Office-Based Anesthesia for Colonoscopy by Gastroenterologists: Higher Rates of
Colon Polyp Detection
Marc Koch, Robert Goldstein, Clifford Gevirtz, Ann Showan, Timothy Hoops, Lee Fleisher

Background: Colonoscopy is performed to evaluate the colon and detect polyps before they evolve into cancer. Anesthesiologists can facilitate colonoscopy through the prudent selection and titration of medications, creating a quiet visual field for endoscopists to examine the bowel. Furthermore, divestiture of anesthesia to an independent anesthesiologist permits endoscopists to focus on a single task—polyp detection. This study evaluated the impact of initiation of office-based anesthesiology service on colon polyp detection in the officebased setting.
Methods: We studied records of 1,740 patients of 40 gastroenterologists who commenced de novo officebased anesthesiology [OBA] services in a procedure room between April and August of 2002, and continuously maintained the service for at least 4 consecutive months. A propofol technique was used for all patients wherein they were generally unaware of tactile or verbal stimuli during uncomfortable portions of the procedure. The first full month of coverage was designated as the baseline and for this and each of
the next four months, data was acquired through extraction from our billing database (Northern Health Solutions). For each month, information was gathered on the number of patients in whom at least one polyp was identified (ICD-9-CM code 211.3) vs. the number of patients in whom none were detected. Average age and gender of patients were also collected.
Results: Patients in whom at least one polyp was detected vs. the number of patients in whom no polyps were detected as a fraction of total patients for the baseline, 1st, 2nd, 3rd and 4th month were 469/1740 (26.95%), 506/1868 (27.09%), 527/1812 (29.08%), and 545/1759(30.9%), respectively. Using a two-tail test and a 90% confidence level, the 3rd month out from baseline showed a statistically significant increase in polyp detection.
Conclusions: In this study of patients for whom gastroenterologists initially provided their own anesthesia while performing colonoscopy in their office, the delegation of anesthesia to an anesthesiologist resulted in improved colon polyp detection. Although this may be partly due to an anesthesia technique, this finding is quite consistent with the well-known shortcomings of multitasking. These data suggest that an environment devoid of clinical multitasking may lead to the discovery of more polyps and enhance cancer detection and
prevention. Subsequent studies to evaluate the rates of polyp detection before and after the initiation of anesthesiology service, as well as controlling for the type of anesthetic medications used may add clarity to our findings.

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