Adenoma detection rates vary minimally with time of day and case rank: a prospective study of 2139 first screening colonoscopies

Overall, time of day and case rank did not influence adenoma detection rate. We observed a small but significant decrease in detection rates in later procedures, which was dependent on physician typical procedure volume. These findings imply that colonoscopy quality in general is stable throughout the day; however, there may be a novel “stamina effect” for some endoscopists, and interventions aimed at improving colonoscopy quality need to take individual physician practice styles into consideration.