Impact of 9-Minute Withdrawal Time on the Adenoma Detection Rate: A Multicenter Randomized Controlled Trial

Zhao, Shengbing; Yang, Xianghong; Wang, Shuling; Meng, Qianqian; Wang, Rundong; Bo, Lumin; Chang, Xin; Pan, Peng; Xia, Tian; Yang, Fan; Yao, Jun; Zheng, Jinghua; Sheng, Jian-qiu; Zhao, Xiaojun; Tang, Stephen; Wang, Yali; Wang, Yiping; Gong, Aixia; Chen, Weigang; Shen, Jianwei; Zhu, Xian Lun; Wang, Shaofeng; Yan, Caiwen; Yang, Youlin; Zhu, Yangbei; Ma, Rujian; Wang, Rong; Ma, Yussanne; Li, Zhao‐Shen

doi:10.1016/j.cgh.2020.11.019

Cited by 34 publications

(41 citation statements)

References 27 publications

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“…Therefore, trainees and even endoscopists early in their career would benefit from longer withdrawal times. This hypothesis was also supported by Zhao et al as the less experienced endoscopists benefitted the most from the 9‐min CWT 20 …”

Section: Discussionsupporting

confidence: 58%

“…Zhao et al . report that proximal colonic lesions were more likely to be detected with an increase in CWT 20 …”

Section: Resultsmentioning

confidence: 94%

“…Thus, seven studies were included in their entirety as shown in Table 1. These included two randomized clinical trials, two cancer registries, and three retrospective studies with a total of 69 551 patients included in the cohort 8,11,20–24 …”

Section: Resultsmentioning

confidence: 99%

“…There is extensive evidence from retrospective and prospective studies showing that longer colonoscopy withdrawal time improves ADR and SDR and reduces risk of cancer development 7,8,11,20,24 . However, these findings have not been reported consistently in other studies 9,14–16 .…”

Section: Discussionmentioning

confidence: 99%

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A comparison of 9‐min colonoscopy withdrawal time and 6‐min colonoscopy withdrawal time: A systematic review and meta‐analysis

Bhurwal

Rattan

Sarkar

et al. 2021

J of Gastro and Hepatol

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Introduction The optimal colonoscopy withdrawal time is still a controversial topic. While several studies demonstrate that longer withdrawal time improves adenoma detection rate, others have contradicted these findings. Methods Three independent reviewers performed a comprehensive review of all original articles published from inception to January 2021 and included studies reporting comparison of the two cohorts—(i) ≥ 6 but less than 9 min of colonoscopy withdrawal time (CWT) and (ii) ≥ 9 min of CWT. The outcome measures were the following: (i) adenoma detection rate (ADR), (ii) advanced ADR, and (iii) sessile serrated adenoma detection rate (SDR). The meta‐analysis was performed, and the statistics were two‐tailed. Results A total of seven studies met the inclusion criteria after a thorough search of the literature was completed. The analysis revealed that ≥ 9 min of CWT had significantly higher odds of adenoma detection as compared with 6–9 min of CWT (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.30–1.82; I2 = 93.7). Additionally, a significantly higher odds of sessile serrated adenoma detection (OR 1.68, 95% CI 1.28–2.22; I2 = 0) and a trend towards higher odds of advanced adenoma detection (OR 1.38, 95% CI 0.98–1.95, I2 = 90) were seen with CWT of at least 9 min when compared with 6–9 min of CWT. Conclusion This systematic review and meta‐analysis analysis provides further evidence that at least 9 min of CWT cohort had significantly higher ADR and SDR as compared with the at least 6 min but less than 9 min of cohort.

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Section: Discussionsupporting

confidence: 58%

“…Zhao et al . report that proximal colonic lesions were more likely to be detected with an increase in CWT 20 …”

Section: Resultsmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

A comparison of 9‐min colonoscopy withdrawal time and 6‐min colonoscopy withdrawal time: A systematic review and meta‐analysis

Bhurwal

Rattan

Sarkar

et al. 2021

J of Gastro and Hepatol

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“…To detect more polyps, a wealth of auxiliary devices and technology have been invented to improve adenoma detection rates (ADRs) and reduce adenoma miss rates (AMRs)[ 8 , 9 ]. However, these devices cannot overcome the limitations of colonoscopists themselves, who could overlook the polyps flashing across the video screen[ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Establishment and validation of a computer-assisted colonic polyp localization system based on deep learning

Zhao¹,

Yang²,

Wang³

et al. 2021

WJG

Self Cite

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BACKGROUND Artificial intelligence in colonoscopy is an emerging field, and its application may help colonoscopists improve inspection quality and reduce the rate of missed polyps and adenomas. Several deep learning-based computer-assisted detection (CADe) techniques were established from small single-center datasets, and unrepresentative learning materials might confine their application and generalization in wide practice. Although CADes have been reported to identify polyps in colonoscopic images and videos in real time, their diagnostic performance deserves to be further validated in clinical practice. AIM To train and test a CADe based on multicenter high-quality images of polyps and preliminarily validate it in clinical colonoscopies. METHODS With high-quality screening and labeling from 55 qualified colonoscopists, a dataset consisting of over 71000 images from 20 centers was used to train and test a deep learning-based CADe. In addition, the real-time diagnostic performance of CADe was tested frame by frame in 47 unaltered full-ranged videos that contained 86 histologically confirmed polyps. Finally, we conducted a self-controlled observational study to validate the diagnostic performance of CADe in real-world colonoscopy with the main outcome measure of polyps per colonoscopy in Changhai Hospital. RESULTS The CADe was able to identify polyps in the test dataset with 95.0% sensitivity and 99.1% specificity. For colonoscopy videos, all 86 polyps were detected with 92.2% sensitivity and 93.6% specificity in frame-by-frame analysis. In the prospective validation, the sensitivity of CAD in identifying polyps was 98.4% (185/188). Folds, reflections of light and fecal fluid were the main causes of false positives in both the test dataset and clinical colonoscopies. Colonoscopists can detect more polyps (0.90 vs 0.82, P < 0.001) and adenomas (0.32 vs 0.30, P = 0.045) with the aid of CADe, particularly polyps < 5 mm and flat polyps (0.65 vs 0.57, P < 0.001; 0.74 vs 0.67, P = 0.001, respectively). However, high efficacy is not realized in colonoscopies with inadequate bowel preparation and withdrawal time ( P = 0.32; P = 0.16, respectively). CONCLUSION CADe is feasible in the clinical setting and might help endoscopists detect more polyps and adenomas, and further confirmation is warranted.

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Linked color imaging versus conventional white light colonoscopy for the detection of colorectal polyps

Watanabe

Kanno

Kakehi³

et al. 2023

Cochrane Database of Systematic Reviews

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Impact of 9-Minute Withdrawal Time on the Adenoma Detection Rate: A Multicenter Randomized Controlled Trial

Cited by 34 publications

References 27 publications

A comparison of 9‐min colonoscopy withdrawal time and 6‐min colonoscopy withdrawal time: A systematic review and meta‐analysis

A comparison of 9‐min colonoscopy withdrawal time and 6‐min colonoscopy withdrawal time: A systematic review and meta‐analysis

Establishment and validation of a computer-assisted colonic polyp localization system based on deep learning

Linked color imaging versus conventional white light colonoscopy for the detection of colorectal polyps

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