Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
권호 표지
DOI QR코드

DOI QR Code

Time as a marker of quality in diagnostic upper endoscopy: a retrospective study of its association with clinically significant findings

  • Received : 2025.09.10
  • Accepted : 2025.10.31
  • Published : 2026.05.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background/Aims: Procedural duration has been proposed as a marker of esophagogastroduodenoscopy (EGD) quality; however, formal benchmarks remain undefined. This study examined the association between EGD duration and clinically significant findings (CSFs), as well as procedural behaviors contributing to diagnostic yield. Methods: We conducted a retrospective analysis of 120 first-time diagnostic EGDs performed at a single academic center and categorized procedures as lasting <3, 3 to 6, or >6 minutes. Logistic regression models were used to assess associations among procedure time, quality metrics (photographs, landmarks, biopsies), clinical indications, and CSF detection. Results: Longer procedures were independently associated with a high rate of CSF detection. Compared with procedures lasting <3 minutes, those lasting >6 minutes had 17.5-fold greater odds of detecting a CSF (p=0.02). Procedures performed for bleeding or "other" indications were independently associated with a high diagnostic yield (p=0.02 and 0.03, respectively). Although increased photo count and landmark documentation correlated with time, neither was independently predictive of CSFs after adjustment. Procedural duration also showed a stepwise increase in the number of biopsies obtained, photographs taken, and landmarks identified. Conclusions: Longer EGD duration was independently associated with increased CSF detection in a stepwise manner. Procedural time may serve as a practical, unifying measure correlated with multiple performance behaviors reflective of comprehensiveness in diagnostic EGD.

Keywords

References

  1. Ahlawat R, Hoilat GJ, Ross AB. Esophagogastroduodenoscopy. StatPearls Publishing; 2025.
  2. Rizk MK, Sawhney MS, Cohen J, et al. Quality indicators common to all GI endoscopic procedures. Gastrointest Endosc 2015;81:3–16. https://doi.org/10.1016/j.gie.2014.07.055
  3. Yadlapati R, Early D, Iyer PG, et al. Quality indicators for upper GI endoscopy. Am J Gastroenterol 2025;120:290–312. https://doi.org/10.14309/ajg.0000000000003252
  4. Ferrari C, Tadros M. Enhancing the quality of upper gastrointestinal endoscopy: current indicators and future trends. Gastroenterol Insights 2024;15:1–18.
  5. Nagula S, Parasa S, Laine L, et al. AGA clinical practice update on high-quality upper endoscopy: expert review. Clin Gastroenterol Hepatol 2024;22:933–943.
  6. Romańczyk M, Romańczyk T, Lesińska M, et al. The relation of esophagogastroduodenoscopy time and novel upper gastrointestinal quality measures. Eur J Gastroenterol Hepatol 2022;34:763–768. https://doi.org/10.1097/MEG.0000000000002385
  7. Gao Y, Cai MX, Tian B, et al. Setting 6-minute minimal examination time improves the detection of focal upper gastrointestinal tract lesions during endoscopy: a multicenter prospective study. Clin Transl Gastroenterol 2023;14:e00612.
  8. Teh JL, Tan JR, Lau LJ, et al. Longer examination time improves detection of gastric cancer during diagnostic upper gastrointestinal endoscopy. Clin Gastroenterol Hepatol 2015;13:480–487. https://doi.org/10.1016/j.cgh.2014.07.059
  9. Park JM, Huo SM, Lee HH, et al. Longer observation time increases proportion of neoplasms detected by esophagogastroduodenoscopy. Gastroenterology 2017;153:460–469. https://doi.org/10.1053/j.gastro.2017.05.009
  10. Romańczyk M, Ostrowski B, Kozłowska-Petriczko K, et al. Scoring system assessing mucosal visibility of upper gastrointestinal tract: The POLPREP scale. J Gastroenterol Hepatol 2022;37:164–168. https://doi.org/10.1111/jgh.v37.1
  11. Katz PO, Dunbar KB, Schnoll-Sussman FH, et al. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol 2022;117:27–56. https://doi.org/10.14309/ajg.0000000000001538
  12. Areia M, Esposito G, Leclercq P, et al. Performance measures for upper gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative: update 2025. Endoscopy 2025;57:1268–1297. https://doi.org/10.1055/a-2674-4912
  13. Kawamura T, Wada H, Sakiyama N, et al. Examination time as a quality indicator of screening upper gastrointestinal endoscopy for asymptomatic examinees. Dig Endosc 2017;29:569–575. https://doi.org/10.1111/den.2017.29.issue-5
  14. Lee SH, Park YK, Cho SM, et al. Technical skills and training of upper gastrointestinal endoscopy for new beginners. World J Gastroenterol 2015;21:759–785. https://doi.org/10.3748/wjg.v21.i3.759
  15. Kim SY, Park JM. Quality indicators in esophagogastroduodenoscopy. Clin Endosc 2022;55:319–331. https://doi.org/10.5946/ce.2022.094
  16. Emura F, Sharma P, Arantes V, et al. Principles and practice to facilitate complete photodocumentation of the upper gastrointestinal tract: World Endoscopy Organization position statement. Dig Endosc 2020;32:168–179. https://doi.org/10.1111/den.v32.2
  17. Supan W, Ongiem A, Noitasaeng P, et al. Incidence of complications in high-risk patients undergoing combined esophagogastroduodenoscopy and colonoscopy with total intravenous anesthesia: a prospective cohort study. Ther Clin Risk Manag 2025;21:1395–1408. https://doi.org/10.2147/TCRM.S541750
  18. Levy I, Gralnek IM. Complications of diagnostic colonoscopy, upper endoscopy, and enteroscopy. Best Pract Res Clin Gastroenterol 2016;30:705-718. https://doi.org/10.1016/j.bpg.2016.09.005