Impact of withdrawal time on adenoma detection rate: results from a prospective multicenter trial

BACKGROUND AND AIMS

Performing a high-quality colonoscopy is critical for optimizing the adenoma detection rate (ADR). Colonoscopy withdrawal time (a surrogate measure) of ≥6 minutes is recommended; however, a threshold of a high-quality withdrawal and its impact on ADR are not known.

METHODS

We examined withdrawal time (excluding polyp resection and bowel cleaning time) of subjects undergoing screening and/or surveillance colonoscopy in a prospective, multicenter, randomized controlled trial. We examined the relationship of withdrawal time in 1-minute increments on ADR and reported odds ratio (OR) with 95% confidence intervals. Linear regression analysis was performed to assess the maximal inspection time threshold that impacts the ADR.

RESULTS

A total of 1142 subjects (age, 62.3 ± 8.9 years; 80.5% men) underwent screening (45.9%) or surveillance (53.6%) colonoscopy. The screening group had a median withdrawal time of 9.0 minutes (interquartile range [IQR], 3.3) with an ADR of 49.6%, whereas the surveillance group had a median withdrawal time of 9.3 minutes (IQR, 4.3) with an ADR of 63.9%. ADR correspondingly increased for a withdrawal time of 6 minutes to 13 minutes, beyond which ADR did not increase (50.4% vs 76.6%, P < .01). For every 1-minute increase in withdrawal time, there was 6% higher odds of detecting an additional subject with an adenoma (OR, 1.06; 95% confidence interval, 1.02-1.10; P = .004).

CONCLUSIONS

Results from this multicenter, randomized controlled trial underscore the importance of a high-quality examination and efforts required to achieve this with an incremental yield in ADR based on withdrawal time. (Clinical trial registration number: NCT03952611.).

Narrow-band imaging versus white light for the detection of proximal colon serrated lesions: a randomized, controlled trial

BACKGROUND

The value of narrow-band imaging (NBI) for detecting serrated lesions is unknown.

OBJECTIVE

To assess NBI for the detection of proximal colon serrated lesions.

DESIGN

Randomized, controlled trial.

SETTING

Two academic hospital outpatient units.

PATIENTS

Eight hundred outpatients 50 years of age and older with intact colons undergoing routine screening, surveillance, or diagnostic examinations.

INTERVENTIONS

Randomization to colon inspection in NBI versus white-light colonoscopy.

MAIN OUTCOME MEASUREMENTS

The number of serrated lesions (sessile serrated polyps plus hyperplastic polyps) proximal to the sigmoid colon.

RESULTS

The mean inspection times for the whole colon and proximal colon were the same for the NBI and white-light groups. There were 204 proximal colon lesions in the NBI group and 158 in the white light group (P = .085). Detection of conventional adenomas was comparable in the 2 groups.

LIMITATIONS

Lack of blinding, endoscopic estimation of polyp location.

CONCLUSION

NBI may increase the detection of proximal colon serrated lesions, but the result in this trial did not reach significance. Additional study of this issue is warranted. (

CLINICAL TRIAL REGISTRATION NUMBER

NCT01572428.).