PTU-054 Out of hours colonoscopy-are we compromising on quality?

IntroductionEndoscopy units nationwide are now offering out of hours (OOH) endoscopy as a means of dealing with ever increasing service demands. It is known that quality of colonoscopy can vary with timing throughout the day and there is a paucity of data regarding quality of OOH procedures1,2. Our aim was to investigate the quality of colonoscopies carried out during evening and Saturday lists at Sheffield teaching hospitals (STH) since the introduction of OOH services.MethodWe retrospectively collected and analysed demographical and procedure related data for non-bowel cancer screening colonoscopies performed between November 2015 to October 2016. Procedures were grouped according to the day of the week and timing of session (am, pm and evening). Kleanprep was used as bowel preparation in the vast majority of procedures. Bowel preparation was recorded at the time of endoscopy according to the Aronchick scale and classified as adequate (excellent/good) or inadequate (fair/poor) for the purpose of statistical analysis.ResultsOut of the 5150 colonoscopies that were carried out 2487 were male and 2663 were females. Table 1 summarises the differences between routine and OOH colonoscopy. It is our unit’s policy not to book patients older than 65 years of age on evening and Saturday lists and this resulted in a significantly lower mean age. Quality of bowel preparation was significantly lower in morning sessions, including Saturdays compared to afternoon and evenings however this did not translate into any significant difference between polyp detection rates (PDR). Caecal intubation rate (CIR) was slightly higher on Saturdays however this did not reach statistical significance.Weekdayp-valueSaturdayp-valueampmeveningamMean age±95% CI (years)58.6±0.6759.0±0.6755.6±1.600.001 (Anova)56.3±1.30.005 (Anova)PDR555/2141 (25.9%)590/2255 (26.2%)85/340 (25.0%)0.899 (χ2)108/414 (26.1%)0.983 (χ2)CIR1998/2141 (93.3%)2103/2255 (93.3%)318/340 (93.5%)0.982 (χ2)398/414 (96.1%)0.079 (χ2)Inadequate bowel preparation502/2093 (24.0%)350/2150 (16.3%)44/319 (13.8%)0.001 (χ2)104/414 (25.1%)0.001 (χ2)ConclusionFrom our experience quality of OOH colonoscopy including Saturdays is comparable to that of routine lists and is an effective means of reducing waiting list pressures. A possible explanation for the better bowel preparation seen in afternoon and evening lists could be the use of split dosing which hasn’t been introduced yet for morning procedures in our centre.References. Teng TY, Khor SN, Kailasam M, Cheah WK, Lau CC. Morning colonoscopies are associated with improved adenoma detection rates. Surg Endosc. 2016May;30(5):1796–803.. Subramanian S, Psarelli EE, Collins P, Haslam N, O’Toole P, Lombard M, Sarkar S. Colonoscopy performance is stable during the course of an extended three-session working day. Endosc Int Open. 2015 Oct;3(5):E494–500.Disclosure of InterestNone Declared