Colon to Rectum
Gastrointest Endosc. 2023;97(3):537–43.e2
Impact of withdrawal time on adenoma detection rate: Results from a prospective multicenter trial
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: The authors 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. They examined the relationship of withdrawal time in 1-minute increments on ADR and reported odds ratio (OR) with 95% confidence intervals (CIs). 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 < 0.01). 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% CI: 1.02–1.10; p = 0.004).
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 adenoma detection rate based on withdrawal time.