@article {635809,
	title = {Adenoma Detection Rate Falls at the End of the Day in a Large Multi-site Sample},
	journal = {Dig Dis Sci},
	volume = {63},
	number = {4},
	year = {2018},
	pages = {856-859},
	abstract = {BACKGROUND:There is concern that mental and physical fatigue among endoscopists over the course of the\&nbsp;day\&nbsp;will lead to lower\&nbsp;adenoma\&nbsp;detection\&nbsp;rate\&nbsp;(ADR). There are mixed findings in the prior literature on whether such an association exists.AIMS:The aim of this study was to measure the association between the number of colonoscopies performed in a\&nbsp;day\&nbsp;and ADR and withdrawal time.METHODS:We analyzed 86,624 colonoscopy and associated pathology reports between October 2013 and September 2015 from 131 physicians at two medical centers. A previously validated natural language processing program was used to abstract relevant data. We identified the order of colonoscopies performed in the physicians{\textquoteright} schedule and calculated the ADR and withdrawal time for each colonoscopy position.RESULTS:The ADR for our overall\&nbsp;sample\&nbsp;was 29.9 (CI 29.6-30.2). The ADR for colonoscopies performed at the 9th\&nbsp;+\&nbsp;position was significantly lower than those at the 1st-4th or 5th-8th position, 27.2 (CI 25.8-28.6) versus 29.9 (CI 29.5-30.3), 30.2 (CI 29.6-30.9), respectively. Withdrawal time steadily decreased by colonoscopy position going from 11.6 (CI 11.4-11.9)\&nbsp;min for the 1st colonoscopy to 9.6 (8.9-10.3)\&nbsp;min for the 9th colonoscopy.CONCLUSION:In our study population, ADR and withdrawal time decrease by roughly 7 and 20\%, respectively, by the\&nbsp;end\&nbsp;of the\&nbsp;day. Our results imply that rather than mental or physical fatigue, lower ADR at the\&nbsp;end\&nbsp;of the\&nbsp;day\&nbsp;might be driven by endoscopists rushing.},
	author = {Marcondes FO and Gourevitch RA and Schoen RE and Crockett SD and Morris M and Mehrotra A}
}
