The Effect of Taking Break During Colonoscopy Session on Adenoma Detection, a Prospective, Randomized Control Study

Not Applicable

Completed

• Conditions: Colonic Adenoma
• Interventions: Other: Break; Other: No break

• Registration Number: NCT01989650
• Lead Sponsor: Chinese University of Hong Kong

Brief Summary

Recent research has suggested that endoscopist fatigue may significantly affect the polyp detection rate. There have been no studies on interventions that may reduce endoscopist fatigue and therefore improve colonoscopy performance.

We want to determine whether a break in the middle of colonoscopy session would maintain a more stable adenoma detection rate

Detailed Description

In recent years, there has been a dramatic increase in the volume of endoscopic procedures performed in most endoscopy centers. With the growing awareness of colorectal cancer screening, there is increasing demand for colonoscopy which has increased the workload of endoscopists in every healthcare system. There are studies showing that physician fatigue impairs quality of care and performance in other medical specialties such as anesthesia and surgery. Colonoscopy by nature is repetitive and frequently prolonged which can promote distractibility and fatigability. Studies from western countries have showed that afternoon colonoscopies are associated with lower adenoma detection rate (ADR) compared with the morning colonoscopies and physician fatigue has been hypothesized as a potential contributor. Previous studies also showed that the polyp detection rate decreases hour-by-hour throughout the day and the colonoscopy completion rate appears to decline with successive procedures due to endoscopist fatigue. The most recent study using the queue position as a surrogate marker for endoscopist fatigue had showed that both the later colonoscopy start time and increasing number of preceding endoscopic procedures are associated with decreasing polyp detection rate. It is not surprising that endoscopist fatigue may contribute to a significant decline in the effectiveness of colonoscopy and yet it is probably not realistic to reduce the number of colonoscopy procedures per session given the heavy clinical demand. There have been no studies on any intervention that may improve the performance of colonoscopy. It would be reasonable to postulate that taking a break half way through the colonoscopy session may alleviate endoscopist fatigue and hence improve the polyp detection rate. This study aims to evaluate the effect of introducing a break in the middle of a colonoscopy session on the quality of colonoscopy performance.

Study Timeline

• Study Start: 2012-02
• Primary Completion: 2013-09
• Study Completion: 2013-09
• Study First Submitted: 2013-11-07
• Study First Submitted QC: 2013-11-15
• Study First Posted: 2013-11-21
• Status Verified: 2015-02
• Last Update Submitted: 2015-02-12
• Last Update Posted: 2015-02-16

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 1379

Inclusion Criteria

• All patients who underwent colonoscopies in the afternoon session at the endoscopy unit in AHNH were eligible for inclusion in this study.

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Exclusion Criteria

• Emergency inpatient colonoscopy
• Patient with history of colorectal cancer , FAP or IBD

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Break	No break	A break of 15 minute will be provided after 3rd colonoscopy in a session of 6 colonoscopies in total
Break	Break	A break of 15 minute will be provided after 3rd colonoscopy in a session of 6 colonoscopies in total

Primary Outcome Measures

Name	Time	Method
Adenoma detection rate	2 years

Secondary Outcome Measures

Name	Time	Method
Complication rate	2 years
Colonoscopy insertion time	2 years
Cecal intubation rate	2 years
Patient satisfaction score	2 years	A questionnaire will be used to asses patient's satisfaction level
Withdrawal time	2 years
Patient pain score	2 years	A questionnaire will be used to asses patient's level of pain

Trial Locations

Locations (1)

Alice Ho Miu Ling Nethersole Hospital; 🇭🇰 Hong Kong, Hong Kong