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Morning colonoscopies are associated with improved adenoma detection rates

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Abstract

Background

Higher adenoma detection rates are associated with decreased risks for subsequent colorectal cancers. Studies have suggested that adenoma detection rate (ADR) may be affected by timing of colonoscopy due to endoscopist fatigue later in the day. The aim of our study is to assess the influence of the timing variables on ADR.

Methods

Univariate analysis and multivariate logistic regression analysis were performed on a prospective colonoscopy database, comparing ADR for colonoscopies performed in the morning shift (AM) and in the afternoon shift (PM) over a 1-year period. Each shift lasted 4 h. Only elective outpatient completed colonoscopies with adequate bowel preparation, performed by four certified staff endoscopists, were included. Surveillance colonoscopies for cancers were excluded. ADR was defined as the detection of at least one histologically confirmed polyp during colonoscopy.

Results

A total of 533 colonoscopies were included. ADR was 25 % in the cohort. Mean age was 59 (SD 14.1). Two hundred and seventy (50.6 %) were done in the AM and 263 (49.4 %) were done in the PM. ADR was 29 % in the AM group compared to 21 % in the PM group (p = 0.03). Excluding time needed for polypectomy, the mean time taken for scope withdrawal was significantly longer in the morning group (12 min) compared with the afternoon group (10 min) (p = 0.002). The longer withdrawal time in the morning was significantly associated with increased ADRs (OR 1.104, 95 % CI 1.063–1.147) (p < 0.0001).

Conclusion

Timing of colonoscopy is an independent predictor for ADR. Colonoscopies performed in the morning have a longer mean withdrawal time, thus leading to a significantly higher ADR. As endoscopists concentration decreases as the day progresses, this may account for the shorter time spent on colonoscopies on the afternoon.

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Acknowledgments

The authors would like to thank the faculty of the Department of General Surgery at Jurong Health Services, Singapore for contributing cases to this study.

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Authors and Affiliations

  1. Department of General Surgery, Ng Teng Fong General Hospital, Jurong Health Services, 1 Jurong East Street 21, Singapore, 609606, Singapore

    Tze Yeong Teng, Shao Nan Khor, Wei Keat Cheah & Cheryl Chien Li Lau

  2. Department of Epidemiology, Ng Teng Fong General Hospital, Jurong Health Services, 1 Jurong East Street 21, Singapore, 609606, Singapore

    Manimegalai Kailasam

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  1. Tze Yeong Teng
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Correspondence to Cheryl Chien Li Lau.

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Drs. Tze Yeong Teng, Shao Nan Khor, Manimegalai Kailasam, Wei Keat Cheah and Cheryl Chien Li Lau have no conflicts of interests or financial ties to disclose.

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Teng, T.Y., Khor, S.N., Kailasam, M. et al. Morning colonoscopies are associated with improved adenoma detection rates. Surg Endosc 30, 1796–1803 (2016). https://doi.org/10.1007/s00464-015-4448-7

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