title: Colonoscopic polyp detection rate is stable throughout the workday including evening colonoscopy sessions.
abstract: OBJECTIVE
  Polyp detection rate (PDR) is an accepted measure of colonoscopy quality. Several factors may influence PDR including time of procedure and order of colonoscopy within a session. Our unit provides evening colonoscopy lists (6-9 pm). We examined whether colonoscopy performance declines in the evening.
  
  
  METHODS
  Data for all National Health Service (NHS) outpatient colonoscopies performed at Norfolk and Norwich University Hospital in 2011 were examined. Timing, demographics, indication and colonoscopy findings were recorded. Statistical analysis was performed using multivariate regression.
  
  
  RESULTS
  Data from 2576 colonoscopies were included: 1163 (45.1%) in the morning, 1123 (43.6%) in the afternoon and 290 (11.3%) in the evening.  Overall PDR was 40.80%. Males, increasing age and successful caecal intubation were all significantly associated with higher polyp detection. The indications 'faecal occult blood screening' (p<0.001) and 'polyp surveillance' (p<0.001) were strongly positively associated and 'anaemia' (p=0.01) was negatively associated with PDR. Following adjustment for  covariates, there was no significant difference in PDR between sessions. With the morning as the reference value, the odds ratio for polyp detection in the afternoon and evening were 0.93 (95% CI = 0.72-1.18) and 1.15 (95%CI = 0.82-1.61) respectively. PDR was not affected by rank of colonoscopy within a list, sedation dose or trainee-involvement.
  
  
  CONCLUSIONS
  Time of day did not affect polyp detection rate in clinical practice. Evening colonoscopy had equivalent efficacy and is an effective tool in meeting increasing demands for endoscopy. Standardisation was shown to have a considerable effect as demographics, indication and endoscopist varied substantially between sessions. Evening sessions were popular with a younger population.
authors.affiliation: Gastroenterology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, NR4 7TJ, UK.
authors.forename: David
authors.initials: D
authors.lastname: Thurtle
authors.affiliation: Norwich Medical School, Norwich, , NR4 7UY, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Pullinger
authors.affiliation: Norwich Medical School, Norwich, , NR4 7UY, UK.
authors.forename: Jordan
authors.initials: J
authors.lastname: Tsigarides
authors.affiliation: Norwich Medical School, Norwich, , NR4 7UY, UK.
authors.forename: Iris
authors.initials: I
authors.lastname: McIntosh
authors.affiliation: Norwich Medical School, Norwich, , NR4 7UY, UK.
authors.forename: Carla
authors.initials: C
authors.lastname: Steytler
authors.affiliation: Gastroenterology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, NR4 7TJ, UK ; Norwich Medical School, Norwich, , NR4 7UY, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Beales