Colonoscopy withdrawal time and polyp/adenoma detection rate: a single‐site retrospective study in regional Queensland

Abstract

Backgrounds Bowel cancer is the second most common non‐cutaneous cancer diagnosed in Australia among both genders. Colonoscopy withdrawal time of at least 6 min has been accepted as the standard to achieve the target polyp detection rate (PDR) and adenoma detection rate (ADR). A retrospective review was conducted in Bundaberg Hospital to evaluate the relationship between colonoscopy withdrawal time against polyp, adenoma and cancer detection rates. Methods A retrospective study was carried out in Bundaberg Hospital on patients who had colonoscopies performed between 1 October 2016 and 30 September 2017 by the general surgical team. Data collection was conducted by reviewing patient charts, general practitioner referral letters and endoscopy reports. Statistical analysis was performed with chi‐squared test using Prism 8.2.1. Results A total of 1579 colonoscopies were analysed. The median age of patients undergoing a colonoscopy was 64 years (95% confidence interval (CI) 60.55–61.93). Median total duration of colonoscopy was 19 min (95% CI 20.9–22.0), with median withdrawal time of 9 min (95% CI 10.06–10.95). PDR, ADR and sessile serrated adenoma (SSA) detection rates were 43.3%, 33.1% and 5.4%, respectively. Cancer detection rate was 2.8%. Longer withdrawal times were associated with higher PDR, ADR and SSA detection rates (P < 0.0001) and higher mean number of polyp/adenoma/SSA detected. Conclusion Colonoscopies with withdrawal times of less than 6 min did not achieve the target detection rates. It is clear that achieving the advocated withdrawal time for screening colonoscopy improves detection rates.

Quality of rural colonoscopy—A prospective single‐centre pilot study

“…By application of conversion factors and comparison to another rural Australian study, it is likely that the ADR in this study is acceptable. 12,13,18 Colonic perforation after colonoscopy is one of the most feared complications. During the data collection period, 2 patients suffered from a perforation.…”

“…4,[7][8][9][10] This is consistent with other single-centre quality assurance studies focusing on colonoscopy undertaken in the rural setting. [18][19][20] The completion rate of colonoscopies in this study met targets outlined by various guidelines and professional groups. 4,[7][8][9][10] The completion rate is also similar to those in other Australian studies.…”

“…4,[7][8][9][10] The completion rate is also similar to those in other Australian studies. 18,19 Although PR has been studied as a surrogate marker for ADR, 12,13 a conversion factor has not been validated in the Australian population. In this study, only the PR was recorded and therefore the true ADR is not known.…”

Challenges in Crohn’s Disease Management after Gastrointestinal Cancer Diagnosis

“…An extremely meticulous bowel preparation is crucial to allow the endoscopic detection of nonpolypoid mucosal lesions [ 76 ]. In addition, an accurate colonoscope withdrawal is crucial and a time longer than 6 minutes has been demonstrated to increase the probability of mucosal malignancy and pre-malignancy detection [ 77 ]. Moreover, a high-definition endoscopy with chromoendoscopy with targeted biopsies of any visible lesions should be performed during surveillance [ 78 ].…”

Improving trainee colonoscopy performance by investigating the withdrawal time from individual colonic segments: a single-center observational study

“…The colonoscopy WT and ADR are widely used quality indicators for colonoscopy performed by trainees (11,24). Multiple studies have shown that a prolonged WT in colonoscopies performed by skilled endoscopists results in a higher ADR (25,26), and a ≥6-minute average WT in negative screening colonoscopies is recommended by the American Society for Gastrointestinal Endoscopy (27). Barclay et al (3) observed a dramatic increase in the ADR for endoscopists with a mean WT >6 minutes compared with those with a WT <6 minutes (28% vs. 12%); the mean WT was 6.3±3.9 minutes.…”