule Colonoscopy in Detecting Colorectal Polyps in a Screening Population. Gastroenterology. 2015;148(5):948-57.e2.
7. Pickhardt, P. J., Hassan, C., Laghi, et al. Small and diminutive polyps detected at screening CT colonography: a decision analysis for referral to colonoscopy. AJR. American journal of roentgenology. 2008; 190(1), 136–144.

Disclosure

A.K.: Co-founder and shareholder of A.J.M. Medicaps; co-director and shareholder of iCERV Ltd.; consultancy fees (Jinshan Ltd.); travel support (Jinshan, Aquilant, and Dr Falk Pharma); research support (grant) from ESGE/Given Imaging Ltd. And (material) IntroMedic/SynMed; honoraria (Dr Falk Pharma UK, Ferring, Jinshan, Medtronic). Member of Advisory board meetings (Dr Falk Pharma UK, Tillots, ANKON).

Introduction

Early detection of colon adenomas and polyps lowers the risk of colorectal cancer development. Quality indicators for screening or diagnostic colonoscopy encompass the adenoma detection rate (ADR), polyp detection rate (PDR), and cecal intubation rate (CIR). Previous research on ADR, PDR, and CIR in groups of patients who were deeply sedated with propofol versus those who underwent colonoscopy without sedation is undetermined.

Aims & Methods

The objective of this study was to analyze the effects of deep sedation versus no sedation on ADR, PDR, and CIR in a population of elderly patients.

This was a retrospective cohort study that included adult patients over the age of 60, presenting for a first screening or diagnostic colonoscopy performed in the period from January 2017 to September 2023 at our clinical center. The exclusion criteria were emergency colonoscopies, inflammatory bowel diseases, intent therapeutic colonoscopies, and bowel preparation quality (based on the Boston Bowel Preparation Score, BBPS) of less than 6. Participants’ characteristics were assessed using descriptive statistics. Normal distribution was assessed using Kolmogorov-Smirnov and Shapiro-Wilk tests. Continuous variables were analyzed using Mann–Whitney test and categorical variables using Chi-square or Fisher exact test. Binary logistic regression was conducted to identify significant predictors of the outcomes. Two-tailed tests were conducted, and statistical significance was considered when p <0.05.

Results

Among 2034 patients (46.4% female; mean age: 70 years) deep sedation was performed in 622 patients (30.6%). Total PDR was 51.65%, ADR was 33.3%, and CIR was 94.25%. Patients' characteristics are shown in table 1.
After adjusting for confounders (age, gender, BMI, BBPS for PDR/ADR and age, gender, BMI, BBPS, previous abdominal/pelvic operation, diverticulosis for CIR) no significant difference was shown in PDR, ADR and CIR between no-sedation and deep sedation groups. Higher BMI (B = .041, p < .01) and male gender (B = .36, p = .02) were independent predictors for ADR.

	No-sedation (N=1412)	Deep sedation with propofol (N=622)
Age*	70 (65-76)	68 (64-73)
Female gender *	655 (46,4%)	359 (57,7%)
BMI	27 (24,3 - 30,5)	27,1 (23,7 - 29,9)
BBPS	9 (6-9)	9 (6-9)
PDR	731 (51,8%)	320 (51,5%)
ADR	472 (33,5%)	202 (32,5%)
CIR	1316 (93,2%)	593 (95,3%)
Abdominal/pelvic operation	488 (34,6%)	186 (29,9)
Diverticulosis *	523 (37,1%)	272 (43,8%)

Table 1; Patient s' characteristics, BMI; Body mass index, BBPS; Boston bowel preparation scale, PDR; Polyp detection rate, ADR; Adenoma detection rate, CIR; Cecal intubation rate, *gender χ2(3, N =2034)=27,37, p<0.01, *diverticulosis χ2(1, N =2031)=8,14, p<0.01, *age U=367989, z=-5,78; p<0,01, PDR: χ2(1, N =2033)=0,01, p=.92, ADR: χ2(1, N =2031)=0,17, p=.68

Conclusion

In our mixed cohort of elderly patients undergoing screening and diagnostic colonoscopies, propofol-induced deep sedation did not enhance ADR, PDR, or CIR. Further research is needed to determine the impact of deep sedation on colonoscopy quality parameters in elderly patients.

Introduction

Glucagon-like-peptide-1 receptors agonists (GLP1-RA) are approved for treatment of diabetes mellitus (DM) and weight reduction.

Aims & Methods

We aimed to investigate the association between GLP1-RA use and poor preparation of colon.
Methods: A multicenter, retrospective study was conducted, including all colonoscopies performed across seven gastroenterology departments from 2016 to 2022. Patients who had undergone colon surgery or had conditions such as Parkinson's disease, cerebrovascular accidents (CVA), scleroderma, amyloidosis, gastroparesis, or those taking narcotic or anti-cholinergic drugs, as well as those with incomplete preparation data, were excluded from the study. The rates of "poor preparation" were collected.

Results

4,104 patients treated with GLP-1 receptor agonists (GLP-1 RA) (age 60 ± 0.2 years, 55.6% females) to 294,643 patients not treated with GLP1 RA (age 56.06 ± 13 years, 52.6% females), these patients were undergoing their first colonoscopy. The study found that 409 (10%) of GLP1 RA patients had poor colonic preparation, compared to 16,811 (5.7%) of patients not treated with GLP1 RA. Subgroup analysis revealed that 173 (8.3%) non-diabetic patients treated with GLP1 RA had poor colonic preparation, compared to 14,810 (5.4%) non-diabetic patients not treated with GLP1 RA (p<0.001). Among diabetic patients, 236 (11.7%) treated with GLP1 RA had poor colonic preparation, compared to 2,001 (9.7%) diabetic patients not treated with GLP1 RA (p=0.004). Multivariate analysis showed that both diabetes mellitus (DM) and treatment with GLP-1 RA were independent risk factors for poor colonic preparation, with odds ratios of 1.7 (p<0.001) and 1.3 (p<0.001), respectively.

Conclusion

GLP-1 RA among diabetes and non-diabetic have an impact on colonic preparation, indicating that these patients may require special consideration and tailored recommendations for their colonoscopy preparation. To establish the most effective approach for these patients, prospective studies are needed.