Colonoscopy is a gold standard investigation that is widely used for the diagnosis, screening, and treatment of colorectal lesions. The performance of high-quality colonoscopy is required as it allows the direct visualization and evaluation of large intestinal mucosa, tissue sampling, and polyp removal. It is considered the preferred and prominent tool used in colorectal cancer (CRC) screening and prevention in the United States [1].

Although colonoscopy is a safe and well-tolerated procedure, it is a complex technique that needs good training and experience to optimize its accuracy; therefore, guidelines have been developed by professional societies, including the American Society of Gastrointestinal Endoscopy (ASGE) and European Society of Gastrointestinal Endoscopy (ESGE), for the optimal and effective utilization of colonoscopy [[2], [3]].

Adenoma detection rate (ADR) is one of the most reliable indicators that could reflect the variations of quality in colonoscopy practice based on the discrepancy among endoscopists in adenoma and colorectal neoplasia detection. However, ADR may be affected by multiple factors, including the quality of bowel preparation; complete colonic examination, including cecal intubation rate (CIR); procedure duration; withdrawal time [[4], [5], [6], [7]]; and the expertise of the endoscopist.

CRC is the most common leading cause of mortality and the third most common cancer worldwide, accounting for approximately 700,000 deaths annually [8]. Geographical variation exists in the CRC incidence rate, with higher rates documented in countries with moderate and high human development indices [9]. The variability in the CRC incidence rate is related to multiple risk factors, including age; sex; nutrition; smoking; family history; underlying diseases, such as inflammatory bowel; and other factors.

In Egypt, although some studies pertaining to CRC have been published, robust national data are not available to date. An Egyptian case series study found that 10.6 % of symptomatic patients who underwent colonoscopy had CRC [[10], [11]]. Another study reported that CRC in Egypt accounted for 4.4 % of newly diagnosed cancer compared with 13 % in Western countries [12]. The paucity of data about the true CRC prevalence in Egypt and the lack of national quality indicators of colonoscopy may contribute to the delay in the implementation of a national screening program in Egypt.