Abstract
Objective
Colonoscopy performed in the afternoon, rather than morning, has been reported to
be associated with lower rates of adenoma and polyp detection (ADR and PDR) and cecal
intubation (CIR). This meta-analysis evaluated the efficacy of afternoon colonoscopy
relative to morning colonoscopy.
Methods
The databases MEDLINE, Web of Science, EMBASE, and the Cochrane Library were searched
to identify potential relevant studies. The primary outcome was ADR and the secondary
outcomes were CIR and PDR. The outcomes were estimated by relative risk (RR) and 95%
confidence interval (CI) with a random effects model.
Results
Sixteen studies with 38,063 participants met the inclusion criteria. The pooled analyses
indicated that ADR (RR: 1.08, 95% CI: 1.00–1.17) and CIR (RR: 1.01, 95% CI: 1.00–1.02)
were stable during the whole day. In subgroup analyses, the effect of full-day block
or inferior bowel preparation were more prominent, reflected by a significant reduction
of ADR (RR: 1.18, 95% CI: 1.09–1.28; RR: 1.12, 95% CI: 1.01–1.24) and CIR (RR: 1.08,
95% CI: 1.02–1.13; RR: 1.02, 95% CI: 1.01–1.03) in the afternoon, respectively.
Conclusions
Colonoscopy quality, as indicated by the ADR and CIR, is not affected by the time
of day for procedures performed in block shifts. However, endoscopists’ working full-day
blocks and inferior bowel preparation are associated with a significant decrease in
ADR and CIR in the afternoon.
Keywords
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Article info
Publication history
Published online: April 09, 2018
Accepted:
March 27,
2018
Received in revised form:
March 20,
2018
Received:
September 11,
2017
Identification
Copyright
© 2018 Published by Elsevier Ltd on behalf of Editrice Gastroenterologica Italiana S.r.l.
