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In our study population, ADR and withdrawal time decrease by roughly 7 and 20%, respectively, by the end of the day. Our results imply that rather than mental or physical fatigue, lower ADR at the end of the day might be driven by endoscopists rushing.

Background The adenoma detection rate (ADR) is a validated and widely used measure of colonoscopy quality. There is uncertainty in the published literature on which colonoscopy examinations should be excluded when measuring a physician’s ADR. Objective To examine the impact of varying the colonoscopy exclusion criteria on physician ADR. Design We applied different exclusion criteria used in 30 prior studies to a dataset of endoscopy and pathology reports. Under each exclusion criterion, we calculated physician ADR. Setting A private practice colonoscopy center affiliated with the University of Illinois College of Medicine. Patients Data on 20,040 colonoscopy examinations and associated pathology notes performed by 11 gastroenterologists from July 2009 to May 2013. Main Outcome Measurements ADR across all colonoscopy exainations, each physician’s ADR, and ADR ranking. Results There were 28 different exclusion criteria used when measuring ADR. Each study used a different combination of these exclusion criteria. The fraction of all colonoscopy examinations in the dataset excluded under these combinations of exclusion criteria ranged from 0 to 93.1%. The mean ADR across all colonoscopy examination was 35.9%. The change in mean ADR after applying the 28 exclusion criteria ranged from −4.6 to +3.1 percentage points. However, the exclusion criteria impacted each physician’s ADR relatively equally, and therefore physicians’ rankings via ADR were stable. Limitations ADR assessment was limited to a single private endoscopy center. Conclusions There is wide variation in the exclusion criteria used when measuring ADR. Although these exclusion criteria can impact overall ADR, the relative rankings of physicians by ADR were stable. A consensus definition on which exclusion criteria are applied when measuring ADR is needed.

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