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News

Polyp detection increases with longer colonoscopy withdrawal time

Serrated and adenomatous polyp detection increases with longer withdrawal time, reports this month's American Journal of Gastroenterology.

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Detection and removal of adenomas and clinically significant serrated polyps (CSSPs) is critical to the effectiveness of colonoscopy in preventing colorectal cancer.

Although longer withdrawal time has been found to increase polyp detection, this association and the use of withdrawal time as a quality indicator remains controversial.

Few studies have reported on withdrawal time and serrated polyp detection.

Using data from the New Hampshire Colonoscopy Registry, Dr Lynn Butterly and colleagues from New Hampshire, USA examined how an endoscopist's withdrawal time in normal colonoscopies affects adenoma and serrated polyp detection.

The researchers analyzed 7,996 colonoscopies performed in 7,972 patients between 2009 and 2011 by 42 endoscopists at 14 hospitals, ambulatory surgery centers, and community practices.

Adenomas were detected in 4% with a minimum withdrawal time of 9 minutes
American Journal of Gastroenterology

CSSPs were defined as sessile serrated polyps and hyperplastic polyps proximal to the sigmoid.

The research team calculated adenoma and CSSP detection rates on median endoscopist withdrawal time in normal exams.

Regression models were used to estimate the association of increased normal withdrawal time and polyp, adenoma, and CSSP detection.

The team found that polyp and adenoma detection rates were highest among endoscopists with 9 min median normal withdrawal time, and detection of CSSPs reached its highest levels at 8–9 min.

The researchers found that incident rate ratios for adenoma and CSSP detection increased with each minute of normal withdrawal time above 6 min, with maximum benefit at 9 min for adenomas, and CSSPs.

When the team used modeling to set the minimum withdrawal time at 9 min, adenomas and CSSPs were detected in 4%, and 2% more patients.

The increase in detection was most striking for the CSSPs, with nearly a 30% relative increase.

Dr Butterly's team concludes, "A withdrawal time of 9 min resulted in a statistically significant increase in adenoma, and serrated polyp detection."

"Colonoscopy quality may improve with a median normal withdrawal time benchmark of 9 min.

Am J Gastroenterol 2014; 109:417–426
18 March 2014

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