391 Rates of Polyp and Adenoma Detection During Screening Colonoscopy are Not Significantly Affected by Time of Day

Colonoscopy yields fewer polyps as the day progresses despite using social influence theory to reverse the trend

“…Community-based sites may be more amenable to such an intervention or may be less likely to see an impact of timing on polyp yield in the first place. 4 In addition, compared with other practices, the volume of colonoscopies performed in our center is relatively low to accommodate teaching time. A larger procedure volume may lead to different results.…”

“…27 This suggests that if the relationship is found in a teaching unit that meets or exceeds quality indicators in the setting of a less time-pressured schedule, then the effect may be present in other units with more time pressure, although the effect may indeed be related to the presence of trainees. 4 Further research is needed to evaluate this finding using detailed process-of-care data collection in other settings and to develop a more effective approach of reversing the trend in settings where the phenomenon is identified, including shorter work shifts, as practiced at the Mayo Clinic, 4 among other possible solutions.…”

“…3 A fourth study, conducted in a community-based nonteaching facility, found a statistically significant 34% higher odds of detecting a polyp in the morning than in the afternoon. 4 However, when focusing only on adenomas, there was a nonsignificant 17% increase in the odds of adenoma detection, although the study did not report hour-by-hour trends within a shift (in contrast to between shifts separated by a work break). In short, it is possible that some providers are more adept at detecting polyps earlier in a work shift, at least in academic teaching facilities.…”

Does time of day affect polyp detection rates from colonoscopy?

“…16 Those authors concluded that cecal intubation rates declined with successive procedures, and they attributed this finding to operator fatigue. 16 So there are now data from teaching, 11,12 nonteaching, 14 VA, 11 non-VA, [12][13][14]16 U.S., [11][12][13][14] and European 16 centers that at least raise time of day as a possible factor affecting colonoscopy outcomes.…”