Journal
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY
Volume 20, Issue 2, Pages E168-E181Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.cgh.2020.11.019
Keywords
Colonoscopy; Withdrawal Time; Adenoma Detection Rate
Categories
Funding
- National Key R&D Program of China [2017YFC1308800, 2018YFC1313103]
- National Natural Science Foundation of China [81670473, 81873546]
- Shu Guang project of Shanghai Municipal Education Commission [19SG30]
- Shanghai Education Development Foundation [19SG30]
- Three Engineering Training Funds in Shenzhen [SYLY201718]
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Prolonging withdrawal time from 6 to 9 minutes significantly improves adenoma detection rate (ADR), especially in the proximal colon and for less experienced colonoscopists.
BACKGROUND & AIMS: Although current quality indicators of colonoscopy recommend 6 minutes as the minimum standard for withdrawal time (WT), the impact of a WT longer than 6 minutes on neoplasia detection is unclear. METHODS: A multicenter randomized controlled trial involving 1027 patients was conducted from January 2018 to July 2019. Participants were randomly divided into a 9-minute (n = 514) and 6-minute (n = 513) WT group, and a timer was used to adjust the withdrawal speed. The primary outcome was the adenoma detection rate (ADR). RESULTS: Intention-to-treat analysis showed a significantly higher ADR in the 9-minute versus 6-minute WT group (36.6% vs. 27.1%, P = .001). Prolonging WT from 6 to 9 minutes significantly increased ADR of the proximal colon (21.4% vs. 11.9%, P < .001) as well as of the less experienced colonoscopists (36.8% vs. 23.5%, P = .001). Improvements were also observed in the polyp detection rate (58.0% vs. 47.8%, P < .001), and mean number of polyps and adenomas detected per colonoscopy (1.1 vs. 0.9, P = .002; 0.5 vs. 0.4, P = .008, respectively). The higher ADRs in 9-minute WT were also confirmed by the per-protocol (PP) analysis and subgroup analyses, with an increased rate of sessile serrated lesion detection in the 9-minute WT by PP analysis (4.0% vs. 1.3%, P = .04). Multivariate logistic regression demonstrated that the 9-minute WT was independently associated with increased ADR (P = .005). CONCLUSIONS: Prolonging WT from 6 to 9 minutes significantly improved ADR, especially in the proximal colon and for less experienced colonoscopists. A 9-minute WT benchmark should be considered as one of the quality indicators of colonoscopy.
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