Impact of withdrawal time on adenoma detection rate: results from a prospective multicenter trial.

Autor: Desai M; Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA; Division of Gastroenterology, University of Kansas School of Medicine, Kansas City, Kansas, USA., Rex DK; Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA., Bohm ME; Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA., Davitkov P; Department of Gastroenterology and Hepatology, Louis Stokes VA Medical Center, Cleveland, Ohio, USA., DeWitt JM; Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA., Fischer M; Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA., Faulx G; Colgate University, Hamilton, New York, USA., Heath R; Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA., Imler TD; Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA., James-Stevenson TN; Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA., Kahi CJ; Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA., Kessler WR; Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA., Kohli DR; Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA., McHenry L; Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA., Rai T; Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA., Rogers NA; Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA., Sagi SV; Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA., Sathyamurthy A; Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA., Vennalaganti P; Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA., Sundaram S; Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA., Patel H; Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA., Higbee A; Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA., Kennedy K; Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA., Lahr R; Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA., Stojadinovikj G; Department of Gastroenterology and Hepatology, Louis Stokes VA Medical Center, Cleveland, Ohio, USA., Campbell C; Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA., Dasari C; Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA., Parasa S; Department of Gastroenterology, Swedish Medical Center, Seattle, Washington, USA., Faulx A; Department of Gastroenterology and Hepatology, Louis Stokes VA Medical Center, Cleveland, Ohio, USA., Sharma P; Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA; Division of Gastroenterology, University of Kansas School of Medicine, Kansas City, Kansas, USA.
Jazyk: angličtina
Zdroj: Gastrointestinal endoscopy [Gastrointest Endosc] 2023 Mar; Vol. 97 (3), pp. 537-543.e2. Date of Electronic Publication: 2022 Oct 10.
DOI: 10.1016/j.gie.2022.09.031
Abstrakt: Background and Aims: Performing a high-quality colonoscopy is critical for optimizing the adenoma detection rate (ADR). Colonoscopy withdrawal time (a surrogate measure) of ≥6 minutes is recommended; however, a threshold of a high-quality withdrawal and its impact on ADR are not known.
Methods: We examined withdrawal time (excluding polyp resection and bowel cleaning time) of subjects undergoing screening and/or surveillance colonoscopy in a prospective, multicenter, randomized controlled trial. We examined the relationship of withdrawal time in 1-minute increments on ADR and reported odds ratio (OR) with 95% confidence intervals. Linear regression analysis was performed to assess the maximal inspection time threshold that impacts the ADR.
Results: A total of 1142 subjects (age, 62.3 ± 8.9 years; 80.5% men) underwent screening (45.9%) or surveillance (53.6%) colonoscopy. The screening group had a median withdrawal time of 9.0 minutes (interquartile range [IQR], 3.3) with an ADR of 49.6%, whereas the surveillance group had a median withdrawal time of 9.3 minutes (IQR, 4.3) with an ADR of 63.9%. ADR correspondingly increased for a withdrawal time of 6 minutes to 13 minutes, beyond which ADR did not increase (50.4% vs 76.6%, P < .01). For every 1-minute increase in withdrawal time, there was 6% higher odds of detecting an additional subject with an adenoma (OR, 1.06; 95% confidence interval, 1.02-1.10; P = .004).
Conclusions: Results from this multicenter, randomized controlled trial underscore the importance of a high-quality examination and efforts required to achieve this with an incremental yield in ADR based on withdrawal time. (Clinical trial registration number: NCT03952611.).
(Copyright © 2023 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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