Longer Examinations Improve the Yield of Upper Endoscopy

Summary and Comment |
December 30, 2014

Longer Examinations Improve the Yield of Upper Endoscopy

  1. David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)

But larger studies are still needed to confirm this somewhat intuitive finding.

  1. David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)

It is well established that polyp and adenoma detection rates during colonoscopy increase when more time is taken to examine the mucosa. Investigators in Singapore evaluated the effect of examination time on the detection of cancer and premalignant lesions of the stomach.

The researchers retrospectively examined data from 837 consecutive symptomatic patients who underwent upper endoscopy (esophagogastroduodenoscopy [EGD]). First, the researchers used data from 224 normal endoscopies without biopsies to divide the 16 endoscopists into equally sized fast and slow groups (mean times, 5.5 minutes and 8.6 minutes, respectively); the break point was a mean total procedure time of 7 minutes. Then, reviewing the data from the remainder of the patients, they determined that the slow endoscopists were twice as likely to detect high-risk lesions (cancer, dysplasia, intestinal metaplasia, and/or gastric atrophy) than the fast endoscopists (odds ratio, 2.5). The benefit was greater when cancer or dysplasia was detected (OR, 3.42). This effect was present in both staff endoscopists and trainees but only reached statistical significance in staff. The authors conclude that a mean EGD examination time of >7 minutes is associated with a greater yield of high-risk gastric lesions and that, as in colonoscopy, examination time may be an appropriate quality indicator.


Although it seems intuitive that a slower, careful examination would pick up more lesions in the stomach than in the colon, this small study of 16 physicians for 3 months does not give us definitive confirmation. Several potentially confounding factors, the dichotomous assignment of endoscopists as slow or fast, and the prevalence of high-risk findings in this population make generalization difficult. Additional large studies, similar to those done for colonoscopies, are needed to confirm the results.

Editor Disclosures at Time of Publication

  • Disclosures for David J. Bjorkman, MD, MSPH (HSA), SM (Epid.) at time of publication Leadership positions in professional societies World Gastroenterology Organization (Treasurer)


Reader Comments (1)

ISMAIL SAEED Physician, Gastroenterology

This seems to be more applicable for endoscopists who are expert in the field as normally the procedure time for juniors and trainees are expected to be longer but without an increased yield of lesion detection.

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