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World J Gastrointest Endosc. Dec 16, 2021; 13(12): 619-627
Published online Dec 16, 2021. doi: 10.4253/wjge.v13.i12.619
When should we perform colonoscopy to increase the adenoma detection rate?
Sang Hoon Kim, Jae Hak Kim
Sang Hoon Kim, Jae Hak Kim, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang 10326, South Korea
Author contributions: All authors equally contributed to data collection, data interpretation, and literature review; all authors wrote the paper, contributed to critical revision of the manuscript and granted final approval of the version to be published.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jae Hak Kim, MD, PhD, Professor, Department of Internal Medicine, Dongguk University Ilsan Hospital, No. 27 Dongguk-ro, Ilsandong-gu, Goyang 10326, South Korea. kimjaehak@dumc.or.kr
Received: March 18, 2021
Peer-review started: March 18, 2021
First decision: July 17, 2021
Revised: July 30, 2021
Accepted: November 30, 2021
Article in press: November 30, 2021
Published online: December 16, 2021
Abstract

The rate of adenoma detection is the most reliable quality indicator of colonoscopy. Studies have reported that colonoscopy performed in morning has a higher adenoma detection rate (ADR) than that performed in the afternoon. These studies have explained that several physician-related factors such as undergoing an emergency procedure the night before colonoscopy, accumulated workload, and increased fatigue level in the afternoon might have led to such finding. However, several opposing articles have indicated that the time of day and ADR is not quite related. Complex confounding factors can impact study results. Colonoscopy withdrawal time and bowel preparation quality are key factors. However, queue list numbers, participation of academic fellows, nurses' assistance, and the number of colonoscopies allocated per hour are also notable factors. Recently, an attempt has been made to homogenize the ADR in the morning and afternoon through artificial intelligence-assisted colonoscopy. This review article introduces the history of this long-debated topic, discusses points to consider in real-world practice, and suggests new ideas for planning future research. By understanding this issue, the rate of adenoma detection during colonoscopy is expected to be improved further.

Keywords: Colonoscopy, Colorectal cancer, Time of endoscopy, Afternoon colonoscopy, Adenoma detection rate

Core Tip: Adenoma detection rate is the most reliable indicator of colonoscopy quality. Studies suggest that colonoscopy performed in the morning is associated with a higher detection rate of adenoma than the procedure performed in the afternoon. However, it is important to endeavor not only to improve patients' bowel preparation quality in the afternoon, but also to create an environment conducive to adenoma detection by physicians during afternoon sessions.