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Docs find more polyps in the morning than in the afternoon
Source: (cancerfacts.com)
Monday, November 16, 2009
LOS ANGELES – Nov. 16, 2009 – People who undergo colonoscopies in the early morning are likely to have more polyps detected than people whose colonoscopies are done later in the day, researchers say.
In addition, the researchers, led by study author Dr. Brennan Spiegel, director of the UCLA-Veterans Affairs Center for Outcomes Research and Education, found that pre-cancerous growths, called adenomas, were detected less often as the day progressed for specialists performing multiple colonoscopies during the day.
"Although individual patient risk is very low, multiplying this effect by thousands of patients across the United States could mean we're missing lots of polyps, some of which might turn into cancer one day," Spiegel said in a prepared statement. "More research needs to be done at a wide range of centers to pinpoint why there's a decrease in the number of polyps found later in the day and to identify ways we might improve outcomes."
In the study conducted at the Veterans Greater Los Angeles-UCLA Healthcare System researchers tracked 477 patients receiving colonoscopies over the course of one year at a single VA hospital. The findings were published online last July, and appear in the Nov. 2009 edition of Clinical Gastroenterology and Hepatology.
After adjusting for a number of demographic and clinical factors, including age, gender and history of polyps or cancer, as well as the skill level of the physician, researchers found that colonoscopies performed early in the day at 8:30 a.m. or earlier, yielded 27 percent more polyps per patient than procedures performed later in the day. The amount of polyps discovered decreased hour by hour as the day progressed. This translates into less than a quarter of a polyp per patient, so the risk for individual patients is very low.
Researchers suggested a couple possible reasons for the difference in the rates of polyp discovery. One possibility is that colonoscopies performed in the morning may have better results partly due to improved bowel preparation the night before. Another reason might be that fatigue may play a role, as it does in other professions with prolonged and repetitive activities, like trucking, surgery and aviation.
In either case, Spiegel warns that patients should understand that this study was conducted in one hospital and that more research needs to be done at multiple sites to determine whether the finding is confirmed or disproved.
Spiegel added that colonoscopy remains a highly effective means of screening for colon cancer, whatever the time of day, and warned against patients insisting on being the first case of the day.
"The impact of appointment time for any individual patient is very, very small," he said. "Patients should feel confident that colonoscopy is helpful regardless of time of day and should be more focused on the quality and experience of their doctor rather than the time of their appointment."
SOURCE: Clinical Gastroenterology and Hepatology: Nov. 2009; Vol. 7, Issue 11, pp. 1217-1223 and press materials provided by UCLA Health Sciences Office of Media Relations and Public Outreach.
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