title: Adenoma detection rates vary minimally with time of day and case rank: a prospective study of 2139 first screening colonoscopies.
abstract: BACKGROUND
  Adenoma detection rate is an important measure of colonoscopy quality; however, factors including procedure order that contribute to adenoma detection are incompletely understood.
  
  
  OBJECTIVE
  The aim of this study was to prospectively evaluate factors associated with adenoma detection rate.
  
  
  METHODS
  Prospective cohort study. Data were collected on patient and physician characteristics, trainee participation, time of day, and case rank.
  
  
  METHODS
  Outpatient tertiary-care center.
  
  
  METHODS
  This study involved consecutive patients presenting for first screening colonoscopies.
  
  
  METHODS
  Adenoma and polyp detection rates (proportion of cases with one or more lesion detected) and ratios (mean number of lesions detected per case).
  
  
  RESULTS
  A total of 2139 colonoscopies were performed by 32 gastroenterologists. Detection rates were 42.7% for all polyps, 25.4% for adenomas, and 5.0% for advanced adenomas. Adenoma detection was associated with male sex and increasing age on multivariate analysis. In the overall study cohort, time of day and case rank were not significantly associated with detection rates. In post hoc analysis, polyp and adenoma detection rates appeared lower after the fifth case of the day for endoscopists with low volumes of cases and after the tenth case of the day for endoscopists with high volumes of cases.
  
  
  CONCLUSIONS
  Single center.
  
  
  CONCLUSIONS
  Overall, time of day and case rank did not influence adenoma detection rate. We observed a small but significant decrease in detection rates in later procedures, which was dependent on physician typical procedure volume. These findings imply that colonoscopy quality in general is stable throughout the day; however, there may be a novel "stamina effect" for some endoscopists, and interventions aimed at improving colonoscopy quality need to take individual physician practice styles into consideration.
authors.affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA. dleffler@caregroup.harvard.edu
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Leffler
authors.forename: Rakhi
authors.initials: R
authors.lastname: Kheraj
authors.forename: Arjun
authors.initials: A
authors.lastname: Bhansali
authors.forename: Hanako
authors.initials: H
authors.lastname: Yamanaka
authors.forename: Naama
authors.initials: N
authors.lastname: Neeman
authors.forename: Sunil
authors.initials: S
authors.lastname: Sheth
authors.forename: Mandeep
authors.initials: M
authors.lastname: Sawhney
authors.forename: J Thomas
authors.initials: JT
authors.lastname: Lamont
authors.forename: Mark D
authors.initials: MD
authors.lastname: Aronson
mesh_terms: D000236:Adenoma / Q000453:epidemiology* / Q000473:pathology*; D003111:Colonic Polyps / Q000453:epidemiology* / Q000473:pathology*; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010361:Patients / Q000145:classification; D011446:Prospective Studies; D013997:Time Factors