Impact of endoscopist withdrawal speed on polyp yield: implications for optimal colonoscopy withdrawal time

Abstract

SummaryBackgroundIn 2002, a U.S. Multi‐Society Task Force on Colorectal Cancer recommended that the withdrawal phase for colonoscopy should average at least 6–10 min. This was based on 10 consecutive colonoscopies by two endoscopists with different adenoma miss rates.AimsTo characterize the relationship between endoscopist withdrawal time and polyp detection at colonoscopy, and to determine the withdrawal time that corresponds to the median polyp detection rate.DesignProcedural data from out‐patient colonoscopies performed at the Mayo Clinic, Rochester during 2003 were reviewed. Endoscopists were characterized by their mean withdrawal time for a negative procedure and individual polyp detection rate.ResultsA total of 10 955 colonoscopies performed by 43 endoscopists were analysed. Median withdrawal time was 6.3 min (range: 4.2–11.9); polyp detection rate was 44.0% (all polyps), 29.8% (≤5 mm), 5.9% (6–9 mm), 6.7% (10–19 mm), 2.1% (≥20 mm). Longer withdrawal time was associated with higher polyp detection rate (r = 0.76; P < 0.0001); this relationship weakened for larger polyps (r = 0.19 for polyps 6–9 mm, r = 0.28 for polyps 10–19 mm, r = 0.02 for polyps ≥20 mm). Overall median polyp detection rate corresponded to a withdrawal time of 6.7 min.ConclusionOur findings support a colonoscopy withdrawal time of at least 7 min, which correlates with higher colon polyp detection rates.

Quality Indicators for Colonoscopy Procedures

“…This study confirmed the work from the Mayo Clinic showed that 50% of polyps were diagnosed an average withdrawal time of 6.7 minutes, and 90% of polyps to a withdrawal time of 12 minutes (17). A recent observational study conducted among 315 gastroenterologists practicing in 17 U.S. states has confirmed the results of Simmons et al study, showing that those with an average withdrawal time equal to 6 min detected 1.8 times more polyps than other (18).…”

Comparison of Pentax HiLine and Olympus Lucera systems at screening colonoscopy

“…The expected incidence of CRC in one study, based on missed adenomas at screening colonoscopy, was 1.1 per 1000 persons within 5 years [3] . The effect of a variety of technical manoeuvres and mucosal enhancement technologies on adenoma detection and miss rates has been studied, including prolongation of colonoscope withdrawal time [4] , systematic patient positioning [5] , pancolonic dye-spray chromoendoscopy [6] , cap-assisted colonoscopy [7] , narrow band imaging (NBI) [8] and endoscopic trimodal imaging [9] , with variable degrees of success.…”

Maintaining Quality in Endoscopy

“…This may be explained by the possibility that longer withdrawal times were representative of more difficult rather than more careful examinations. Additionally longer withdrawal times have been found to correlate with the detection of smaller polyps (Simmons, Harewood et al 2006), not all of which might have been removed at colonoscopy.…”

“…Endoscopists who took longer than 6 minutes to withdraw the colonoscope were found to have very low miss rates and more than 2-fold higher rates of detection of both small and large adenomas Barclay, Vicari et al 2006;Simmons, Harewood et al 2006). It has therefore been recommended that withdrawal of the colonoscope in patients without any prior colonic surgery should last at least 6 minutes on average (Rex, Petrini et al 2006).…”