Minor performance measure	Withdrawal time
Description	Time spent on withdrawal of the endoscope from cecum to anal canal and inspection of the entire bowel mucosa at negative (no biopsy or therapy) screening or diagnostic colonoscopy
Domain	Identification of pathology
Category	Process
Rationale	A mean withdrawal time of 6 min or longer was associated with higher ADRs and lower interval cancer rates as compared to shorter withdrawal times.
Construct	Withdrawal time is measured from cecum to anal sphincter
	Denominator: Number of negative (no biopsy/therapy) screening or diagnostic colonoscopies
	Numerator: Sum of withdrawal time in colonoscopies included in the numerator
	Exclusions:
	– Emergency colonoscopy
	– Incomplete colonoscopy
	Calculation: Mean time in minutes
	Level of analysis: Endoscopist level
	Frequency: Measured only if the ADR is insufficient, using a sample of 100 consecutive colonoscopies
Standards	Minimum standard: mean 6 min
	Target standard: mean 10 min
	Time can be measured by different methods: stopwatch operated by a nurse, time stamp on photodocumentation of the cecum and rectum, length of video recording, or external device (this requires inclusion of the withdrawal time in the colonoscopy report).
	Withdrawal time should be measured only when the ADR is insufficient.
	Feedback on mean withdrawal time should be given to endoscopists.
Consensus agreement	87.5%
PICO	3.6 (see Supporting Information)
Evidence grading	Moderate quality evidence