24 Sep 2009

Race

To many endoscopists, the colon is like a racecourse.

Some years ago, YT conducted a clinical trial testing the performance of a new colonoscopic technique. As part of the study, the intubation time (from anus to cecum) and extubation time (the way out) were recorded. Soon, endoscopists kept breaking and boasting about their new records. “I reached cecum in less than three minutes!” Of course, people only remembered their triumph and would never mention how long it took to struggle through a difficult case.

At the end of the study, we got a report card. As a whole, all of us did well. If you compare various endoscopists, I was on the slow side. It is hard to uphold self esteem in a place full of virtuosos.

Finally, some sensible people came to my consolation. In an elegant study, Barclay and colleagues demonstrated that the extubation time was proportional to polyp detection rate (NEJM 2006;355:2533-41). In other words, endoscopists who pull out the endoscope quickly are likely to miss important findings. After all, no patient would really mind if the procedure takes five more minutes. Quality is more important than speed.

Just for fun, LL looked at our data again and showed us the extubation time and polyp detection rate of each teammate. This time, I could say that my polyp detection rate was not bad. YT was even slower than me but found more polyps. WK was an outlier. He was fast but also found many polyps. The One whom I dare not name was the fastest. I also dare not report his polyp detection rate.

My memories were brought up by funny stories I heard from endoscopy nurses recently. In a community screening project, we need to record intubation and extubation time again. You Know Who just broke the new record of withdrawing the endoscope in ninety seconds. On another occasion, JL did a rather difficult procedure. After reaching the cecum finally, a nurse said “11 minutes 40 seconds” loudly for recording purpose. The Professor of Surgery did not realize that was a study case and thought the nurse was teasing him. According to the nurse, “he stared at me angrily”.

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