Impact of operator fatigue on endoscopy performance: implications for procedure scheduling.

Background: With increasing volumes of endoscopic procedures, endoscopists' workload has had to increase to meet this escalating demand. The aim of this study was to characterize the impact of endoscopist fatigue on quality of endoscopy performance by comparing outcomes based on chronological procedure order.
Methods: Consecutive endoscopic procedures were prospectively observed. Quality indicators of colonoscopy (cecal intubation rate, lesion detection, withdrawal time, insertion time) and esophagogastroduodenoscopy (EGD) duration were compared among procedures based on their chronological sequence.
Results: Colonoscopy completion rates declined with successive procedures; completion for 1st to 3rd procedures (90%) was significantly higher than for 4th and subsequent procedures (76%) (P = 0.03). Median insertion times lengthened; times for 1st to 4th procedures [8 min, interquartile range (IQR) 6-11 min] were shorter than for 5th and subsequent procedures (10 min, IQR 7-15 min) (P = 0.06). Lesion detection rates, withdrawal times, and EGD duration remained stable with procedure order.
Conclusions: Colonoscopy cecal intubation rates appear to decline with successive procedures. There also appears to be a trend for insertion times to lengthen. Reassuringly, other quality indicators of colonoscopy (lesion detection and withdrawal time) and EGD duration do not appear to be impacted by repetitive procedures.