CHICAGO – Significantly more polyps were detected during colonoscopies when an anesthesiologist was present, compared with colonoscopies without an anesthesiologist, based on data from more than 4.5 million index colonoscopies. The findings were presented at the annual Digestive Disease Week.
Use of an anesthesiologist during colonoscopy has been associated with improved patient and provider satisfaction, but the diagnostic impact on polyp detection has not been well studied, said Dr. Brooks D. Cash of the National Naval Medical Center in Bethesda, Md.
The report "represents one of the first products of the new AGA [American Gastroenterological Association] Digestive Health Outcomes Registry," said Dr. Cash. "It has become increasingly important to have registries that look at quality and effectiveness of what we do as gastroenterologists," he said.
In this study, Dr. Cash and colleagues reviewed data from 4,539,547 index colonoscopies performed between 2001 and 2010. Based on coding data, approximately one-third of the colonoscopies involved an anesthesiologist.
Overall, the polyp detection rate was 37.7% for procedures with an anesthesiologist present, compared with 37% in procedures without an anesthesiologist. Because of the large numbers in the study, this difference was statistically significant (P less than .05).
In addition, significantly more individuals were diagnosed with colorectal cancer within 3 years of the index colonoscopy with an anesthesiologist present than without an anesthesiologist (1.97% vs. 1.71%).
Among men, the polyp detection rate was 43.18% with an anesthesiologist and 43.08% without an anesthesiologist. Among women, these rates were 33.17% and 31.95%, respectively. The differences were significant for both sexes.
The differences in colorectal cancer diagnosis after 3 years also remained significant by sex, the researchers noted. Among men, 2.12% of those who had an anesthesiologist present for their colonoscopies were diagnosed with colorectal cancer within 3 years, compared with 1.93% of those without an anesthesiologist present. Among women, 1.84% of those who had an anesthesiologist present at their colonoscopies were diagnosed with colorectal cancer within 3 years, compared with 1.54% of those without an anesthesiologist present.
The trends held constant for age as well as sex: Both polyp detection and colon cancer incidence after 3 years were slightly higher when an anesthesiologist was present for patients aged younger than 65 years and for those aged 65 years and older.
The study is important because there are significant costs – up to $700 per case – when an anesthesiologist is involved in a colonoscopy, although the cost varies by region, Dr. Cash said.
The use of anesthesiologists for colonoscopies began with comorbid patients who had a higher risk of moderate sedation complications, Dr. Cash said. "We have seen that the use of anesthesiologists has become more common, even for patients who are at average risk," he noted.
"What we are going to have to figure out as a society and as professional organizations is whether those additional costs merit the very slight increases in polyp detection rate," said Dr. Cash. "We also need to figure out why the colorectal cancer incidence 3 years after index colonoscopies with anesthesia providers is slightly higher," he said.
Dr. Cash had no financial conflicts to disclose.