There are several known predictors of an incomplete colonoscopy or difficult colonoscopy.
In addition, inadequate bowel preparation has been reported in procedures scheduled later in the day.
Operator fatigue, which tends to be higher as the day passes on, may also impact colonoscopy completion rate.
Dr Sanaka Madhusudhan and colleagues from Ohio determined the influence of performing outpatient colonoscopies in the afternoon versus morning.
The researchers evaluated the effect on the completion rates of colonoscopy and adequacy of bowel preparation.
|Inadequate bowel preparation occurred in 20% of afternoon colonoscopies|
|American Journal of Gastroenterology|
The team retrospectively reviewed charts of all outpatient colonoscopies.
The colonoscopies were performed between 2003 and 2004 in the Division of Gastroenterology at MetroHealth Medical Center in Ohio.
The researchers reviewed patient demographics, indications for procedure, and colonoscopic findings.
Patients received polyethylene glycol electrolyte-based bowel preparation in the evening prior to the day of the scheduled colonoscopy.
A total of 2087 colonoscopies was performed, of which 1084 were in the morning and 999 were in the afternoon.
The researchers found that patients in the morning and afternoon were similar in regards to the known risk factors predictive of an incomplete colonoscopy.
The team noted that the incompletion rate was significantly higher in the afternoon compared to the morning.
The researchers found inadequate bowel preparation in 15% of colonoscopies in the morning and 20% of colonoscopies in the afternoon.
Even after excluding incomplete colonoscopies due to poor bowel preparation precluding examination, the incompletion rate was still higher in the afternoon.
Dr Madhusudhan's team concludes, “Scheduling of colonoscopies in the afternoon compared to the morning may be an independent predictor of an incomplete colonoscopy and inadequate bowel preparation.”
“According to our study findings, scheduling of all outpatient colonoscopies preferentially in the morning would avoid suboptimal procedures in 5% of patients.”
“It would also avoid the need for unnecessary repeat colonoscopy or an alternative imaging study in about 2% of patients.”