Mo1151 EFFECT OF ENDOSCOPIST FATIGUE IN RELATION TO ENDOSCOPIC MUCOSAL RESECTION OF LARGE COLON POLYPS

Endoscopic mucosal resection (EMR) of large colon polyps is technically challenging and therefore often performed by endoscopists with significant experience in this procedure. It is not known if endoscopist fatigue influences the success of colon EMR for large colon polyps. The primary objective of our study is to assess whether procedural success of colon EMR is affected by endoscopist fatigue or time of day when colon EMR is performed. We conducted a retrospective review of all colon EMR procedures performed by four therapeutic endoscopists at two academic tertiary care hospitals between 1/1/2015 – 12/31/2016. Patients included for this review had colon polyps > 20 mm that were removed with injection-lift EMR technique. Technical success was defined as endoscopist assessment of complete resection of the polyp. All patients for whom follow-up information was available were assessed for residual neoplasia on follow-up colonoscopy. We assessed whether endoscopist fatigue as measured by: afternoon versus morning, number of endoscopic procedures performed before the procedure under consideration, including adjustment for procedure complexity and the total procedure related RVUs had an impact on the technical success of the procedure or the rate of residual neoplasia. In order to examine these fatigue measures we stratified the cases under review into quartiles. Quartile 1 represents the colon EMR cases with fewest preceding cases, while quartile 4 represents colon EMR cases with the largest number of preceding cases. A total of 154 patients underwent colonoscopy to resect 170 large colon polyps by EMR technique. Overall, 87.7% of the lesions were removed successfully. 21 lesions could not be removed endoscopically. Follow-up information was available for 68.3% of patients. 28 patients underwent surgery (14 for invasive carcinoma, 3 for high grade dysplasia, 11 for unresectable lesions). Of 75 patients who underwent successful colon EMR and had follow-up colonoscopy, 80% had no evidence of residual neoplasia. When assessing endoscopist fatigue by total number of procedures, number of procedures adjusted for complexity and total procedure-related RVUs prior to performing colon EMR, no effect was found in relation to technical success or rates of residual neoplasia on follow-up. There appeared to be a trend towards lower rate of technical success and a higher rate of residual neoplasia for colon EMR procedures performed in the afternoon versus the morning, however this difference was not statistically significant. We conducted similar analysis for each endoscopist individually with the same findings. Endoscopist fatigue did not have a significant effect on the technical success of colon EMR, nor did it adversely impact the rate of residual neoplasia on follow-up colonoscopy.Tabled 1Association between endoscopist fatigue and colon EMR outcome measuresFatigue measureTechnical successResidual neoplasia rateStart timeMorning exam89.5% (referant)20.4% (referent)Afternoon exam83.0% (p=0.25)34.8% (p=0.18)Raw fatigue scoreQuartile 192.7% (referent)25.0% (referent)Quartile 284.4% (p = 0.27)32.1% (p=0.62)Quartile 381.6% (p= 0.14)30.8% (p=0.73)Quartile 490.2% (p=0.69)15.8 % (p=0.50)Consensus fatigue scoreQuartile 192.7% (referent)25.0% (referent)Quartile 281.6% (p=0.15)26.3% (p=0.93)Quartile 382.5% (p =0.18)30.0% (p=0.74)Quartile 490.9% (p=0.77)13.6% (p=0.38)RVU fatigue scoreQuartile 192.7% (referent)25.0% (referent)Quartile 280.5% (p=0.12)26.3% (p=0.93)Quartile 380.5% (p=0.12)36.8% (p=0.43)Quartile 495.0% (p=0.67)15.8% (p=0.48) Open table in a new tab