Li TY, Gurram H, Li Y, Sals A, Keswani RN. Modifiable factors including weekend consultations are major contributors to inpatient colonoscopy delays. World J Gastrointest Endosc 2026; 18(9): 122102 [DOI: 10.4253/wjge.122102]
Corresponding Author of This Article
Thomas Y Li, School of Medicine, Baylor College of Medicine, 1 Baylor Plz, Houston, TX 77030, United States. thomas.li@bcm.edu
Research Domain of This Article
Gastroenterology & Hepatology
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research-article
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Li TY, Gurram H, Li Y, Sals A, Keswani RN. Modifiable factors including weekend consultations are major contributors to inpatient colonoscopy delays. World J Gastrointest Endosc 2026; 18(9): 122102 [DOI: 10.4253/wjge.122102]
World J Gastrointest Endosc. Sep 16, 2026; 18(9): 122102 Published online Sep 16, 2026. doi: 10.4253/wjge.122102
Modifiable factors including weekend consultations are major contributors to inpatient colonoscopy delays
Thomas Y Li, Harini Gurram, Yan Li, Alexandra Sals, Rajesh N Keswani
Thomas Y Li, School of Medicine, Baylor College of Medicine, Houston, TX 77030, United States
Thomas Y Li, Harini Gurram, Yan Li, Alexandra Sals, Rajesh N Keswani, Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
Co-first authors: Thomas Y Li and Harini Gurram.
Author contributions: Li TY and Gurram H contributed to collecting the data, interpreting the data, and drafting and editing the manuscript as co-first authors; Li TY, Gurram H, and Keswani RN contributed to final revision of the manuscript; Gurram H and Keswani RN contributed to designing the study; Li Y and Sals A contributed to collecting the data and interpreting the data; all of the authors read and approved the final version of the manuscript to be published.
AI contribution statement: Generative AI tools were not used in the creation of this manuscript.
Institutional review board statement: This retrospective cohort study was approved by the Northwestern University Institutional Review Board (No. STU00211125).
Informed consent statement: Given the retrospective cohort nature of this study, a waiver of informed consent was approved by the Northwestern University Institutional Review Board.
Conflict-of-interest statement: Keswani RN consults for Medtronic, Boston Scientific, Neptune Medical, Cook Medical, and Olympus. All authors report no other conflicts of interest.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Data sharing statement: No additional datasets were generated.
Corresponding author: Thomas Y Li, School of Medicine, Baylor College of Medicine, 1 Baylor Plz, Houston, TX 77030, United States. thomas.li@bcm.edu
Received: April 10, 2026 Revised: July 17, 2026 Accepted: August 28, 2026 Published online: September 16, 2026 Processing time: 153 Days and 21.2 Hours
Abstract
BACKGROUND
In value-based care, identifying modifiable “logistical delays“ is important for reducing hospital length of stay (LOS). While clinical factors such as bowel preparation are well established as contributors to inpatient colonoscopy delays, logistical factors, such as the “weekend effect”, are not as well studied.
AIM
To identify logistical and/or modifiable causes of delayed colonoscopies and their impact on LOS.
METHODS
This is a retrospective single-center cohort study of all inpatients who underwent colonoscopy at a single center over a 15-month period. “Delay“ was defined as > 1 calendar day from gastrointestinal (GI) consult signature to procedure for Sunday-Thursday consultations, > 2 days for Saturday consultations, and > 3 days for Friday consultations. Factors predictive of delay and LOS were analyzed using pre-specified logistic and negative binomial regression.
RESULTS
A total of 771 inpatient colonoscopies were included, with 302 (39.2%) delayed. Of these, 65.6% had only clinical delays, 14.9% had only logistical delays, and 19.5% had both clinical and logistical delays. One major logistical factor was weekend scheduling issues. Colonoscopies with consult notes signed on the weekend were associated with increased odds of delay [odds ratio (OR) = 1.66; 95%CI: 1.16-2.37]. Other predictors of delay included non-GI admissions (OR = 3.78; 95%CI: 1.92-7.52) and having both non-GI and GI admission indications (OR = 1.69; 95%CI: 1.22-2.34). Delayed colonoscopies overall were associated with significantly longer LOS [13.4 days (95%CI: 11.5-15.6) vs 9.5 days (95%CI: 8.1-11.0)].
CONCLUSION
Weekend scheduling issues are a significant contributor to inpatient colonoscopy delay. While clinical delays are often unavoidable, logistical delays highlight systemic bottlenecks that are associated with extended LOS.
Core Tip: While clinical factors are known to delay inpatient colonoscopies, the impact of modifiable logistical factors is often underestimated. This study demonstrates that 39.2% of all delays have a logistical component, with weekend consultation being a dominant driver. Consultations initiated on Saturdays or Sundays were associated with 1.7 times increased odds of delay, and procedural delay was in turn associated with an increase in hospital length of stay by an average of 3.9 days. These findings suggest that establishing dedicated weekend endoscopy scheduling capacity and increasing weekend resource allocation to increase staffing offer an opportunity to improve patient care and hospital efficiency.
