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

Background & Aims: Screening colonoscopy can prevent cancer by removal of adenomatous polyps. Recent evidence suggests that insufficient time for inspection during overly rapid colonoscope withdrawal may compromise adenoma detection. We conducted a study of the effect of a minimum prespecified time for instrument withdrawal and careful inspection on adenoma detection rates during screening colonoscopy. MethodS: Baseline data consisted of neoplasia detection rates during 2053 screening colonoscopies performed without a specified withdrawal protocol. During a subsequent 13-month period we performed 2325 screening colonoscopies using dedicated inspection techniques and a minimum 8-minute withdrawal time. With colonoscopists comprising the study population, we compared overall and individual rates of neoplasia detection in postintervention procedures with those in baseline examinations. Results: As compared with baseline subjects, postintervention subjects had higher rates of any neoplasia (34.7% vs 23.5%, P <.0001) and of advanced neoplastic lesions per patient screened (0.080 +/- 0.358 vs 0.055 +/- 0.241, P <.01). Twenty-five percent of advanced neoplastic lesions detected in postintervention examinations were 9 mm or less in diameter, versus 10% in baseline examinations (P <.001). Endoscopists with mean withdrawal times of 8 minutes or longer had higher rates of detection of any neoplasia (37.8% vs 23.3%, P <.0001) and of advanced neoplasia (6.6% vs 4.S%, P =.13) compared with those with mean withdrawal times of less than 8 minutes. Conclusions: After implementing a protocol of careful inspection during a minimum of 8 minutes to withdraw the colonoscope, we observed significantly greater rates of overall and advanced neoplasia detection during screening colonoscopy.