Polyp detection rate in transverse and sigmoid colon significantly increases with longer withdrawal time during screening colonoscopy

Abstract

BackgroundThe guidelines for colonoscopy present withdrawal time (WT) and adenoma detection rate (ADR) as the quality indicator. The purpose of this retrospective study is to analyze the predicting factors with polyp detection rate (PDR) as a surrogate for ADR by using comprehensive health checkup data, and assess the correlation between PDR per each colonic segment and WT, and factors influencing WT.MethodsOne thousand and thirty six consecutive health checkup cases from April 2015 to March 2016 were enrolled in this study, and 880 subjects who undertook colonoscopy without polyp removal or biopsy were divided into the two groups (polyp not detected group vs polyp detected group). The two groups were compared by subjects and clinical characteristics with univariate analysis followed by multivariate analysis. Colonoscopies with longer WT (≥ 6 min) and those with shorter WT (< 6 min) were compared by PDR per each colonic segment, and also by subjects and clinical characteristics.ResultsA total of 1009 subjects included two incomplete colonoscopies (CIR, 99.9%) and overall PDR was 35.8%. A multiple logistic regression model demonstrated that age, gender, and WT were significantly related factors for polyp detection (odds ratio, 1.036; 1.771; 1.217). PDR showed a linear increase as WT increased from 3 min to 9 min (r = 0.989, p = 0.000) and PDR with long WT group was higher than that with short WT group per each colonic segment, significantly in transverse (2.3 times, p = 0.004) and sigmoid colon (2.1 times, p = 0.001). Not only bowel preparation quality but also insertion difficulty evaluated by endoscopist were significant factors relating with WT (odds ratio, 3.811; 1.679).ConclusionThis study suggests that endoscopists should be recommended to take more time up to 9 min of WT to observe transverse and sigmoid colon, especially when they feel no difficulty during scope insertion.

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“…We retrospectively searched the electronic clinical databases for consecutive 1036 cases who underwent regular health check-ups, including colonoscopy, over a 12-month period (April 2015 to March 2016). These cases were the same as those reported previously [ 13 ]. Colonoscopes used were 260 series variable stiffness instruments (PCF-Q260AI and PCF-PQ260L/I; Olympus Medical System.…”

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“…Cecum cannulation was done in all STRC patients compared to 87.18 % of no-STRC group. Withdrawal time should last a minimum of 6 minutes to ensure good examination 27 and more than 9 minutes for high-quality colonoscopy 28 . In our study, withdrawal times (> 9 minutes) were similar in both groups.…”

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“…Fourth, other factors such as withdrawal time and sedation administered were inconsistent or not reported. [ 19 , 20 ] Fifth, our results shown that no statistically significant difference of the advanced lesions detection rate was found. Due to the small sample size of each trial and small number of advanced lesions, type II error appears to be quite likely exist.…”