Longer Observation Time Increases Proportion of Neoplasms Detected by Esophagogastroduodenoscopy

Abstract

Background & aims: Esophagogastroduodenoscopy (EGD) is commonly used to detect upper gastrointestinal (GI) neoplasms. However, there is little evidence that longer examination time increases rate of detection of upper GI neoplasia. We investigated the association between length of time spent performing a normal screening EGD and rate of neoplasm detection.

Methods: We performed a retrospective analysis of data from 111,962 subjects who underwent EGD as part of a comprehensive health-screening program from January 2009 to December 2015 in Korea. Endoscopy findings were extracted from reports prepared by 14 board-certified endoscopists. Endoscopists were classified as fast or slow based on their mean examination time for a normal EGD without biopsy during their first year of the study. All endoscopists used the same endoscopy unit. We obtained findings from histologic analyses of GI biopsies from patient records; positive findings were defined as the detection of neoplasms (esophageal, gastric, or duodenal lesions). We examined the association between examination time and proportions of neoplasms detected. The primary outcome measure was the rate of neoplasm detection for each endoscopist (total number of neoplastic lesions detected divided by the number of subjects screened) and as the proportion of subjects with at least 1 neoplastic lesion.

Results: The mean examination time was 2 minutes 53 seconds. Using 3 minutes as a cutoff, we classified 8 endoscopists as fast (mean duration, 2:38 ± 0:21 minutes) and 6 endoscopists as slow (mean duration, 3:25 ± 0:19 minutes). Each endoscopist's mean examination time correlated with their rate of neoplasm detection (R² = 0.54; P = .046). Fast endoscopists identified neoplasms in the upper GI tract in 0.20% of patients, whereas slow endoscopists identified these in 0.28% of patients (P = .0054). The frequency of endoscopic biopsy varied among endoscopists (range, 6.9%-27.8%) and correlated with rate of neoplasm detection (R² = 0.76; P = .0015). On multivariable analysis, slow endoscopists were more likely to detect gastric adenomas or carcinomas than fast endoscopists (odds ratio, 1.52; 95% CI, 1.17-1.97).

Conclusions: In a retrospective analysis of data from more than 100,000 subjects who underwent EGD in a screening program, we found slow endoscopists detected a higher proportion of neoplasms than fast endoscopists. Examination time is therefore a useful indicator of quality for EGD.

Keywords: Esophagus; Quality indicators; Stomach; Tumor.