Colonoscopy is the cornerstone of colorectal cancer screening programs. There is significant variability in the quality of colonoscopy between endoscopists. Colonoscopy quality assessment tracks various metrics in  order  to  improve  the  effectiveness  of  colonoscopy,  aiming  at  reducing  the  incidence  and  mortality  from colorectal cancer. Adenoma detection rate is the prime metric, as it is associated with the risk of interval  cancers.  Implementing  processes  to  measure and improve the adenoma detection rate  is  essential to improve the quality of colonoscopy.