Sa1406 Technical Difficulty Experienced by Endoscopists During Screening and Surveillance Colonoscopy Is Associated With Lower Adenoma Detection

flat polyps were more frequently observed in the right colon. Conclusion: The flat lesion detection rate is well correlated with adenoma detection. This parameter could be used as a surrogate index for the quality of colonoscopy. Sa1406 Technical Difficulty Experienced by Endoscopists During Screening and Surveillance Colonoscopy Is Associated With Lower Adenoma Detection Roy D. Yen*, Gregory L. Austin, Lindsay Hosford, Brian C. Brauer, Paul Menard-Katcher, Dennis J. Ahnen, Sachin Wani Dept of Gastroenterology/Therapeutic Endoscopy, University of Colorado Anschutz Medical Campus, Aurora, CO; Dept of Gastroenterology, Department of Veterans Affairs Eastern Colorado Health Care System, Denver, CO Background: Physician (MD) factors associated with missing adenomas during colonoscopy include suboptimal technique, shorter withdrawal time (WT) and possibly MD fatigue. The impact of technically difficulty during colonoscopy on adenoma detection (AD) has not been previously studied. Aim: To determine the association of technical difficulty experienced by MDs during screening/surveillance colonoscopy (SSC) on AD. Methods: Pts age O40yrs who underwent screening or surveillance colonoscopy from 10/11/10 12/31/12 at an academic medical center were included in this analysis. Exclusion criteria included: h/o colorectal cancer, IBD, and inpatient procedures. Data collected included pt demographics, procedure characteristics (including technical difficulty during SSC as noted by MD), and finding of adenomas (whether any adenomas were detected on each SSC). Multiple regression modeling was used to adjust WT for endoscopic maneuvers (such as biopsy, polypectomy) that did not contribute to examination time, specific for MD performing SSC. A multivariate mixed-effect logistic model was used to test the effect of technical difficulty during colonoscopy on the outcome of AD. A random intercept term was used to account for the multiple colonoscopies performed by each MD. Test statistics were considered significant at aZ.05. Results: 4,879 colonoscopies performed by 35 MDs were eligible for analysis. 47.1% pts were male with mean age of 59.8yrs (SD 8.9). Adenomas were detected in 34.2% of pts. The overall mean adj WT was 10.4min (SD 5.1). Technical difficulty during colonoscopy was noted by MD in 10.6% of SSCs. The reasons cited by MD for technical difficulty during colonoscopy are listed in Table 1. Technical difficulty during colonoscopy was found to be a significant independent negative predictor for AD (OR .74, 95% CI .59-.94, pZ.014). Other independent predictors of adenoma detection included pt age, pt male gender, pt h/o polyps, fellow involvement, bowel prep, and adjusted (adj) WT (Table 2). Technically difficult colonoscopy had significantly longer cecal intubation times (17.9 vs 8.3 min, p!.0001). On multivariate analysis, adj WT was not found to be significantly shorter in technically difficult colonoscopy. Conclusions: Looping and tortuous colon anatomy were most often cited as the reason for technical difficulty experienced during SSC, which may have induced physician fatigue or lowered physician vigilance during a longer procedure. Technically difficult colonoscopy was associated with a 25% decrease in adenoma detection. Physicians experiencing technical difficulty during SSC must be conscious of fatigue issues, remain particularly vigilant to detect adenomas, and consider shortening screening/surveillance intervals. Table 1. Most frequent reasons cited by MD for Technical Difficulty with SSC (n[518, 10.6%) Reason for Technical Difficulty AB200 GASTROINTESTINAL ENDOSCOPY Volume 79, No. 5 %