Optimal Sequence for Same-Day Bidirectional Endoscopy.

Background/Aims The optimal sequence for same-day bidirectional endoscopy remains controversial. This study aims to further investigate the impact of procedure sequence on cecum insertion time, with a particular focus on differences between experts (≥10 years) and trainees (<1 year). We hypothesized that abdominal gas insufflation from esophagogastroduodenoscopy (EGD) could impact colonoscopy (CF), specifically prolonging cecal insertion time in trainees. Methods This retrospective cohort study was conducted at Daegu Catholic University Medical Center from March 2023 to February 2024. A total of 1095 CF cases were included, with 655 performed by experts and 440 by trainees. Among the expert cases, 269 followed EGD first, and 386 followed CF first. In the trainee group, 236 followed EGD first, and 204 followed CF first. Cecum insertion times were compared between these groups. Results In the expert group, the cecum insertion time was 8.6 minutes for the EGD-first group and 8.0 minutes for the CF-first group, indicating no significant difference (p=0.127). In the trainee group, the cecum insertion time was 13.8 minutes for the EGD-first group and 12.2 minutes for the CF-first group, showing a statistically significant difference (p=0.011). Conclusion This study demonstrates a significant difference in cecum insertion times between the EGD-first and CF-first procedures in the trainee group but not in the expert group. These findings suggest that performing EGD before CF can increase cecum insertion time for trainees, highlighting the need for protocol considerations in training programs. No significant impact was observed for experienced practitioners. [ABSTRACT FROM AUTHOR]