1. R4 채정민 / Prof 이창균

2. INTRODUCTION colonoscopy is a widely used screening tool for colorectal cancer adenoma detection rate (ADR) important quality indicator for screening colonoscopy several factors have been reported to affect ADR withdrawal time cecal intubation quality of bowel preparation fellow participation the timing of colonoscopy

3. INTRODUCTION

5. physician fatigue possible cause for the lower ADR and higher failure rates primary hypothesis morning and afternoon ADRs would not differ significantly when performed in half-day blocks by different endoscopists

6. METHODS included Mayo Clinic from January 2009 to December 2009 all patients who underwent colonoscopies in 2009 excluded patients with incomplete data indications of bleeding, anemia, IBD repeat colonoscopies

7. METHODS recorded factors patient demographics time of procedure (morning vs. afternoon) indication for procedure type of bowel preparation quality of bowel preparation completion of colonoscopy patient tolerance total time of procedure withdrawal time

8. METHODS morning colonoscopies from 0800 to 1200 hours afternoon colonoscopies from 1300 to 1700 hours procedure start time recorded by the endoscopy nurse adenoma polyp with adenomatous tissue confirmed by pathology sessile serrated adenomas and advanced adenomas not invasive cancer

9. METHODS ADR percentage of colonoscopies in which at least one adenoma was detected per colonoscopy complete colonoscopy as intubating the cecum and identifying the appendiceal orifice and ileo-cecal valve patient tolerance of the procedure “ Unable to perform Procedure ” “ Poor / combative ” “ Uncomfortable” “ Fair-mod discomfort ” “ Good ” “ Excellent ”

10. METHODS quality of bowel preparation “ excellent ” “ good ” “ fair-adequate ” “ inadequate ” “ poor ” standard high-definition colonoscopies sedation with choice of intravenous fentanyl, midazolam, or meperidine polyethylene glycol-based bowel preparations

11. 20: attending gastroenterologists 6: gastroenterology fellows 3: colorectal surgeons

16. CONCLUSION performing colonoscopies in half-day blocks by different endoscopists → increases the detection of adenomas in afternoon procedures → probably by reducing physician fatigue