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

BACKGROUND: 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 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 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.