Ask for the First Appointment of the Day… and More

Here’s some consumer advice that’s probably new to you — recent research has found that early morning colonoscopies uncover more polyps than those performed later in the day.

To learn why — and to get other expert tips on how to make sure your colonoscopy is of the best quality — I called Brennan M.R. Spiegel, MD, assistant professor of medicine at the West Los Angeles Veterans Affairs Medical Center, which is part of the David Geffen School of Medicine at the University of California-Los Angeles, where he and his colleagues examined the records of 477 individuals who had colonoscopies during a one-year period. They found that early morning procedures — ones that started at 8:30 or earlier — resulted in the detection of 27% more polyps per patient, on average, than screenings done later in the day… and that as the hours wore on, physicians discovered progressively fewer polyps.

One possible explanation is that patients’ self-administered bowel preparation worsens as the day goes on, since there is more time and temptation to eat something while waiting for the procedure — but even after accounting for this and other independent factors, such as age, gender and cancer or polyp history, doctors still detected fewer polyps as the day wore on. Dr. Spiegel speculates that like other professionals, physicians may simply become fatigued or distracted over time.

The findings were published in the November 2009 issue of Clinical Gastroenterology and Hepatology.

Got Skills? That Counts, Too

According to Dr. Speigel, skill counts even more than time of day, and your primary goal should be to find an appropriately trained and experienced physician. Dr. Speigel suggests that you should expect your doctor to have performed at least 140 colonoscopies, which is what’s required to graduate from a gastrointestinal training program — but 1,000 is the level that he considers to be “fully proficient.”

He says it is also a good idea to ask a doctor about his/her outcome history, as follows…

  • How often do you reach the cecum (the very end of the colon)? The ideal is to get there at least 90% of the time. (Obstruction or poor bowel preparation sometimes makes it impossible, which is why 100% isn’t a reasonable expectation.)
  • How often do you detect polyps? A good answer would be: In at least 15% of women and 25% of men age 50 and older.
  • How long do you spend examining the colon? Doctors should take at least six minutes to examine the whole colon — longer for obese patients and for those who are heavy smokers. Those patients require more careful examination, as they are at higher risk for colon cancer.

What This Means To You

On the individual level, Dr. Spiegel says the net effect of the time-of-day study is inconsequential — though in my view, 27% is enough of a difference that I will make a point of scheduling my next colonoscopy first thing in the morning. Regarding the big picture, Dr. Speigel acknowledges that “multiplying this effect by thousands of patients across the US could mean we’re missing lots of polyps, some of which might turn into cancer one day.” He emphasizes, however, that this data is from one center only and says the main focus should be on the quality of your doctor. That’s because regardless of the hour, an accurate assessment by a skilled and experienced practitioner provides the best odds of preventing colorectal cancer.

Related Articles