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The Relationship Between Colonoscopy Procedure Order and Adenoma Detection Rates

A Prospective Study

Kang, Hae Yeon, MD, PhD*; Kim, Donghee, MD, PhD*; Kim, Hwa Jung, MD, PhD; Kang, Seung Joo, MD, PhD*; Chung, Goh Eun, MD, PhD*; Song, Ji Hyun, MD, PhD*; Yang, Sun Young, MD, PhD*; Kim, Young Sun, MD, PhD*; Park, Min Jung, MD, PhD*; Yim, Jeong Yoon, MD, PhD*; Lim, Seon Hee, MD, PhD*; Kim, Joo Sung, MD, PhD*,‡

Journal of Clinical Gastroenterology: September 2015 - Volume 49 - Issue 8 - p 683–689
doi: 10.1097/MCG.0000000000000258
ALIMENTARY TRACT: Original Articles

Goals: The aim of this study was to prospectively assess the effects of the order of colonoscopic procedures and other possible factors on the adenoma detection rate (ADR).

Background: There have been conflicting studies regarding the timing or order of a colonoscopy and its ability to detect adenomas.

Study: Between March 2011 and July 2011, consecutive colonoscopies were prospectively performed by 7 board-certified staff endoscopists at the Seoul National University Hospital Healthcare System Gangnam Center. The primary outcome was the overall ADR according to the procedure order of the colonoscopies, and the secondary outcome was the identification of other possible factors influencing the ADR.

Results: A total of 1908 colonoscopies were analyzed. The detection rate was 56.5% for all polyps and 37.3% for adenomas. The ADR increased as the performance order of the colonoscopy increased and was highest for the third procedure (43.4%). However, the ADR of the remaining procedures, including later procedures, was similar throughout the workday. In the multivariable analysis, the ADR was significantly associated with older age, male sex, high body mass index, personal history of colorectal polyps, long withdrawal time, and an experienced endoscopist. However, the colonoscopy procedure order was not significantly associated with the ADR.

Conclusions: The ADR was stable according to the procedure order for the later procedures of the workday in a setting of moderate daily procedure volumes. The withdrawal time and experience level of the endoscopist were more important than the procedure order in detecting adenomas by colonoscopy.

*Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center

Department of Preventive Medicine, Ulsan University College of Medicine

Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea

D.K. and H.Y.K.: designed and performed the research; S.J.K., G.E.C., J.H.S., S.Y.Y., M.J.P., J.Y.Y., and S.H.L.: performed colonoscopy; H.Y.K., D.K., and H.J.K.: analyzed and interpreted data; H.Y.K. and D.K.: wrote the paper; D.K., Y.S.K., and J.S.K.: revised the article for the important intellectual content. All authors approved the final version.

Supported by Grant 0420101030 (2010-1143) from the Seoul National University Hospital Research Fund.

The authors declare that they have nothing to disclose.

Reprints: Donghee Kim, MD, PhD, Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, 39th FL, Gangnam Finance Center, 737 Yeoksam-dong, Gangnam-gu, Seoul 135-984, South Korea (e-mail:

Received March 27, 2014

Accepted September 9, 2014

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.