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MORNING VS. AFTERNOON COLONOSCOPY: EFFECT OF PROCEDURE TIME ON ADENOMA DETECTION

Mahsa Taghiakbari 1, Sara-Ivana Calce 1, Douglas Kevin Rex 2, Roupen Djinbachian 1, Alan N. Barkun 3, Victoire Michal 4, Claire Gefflot 4, Mickael Bouin 1, Simon Bouchard 1, Benoit Panzini 1, Erik Deslandres 1, Dane Christina Daoud 1, Robert Battat 1, Katarzyna Orlicka 1, Edmond-Jean Bernard 1, Jeremy Liu Chen Kiow 1, Daniel von Renteln 1

Affiliations

1 University of Montreal Hospital Center (CHUM), Montreal, Canada

2 Indiana University School of Medicine, Indianapolis, United States

3 McGill University Health Centre and McGill University, Montreal, Canada

4 University of Montreal Hospital Research Center (CRCHUM), Montreal, Canada

Summary

AI Generated

Prospective video-recorded study of 1,437 colonoscopies found morning procedures had longer corrected withdrawal time and modestly higher adenoma detection rates than afternoon procedures, suggesting time-of-day effects on endoscopist performance.

Morning colonoscopies had significantly longer mean corrected withdrawal time than afternoon procedures (8'49'' vs. 8'11''; P=0.002), despite similar per-lesion intervention durations.
Afternoon procedures required on average 1'42'' more corrected withdrawal time to achieve adenoma detection rate threshold of 35% compared to morning procedures (10'02'' vs. 8'20'').
For each additional minute of corrected withdrawal time, adenoma detection odds increased by 7.2% in morning versus 5.9% in afternoon, and advanced adenoma detection increased by 13.1% in morning versus 7.8% in afternoon.
Mean adenoma detection rate was higher in morning (36.2%) than afternoon (32.4%), though not statistically significant (P=0.138); advanced adenoma detection rate showed similar pattern (7.2% vs. 6.5%, P=0.652).
Study of 19 endoscopists at single center used video recording with real-time annotation and adjusted for patient demographics, bowel preparation quality, and other factors.

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Abstract

Introduction

Endoscopist performance may fluctuate throughout the day, potentially influencing adenoma detection during colonoscopy. Endoscopist fatigue has been proposed as contributing factor but few studies have rigorously examined its impact using precise quality metrics^1,2.

Aims & Methods

This study compared corrected withdrawal time (cWT) and lesion detection metrics between morning and afternoon procedures to assess the effect of procedural timing.
We conducted a prospective analysis of elective colonoscopies performed in adult patients (≥18 years) at the University of Montreal Hospital Center by 19 endoscopists. All procedures were video-recorded and annotated in real-time by trained research assistants. Procedures performed solely for polypectomy, those with incomplete examinations, technical failures, or performed by endoscopists with fewer than 10 colonoscopies were excluded. cWT was defined as the withdrawal time minus the duration of all therapeutic interventions. The primary outcome was the comparison of mean cWT between morning and afternoon colonoscopies. Secondary outcomes included the cWT required to reach ADR threshold ≥35%, adenoma detection rate (ADR), advanced ADR (AADR), sessile serrated lesion detection rate (SSLDR), adenomas per colonoscopy (APC), and the per-lesion intervention time, all stratified by time of day. The increase of all performance measures per additional cWT minute were further compared across time of day, adjusting for patient demographics, bowel preparation quality, indication for colonoscopy, computed-assisted detection use, and clustering by individual endoscopist using generalized estimated equations.

Results

A total of 1,437 colonoscopies were included, of which 665 were performed in the morning and 772 in the afternoon. Morning colonoscopies had significantly longer mean cWT than afternoon procedures (8'49'' vs. 8'11''; P=0.002), despite similar per-lesion intervention durations (1’32’’ vs 1’28’’, P=0.425). To achieve an ADR ≥35%, afternoon procedures required on average 1’42’’ more cWT than morning ones (10'02'' vs. 8'20''). Mean ADR and AADR were higher in the morning (ADR: 36.2% vs. 32.4%, P=0.138; AADR: 7.2% vs. 6.5%, P=0.652), although not statistically significant (Table 1). For each additional cWT minute, adenoma detection odds increased by 7.2% in the morning (P=0.003) and 5.9% in the afternoon (P=0.049), suggesting reduced detection efficiency later in the day despite comparable polyp intervention times. Also, the increases in the odds of detecting advanced adenoma dropped from 13.1% in the morning to 7.8% in the afternoon for each additional cWT minute. This reduction was not as steep for SSLDR and APC metrics.

Table 1. Metrics’ estimated summaries overall and by time of day.

Metrics	Overall Mean (95% CI)	Morning Mean (95% CI)	Afternoon Mean (95% CI)	Overall Increase/additional cWT minute (p-value)	Morning Increase/additional cWT minute (p-value)	Afternoon Increase/additional cWT minute (p-value)
ADR	34.2% (31.7-36.7)	36.2% (32.6-40.0)	32.4% (29.1-35.8)	6.6% (0.003)	7.2% (0.003)	5.9% (0.049)
AADR	6.8% (5.6-8.3)	7.2% (5.4-9.5)	6.5% (4.9-8.5)	10.6% (<0.001)	13.1% (<0.001)	7.8% (0.100)
SSLDR	4.8% (3.8-6.1)	4.7% (3.2-6.6)	4.9% (3.6-6.8)	12.4% (<0.001)	13.1% (0.001)	12.1% (<0.001)
APC	0.6 (0.6-0.7)	0.7 (0.6-0.8)	0.6 (0.5-0.7)	7.4% (<0.001)	7.4% (<0.001)	7.3% (<0.001)

ADR, adenoma detection rate; AADR, advanced adenoma detection rate; SSLDR, sessile serrated lesion detection rate; APC, adenoma per colonoscopy; cWT, corrected withdrawal time.

Conclusion

Colonoscopy outcomes were influenced by procedural timing, with morning examinations associated with higher adenoma detection and more efficient use of WT. Afternoon procedures required longer cWT to achieve comparable detection benchmark of ≥35%, indicating potential performance fatigue. These findings suggest that optimizing endoscopy scheduling may enhance diagnostic yield and overall quality of care.

References

1. Sanaka MR, Deepinder F, Thota PN, Lopez R, Burke CA. Adenomas are detected more often in morning than in afternoon colonoscopy. Am J Gastroenterol. 2009;104(7):1659–1665. doi:10.1038/ajg.2009.188

2. Lee CK, Cha JM, Kim WJ, et al. Endoscopist fatigue may contribute to a decline in the effectiveness of screening colonoscopy. J Clin Gastroenterol. 2015;49(7):e51–e56. doi:10.1097/MCG.0000000000000300

Disclosure

Daniel von Renteln has received research funding from ERBE Elektromedizin GmbH, Ventage, Pendopharm, Fujifilm, and Pentax, and has received consultant or speaker fees from Boston Scientific Inc., ERBE Elektromedizin GmbH, and Pendopharm. Roupen Djinbachian has received speaker fees from Fujifilm. The remaining authors declare that they have no conflict of interest.

Conference

UEG Week Berlin 2025

Topics

Colorectal

Submission format

Abstract

Session

Colorectal polyp detection and characterisation (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Round table: What is the future of endoscopy nursing?

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Round table: What is the future of endoscopy nursing?

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Abstract

Event

UEG Week Berlin 2025

Topics

Nurses

Session

ESGENA: Opening Session

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Lucy Hicks

Welcome

Deepa Jegadish Gandhi

Developing a nurse-led counselling service in hepatology across two hospitals

Sonja Beckman

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Perceived satisfaction of outpatients undergoing endoscopic examination: Cross-sectional observational study

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Perceived satisfaction of outpatients undergoing endoscopic examination: Cross-sectional observational study

Fabio Grilli 1

Affiliations

1 Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy

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Abstract

Event

UEG Week Berlin 2025

Topics

Nurses

Session

Patient care: Differences matter

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Lucy Hicks

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Deepa Jegadish Gandhi

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See It. Learn It. Use It: The new EUS-FNB needle in action

Andrea Lisotti 1

Affiliations

1 Hospital of Imola, University of Bologna, Bologna, Italy

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Abstract

Event

UEG Week Berlin 2025

Topics

Nurses

Session

New trends and developments in endoscopic techniques

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Lucy Hicks

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Deepa Jegadish Gandhi

Developing a nurse-led counselling service in hepatology across two hospitals

Sonja Beckman

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NURSE-LED CLINIC (NLC) TO STREAMLINE OPHTHALMOLOGY SCREENING FOR IBD PATIENTS PRIOR TO INITIATING SPHINGOSINE-1-PHOSPHATE RECEPTOR (S1PR) MODULATOR THERAPY

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NURSE-LED CLINIC (NLC) TO STREAMLINE OPHTHALMOLOGY SCREENING FOR IBD PATIENTS PRIOR TO INITIATING SPHINGOSINE-1-PHOSPHATE RECEPTOR (S1PR) MODULATOR THERAPY

Anum Javed 1, Anita D'Souza 1, James Alexander 1, Lucy Hicks 1

Affiliations

1 Imperial College Healthcare NHS Trust, London, United Kingdom

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Abstract

Introduction

S1PR modulators, a new class of small molecules, have shown promising results in the treatment paradigm of moderate to severe ulcerative colitis (UC). The two approved drugs, etrasimod and ozanimod, have been associated with an increased risk of macular oedema. In approved labelling for S1PR modulators, an ophthalmic evaluation is recommended prior to commencing treatment in all patients. We established a NLC to facilitate prompt ophthalmology screening at a tertiary IBD centre.

Results & Findings

In our IBD clinics, we identified 9 potential eligible patients for treatment with S1PR modulators between July 2024 – March 2025. However, 3 of these patients were eliminated from data (2 declined to initiate therapy, 1 developed acute severe UC). The remaining 6 patients were promptly referred to the Ophthalmology clinic and completed comprehensive assessment. The examination included optical coherence tomography (OCT) followed by review by Consultant Ophthalmologist as a one-stop clinic. The results were reviewed by the specialist IBD nurses who discussed the findings with the patients and arranged further follow-up if required. The treating clinician was informed of the results and patients’ GP notified. This process facilitated the establishment of a structured protocol, leading to a measurable reduction in the time required to undergo the necessary ophthalmological examinations, which would otherwise fall under the domain of primary care.

Summary & Discussion

This initiative demonstrates that a NLC can streamline the pre-treatment process for patients initiating S1PR modulators by integrating ophthalmology screening into the care pathway. The structured protocol not only ensured timely access to OCT and specialist review but also optimised communication across multidisciplinary teams. By shifting initial assessments from consultant-led services to a nurse-led model, we improved efficiency and patient experience. This model may be replicated in other centres aiming to adopt advanced therapies requiring specialist monitoring.

Conclusion

As prescribing of advance therapies including small molecules is expected to increase, demand for treatment counselling and monitoring will follow. This direct access pathway is an effective use of resources to provide a timely and valuable service, as well as reducing consultant time.

References

Sandborn WJ, Vermeire S, Peyrin-Biroulet L, et al. Etrasimod as induction and maintenance therapy for ulcerative colitis (ELEVATE): two randomised, double-blind, placebo-controlled, phase 3 studies. Lancet. 2023, 401(10383):1159-71. https://doi.org/10.1016/s0140-6736(23)00061-2

Event

UEG Week Berlin 2025

Topics

Nurses

Submission format

Abstract

Session

Abstracts II: Patient care and endoscopic techniques

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Deepa Jegadish Gandhi

Developing a nurse-led counselling service in hepatology across two hospitals

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Welcome

Ulrike Beilenhoff 1, Deepa Jegadish Gandhi 2

Affiliations

1 ESGENA Scientific Secretary, Ulm, Germany

2 Mater Misericordiae University Hospital, Dublin, Ireland

Summary

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Abstract

Event

UEG Week Berlin 2025

Topics

Nurses

Session

ESGENA: Opening Session

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Andrea Lisotti

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Lucy Hicks

Welcome

Deepa Jegadish Gandhi

Developing a nurse-led counselling service in hepatology across two hospitals

Sonja Beckman

UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Developing a nurse-led counselling service in hepatology across two hospitals

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

Developing a nurse-led counselling service in hepatology across two hospitals

Sonja Beckman 1

Affiliations

1 None, None, Switzerland

Summary

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Abstract

Event

UEG Week Berlin 2025

Topics

Nurses

Session

Innovative approaches in liver disease management

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

More Like This:

Round table: What is the future of endoscopy nursing?

Perceived satisfaction of outpatients undergoing endoscopic examination: Cross-sectional observational study

Fabio Grilli

See It. Learn It. Use It: The new EUS-FNB needle in action

Andrea Lisotti

NURSE-LED CLINIC (NLC) TO STREAMLINE OPHTHALMOLOGY SCREENING FOR IBD PATIENTS PRIOR TO INITIATING SPHINGOSINE-1-PHOSPHATE RECEPTOR (S1PR) MODULATOR THERAPY

Lucy Hicks

Welcome

Deepa Jegadish Gandhi

Developing a nurse-led counselling service in hepatology across two hospitals

Sonja Beckman

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