Effect of a Time-Dependent Colonoscopic Withdrawal Protocol on Adenoma Detection During Screening Colonoscopy

Barclay, Robert L.; Vicari, Joseph J.; Greenlaw, Roger L.

doi:10.1016/j.cgh.2008.04.018

Cited by 246 publications

(167 citation statements)

References 35 publications

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“…8,21 The ADR for all patients undergoing first-time screening colonoscopy irrespective of diverticulosis status was 33.1% in this study. This high ADR may be attributable to use of high-definition or highresolution colonoscopes and to careful examinations denoted by a median withdrawal time of 11 minutes, which was in excess of the minimum 6-8 minutes withdrawal time that has been recommended in recent studies 22,23 and by ASGE guidelines on "Quality Indicators for Colonoscopy." 8 It should be noted that most polyps were removed during scope withdrawal, and the time required for polypectomy was also included in the withdrawal time.…”

Section: Discussionmentioning

confidence: 99%

Colonic diverticulosis is associated with an increased adenoma detection rate in patients undergoing first-time screening colonoscopy

Gohil

Patrie²,

Shami³

et al. 2012

jig

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Background: Diverticulosis is a common finding in patients undergoing colonoscopy. The effect of colonic diverticulosis on the colorectal adenoma detection rate (ADR) and other colonoscopy quality indicators remains unclear. Objectives: To determine if colonic diverticulosis is associated with differences in (1) colorectal ADR and (2) other quality indicators and operating characteristics in patients undergoing first-time screening colonoscopy. Methods: Retrospective cohort study conducted at an outpatient surgical center affiliated with an academic medical center. Results: 300 consecutive patients (190 women) with a median age of 57 years (range: 23-70 years) who underwent colonoscopy for various indications were included. 108 (36%) of these 300 patients had diverticulosis found on colonoscopy. 142 (47.3%) of these patients (88 women, median age of 52 years) underwent their first screening colonoscopy. In this population, the frequency of colonic diverticula was 39.2%, and the ADR was 47.5% for patients with diverticulosis and 27.4% for patients without diverticulosis. Multivariate analysis revealed that the presence of diverticulosis had an associated odds ratio of 2.3 (p=0.04) in favor of finding at least one adenoma. No statistically significant differences were found among the rates of total colonoscopy, median scope insertion and withdrawal times, and the amounts of midazolam and fentanyl required for sedation when patients with diverticulosis were compared to those without diverticulosis. Conclusion: Colonic diverticulosis was associated with an increased ADR in patients undergoing first-time screening colonoscopy. The presence of colonic diverticulosis did not adversely affect the cecal intubation rate, scope insertion or withdrawal times, or sedation requirements.

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Section: Discussionmentioning

confidence: 99%

Colonic diverticulosis is associated with an increased adenoma detection rate in patients undergoing first-time screening colonoscopy

Gohil

Patrie²,

Shami³

et al. 2012

jig

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“…In Barclay's et al intervention 78 , the education component, that preceded the withdrawal protocol implementation, likely played an important role. The Endoscopic Quality Improvement Program (EQUIP) is a recently described educational process 79 .…”

Section: Withdrawal Time Interventionsmentioning

confidence: 99%

Colonoscopy Quality Assessment

Fayad

Kahi

2015

Gastrointestinal Endoscopy Clinics of North America

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Abstract: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.

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“…Intraprocedure variables a ecting careful mucosal inspection include: adequate air insu ation, washing and suctioning of debris and uid, attention to exures and folds, and repetitive segment viewing. Finally, slow withdrawal of the colonoscope leads to higher adenoma detection rates and higher detection of advanced adenomas (3,4) .…”

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confidence: 99%

Editorial: The Influence of Timing of Colonoscopy on Adenoma Detection: Is Timing Everything?

Vicari¹

2009

Am J Gastroenterol

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Colorectal cancer is a common disease in the United States. The majority of sporadic colorectal cancers develop from adenomatous polyps. In the United States, the incidence of colorectal cancer is declining, most likely because of colonoscopic polypectomy. Adenoma detection rate is affected by the quality of prep, careful mucosal inspection, and withdrawal time. In this issue of the Journal, there is intriguing evidence that the timing of colonoscopy, morning vs. afternoon, affects adenoma detection rate. Physician fatigue is postulated as a factor leading to lower polyp detection rates in the afternoon compared with the morning. Further, prospective studies are needed to confi rm these fi ndings and determine the effect on clinical practice. Am J Gastroenterol 2009; 104:1666-1667 doi: 10.1038/ajg.2009 Colorectal cancer is the second leading cause of cancer and the third leading cause of cancer death in the United States.e incidence of colon cancer is declining in the United States, most likely because of colonoscopic polypectomy. Colonoscopy and polypectomy are prominent tools in both the diagnosis and prevention of colorectal cancer (1) .e e ectiveness of colonoscopy in detecting and removing polyps depends on the technical aspects of colonoscopy. Colonoscopy is a technically challenging procedure to carry out. Several factors a ect the outcome of a successful colonoscopy: cecal intubation, careful mucosal inspection, and withdrawal time (2) . Cecal intubation is critical to an e ective colonoscopy. Cecal intubation is achieved when the tip of the colonoscope has passed beyond the lip of the ileocecal valve into the caput coli, allowing e ective visualization of the medial walls of the cecum lining proximal to the ileocecal valve (1) . Cecal intubation rates ≥ 95 % should be achieved for screening colonoscopy.Careful mucosal inspection depends on several variables. A quality preparation is crucial to successful visualization of the colonic mucosa. Intraprocedure variables a ecting careful mucosal inspection include: adequate air insu ation, washing and suctioning of debris and uid, attention to exures and folds, and repetitive segment viewing. Finally, slow withdrawal of the colonoscope leads to higher adenoma detection rates and higher detection of advanced adenomas (3,4) .In this issue of the Journal, Sanaka et al. (5) examined the in uence of the timing of colonoscopy, morning vs. a ernoon, on adenoma detection rate. is was a retrospective study of asymptomatic patients. e most pertinent nding is a signicantly higher adenoma detection rate in the morning (29.3 % ) compared with the a ernoon (25.3 % ). In addition, there was a signi cant decline in adenoma detection rate with each subsequent hour of the day. e highest adenoma detection rate was found in the initial hour of the morning (34.2 % ) and the lowest adenoma detection rate was found in the nal hour of the a ernoon (22.4 % ). ere was no signi cant di erence in size, number, or pathology of adenomas when comparing the groups. ere was a signi...

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Effect of a Time-Dependent Colonoscopic Withdrawal Protocol on Adenoma Detection During Screening Colonoscopy

Cited by 246 publications

References 35 publications

Colonic diverticulosis is associated with an increased adenoma detection rate in patients undergoing first-time screening colonoscopy

Colonic diverticulosis is associated with an increased adenoma detection rate in patients undergoing first-time screening colonoscopy

Colonoscopy Quality Assessment

Editorial: The Influence of Timing of Colonoscopy on Adenoma Detection: Is Timing Everything?

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