Modifiable endoscopic factors that influence the adenoma detection rate in colorectal cancer screening colonoscopies

Dec 11, 2012Gastrointestinal endoscopy

Adjustable endoscopy factors linked to finding precancerous growths during colorectal cancer screening

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Abstract

A mean withdrawal time longer than 8 minutes is associated with a 1.51 times higher adenoma detection rate in screening colonoscopies.

Longer withdrawal times may improve adenoma detection rates during colonoscopy.
Split bowel preparation shows a potential association with increased adenoma detection rates.
For advanced adenomas, withdrawal time is the only factor that consistently relates to detection rates.
Withdrawal time and cecal intubation are significant for detecting proximal adenomas.
For distal adenomas, a withdrawal time longer than 8 minutes and a preparation interval of less than 10 hours are associated with increased detection rates.

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BACKGROUND: Adenoma detection rate (ADR) has become the most important quality indicator for colonoscopy.

OBJECTIVE: The aim of this study was to investigate which modifiable factors, directly related to the endoscopic procedure, influenced the ADR in screening colonoscopies.

DESIGN: Observational, nested study.

SETTING: Multicenter, randomized, controlled trials.

PATIENTS: Asymptomatic people aged 50 to 69 years were eligible for a multicenter, randomized, controlled trial designed to compare colonoscopy and fecal immunochemical testing in colorectal cancer screening. A total of 4539 individuals undergoing a direct screening colonoscopy were included in this study.

INTERVENTION: Colonoscopy.

MAIN OUTCOME MEASUREMENTS: Bowel cleansing, sedation, withdrawal time in normal colonoscopies, and cecal intubation were analyzed as possible predictors of adenoma detection by using logistic regression analysis, adjusted for age and sex.

RESULTS: In multivariate analysis, after adjustment for age and sex, factors independently related to the ADR were a mean withdrawal time longer than 8 minutes (odds ratio [OR] 1.51; 95% CI, 1.17-1.96) in normal colonoscopies and split preparation (OR 1.26; 95% CI, 1.01-1.57). For advanced adenomas, only withdrawal time maintained statistical significance in the multivariate analysis. For proximal adenomas, withdrawal time and cecal intubation maintained independent statistical significance, whereas only withdrawal time longer than 8 minutes and a <10-hour period between the end of preparation and colonoscopy showed independent associations for distal adenomas.

LIMITATIONS: Only endoscopic variables have been analyzed.

CONCLUSION: Withdrawal time was the only modifiable factor related to the ADR in colorectal cancer screening colonoscopies associated with an increased detection rate of overall, advanced, proximal, and distal adenomas.

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Modifiable endoscopic factors that influence the adenoma detection rate in colorectal cancer screening colonoscopies

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