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Ambient Light Could Improve End-of-day Adenoma Detection
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SAN ANTONIO — Performing colonoscopies in a room with ambient light could improve the decrease in adenoma detection rate that generally occurs over the course of the beginning to the end of the day, according to study results presented at the American College of Gastroenterology Annual Meeting.
Ryan T. Hoff, DO, of Advocate Lutheran General Hospital in Park Ridge, Illinois, said it is known that ADR decreases as the number of consecutive hours performing colonoscopies goes up.
“There’s this concept of operator fatigue,” he said in his presentation. “As we’re working longer hours, we’re becoming tired and our performance starts to slip.”
Additionally, up to 72% of video display unit users experience symptoms of eye fatigue, and those symptoms get worse after at least 6 hours of screen time. According to Hoff, having to adapt between a bright screen and a dark room may make those symptoms worse.
Hoff and colleagues conducted a single-center study that compared screening colonoscopies in a dimly lit room with those performed in a room with more ambient lighting. They analyzed retrospective data collected over a 6-month period for both light levels from a group of nine gastroenterologists. The participating GIs completed an eye fatigue survey before and after the use of ambient lighting.
In 498 low-light cases, physicians detected 172 adenomas with an ADR rate of 34.5%. In 611 ambient light cases, endoscopists identified 220 adenomas with an ADR of 36%. In the low light cases, the ADR for the first case of the day was 37.5% and 31.9% in the last. The corresponding ADRs for ambient light cases were 34.1% and 36.9%, respectively. The overall difference in ADR between the first and last cases using ambient lighting was +2.8% compared with –5.6% in low light cases (P = .01).
In the survey, 41% of participating GIs agreed or strongly agreed that ambient light produced fewer symptoms of eye strain, and 54% believed that it helped improve detection of changes in patient status.
Hoff said these data show that ambient light may improve differential change in ADR over the course of a day compared with having the lights off.
“Further investigating on the use of ambient light is warranted,” Hoff said. “After completion of this study, three physicians have since changed their practice and now are routinely using ambient light in the endoscopy unit.”
Reference:
Hoff RT, et al. Abstract 69. Presented at: American College of Gastroenterology Annual Meeting; Oct. 25-30, 2019; San Antonio.
Disclosures: Hoff reports no relevant financial disclosures.
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Brian B. Baggott, MD
Recent literature has looked at operator fatigue and the impact on performance. Anything we can do to change that is welcome. This data suggests a simple change in the room using ambient light late in the day as opposed to performing an endoscopy in a dark room can have that effect. This is a simple intervention to potentially reduce operator fatigue, as you do not need any special equipment or design.
In gastrointestinal endoscopy, studies have shown that operator fatigue is partially a function of what order in the day you have the endoscopy — first of the morning vs. last of the day. There have been varying results, but there does seem to be a consistent effect that quality as measured by polyp detection rates degenerates as the day goes on.
That said, more studies should be done. We see a suggestion of an association between room lighting and polyp detection rate in this early study. This is an easy thing to do, as all it takes is implementing a change in the lighting environment. I would not be surprised if physicians implement this change just to see if it has an impact on their own performance metrics.
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