title: Endoscopist Fatigue May Contribute to a Decline in the Effectiveness of Screening Colonoscopy.
abstract: OBJECTIVE
  To assess whether endoscopist fatigue adversely affects the adenoma detection rate (ADR) during screening colonoscopy.
  
  
  BACKGROUND
  Endoscopist fatigue may affect the ADR during colonoscopy; however, this association has not been directly studied.
  
  
  METHODS
  A prospective, multi-center study was performed on screening colonoscopies performed for asymptomatic subjects between March 2012 and December 2012 in Korea. Endoscopist fatigue was defined and measured by Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) questionnaire. The ADR was compared between fatigued endoscopists and nonfatigued endoscopists, and a multivariate regression analysis was performed to identify independent factors related to the detection of colorectal adenoma.
  
  
  RESULTS
  During the study period, a total of 457 subjects underwent screening colonoscopy. After excluding 62 subjects, outcomes of 395 subjects were analyzed. The overall ADR of the study population was 39.7%. The mean score of FACIT-F was 36.4±10.8, and a cutoff score of 25 was chosen to define fatigue. The ADR was lower in fatigued endoscopists than nonfatigued endoscopists (25.0% vs. 42.6%, P=0.008). Using multivariate regression analysis, endoscopist fatigue measured with FACIT-F (odds ratio=3.585; 95% confidence interval, 1.663-7.728; P=0.001) was found to be an independent factor for the ADR.
  
  
  CONCLUSIONS
  FACIT-F score may be a novel measure for endoscopist fatigue, and ADR was adversely influenced by endoscopist fatigue measured by FACIT-F. Our results suggest that endoscopist fatigue may contribute to a decline in the effectiveness of screening colonoscopy.
authors.affiliation: *Department of Internal Medicine, Kyung Hee University School of Medicine, Kyung Hee University Hospital †Department of Internal Medicine, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gang Dong, Seoul ‡Department of Internal Medicine, Soon Chun Hyang University College of Medicine, Soon Chun Hyang University Hospital at Gumi, Gumi, Republic of Korea.
authors.forename: Chang Kyun
authors.initials: CK
authors.lastname: Lee
authors.forename: Jae Myung
authors.initials: JM
authors.lastname: Cha
authors.forename: Wan Jung
authors.initials: WJ
authors.lastname: Kim
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000328:Adult; D002983:Clinical Competence; D003113:Colonoscopy / Q000592:standards*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000592:standards / Q000706:statistics & numerical data; D005221:Fatigue; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D056910:Republic of Korea; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D000066477:Work Performance / Q000592:standards / Q000706:statistics & numerical data*