Implementation effect of institutional policy of esophagogastroduodenoscopy observation time on neoplasm detection.

Park, Jae Myung; Kim, Sang Yoon; Shin, Gayoung; Choe, Younghee; Cho, Hyun Sun; Lim, Chul-Hyun; Cho, Yu Kyung; Choi, Myung-Gyu

BACKGROUND AND AIMS Esophagogastroduodenoscopy (EGD) observation time is associated with detection rate of premalignant or neoplastic lesions in the upper gastrointestinal (UGI) tract. The aim of this study was to evaluate of an institutional policy of EGD observation time on the detection rate of UGI neoplasms. METHODS From July 2017 to March 2019, all endoscopists were requested to adhere to our institutional policy of spending more than 3 minutes of observation time in every screening EGD. Observation time was defined as the time from when the endoscope reached the duodenum to when it was withdrawn. We obtained neoplasm detection rate (NDR) during this period, which was compared with that of baseline period from 2009 to 2015. RESULTS During the study period, 30,506 EGDs were performed. The age of subjects was 49.9 ± 10.5 years, and 56.5% were male. All endoscopists achieved the average EGD observation time more than 3 minutes during this period. Mean observation time was 3:35 ± 0:50, which was significantly longer than that of baseline (2:38 ± 0:21, P<0.001). NDR was 0.33%, which was higher than that of baseline (0.23%, P<0.001). Even after adjusting for subjects' age and gender, smoking history, and endoscopists' biopsy rate, prolonged EGD observation time more than 3 minutes increased NDR of UGI neoplasms (odds ratio, 1.51; 95% CI, 1.21 -1.75). CONCLUSIONS This study provides evidence that implementing a protocol of a prolonged observation time could increase NDR. Observation time should be an important quality indicator of EGD examination.