Document Detail

Effect of simply recording colonoscopy withdrawal time on polyp and adenoma detection rates.
MedLine Citation:
PMID:  20363418     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: According to national recommendations, colonoscopy withdrawal time (WT) on negative screening examinations should average more than 6 minutes because this time is associated with a higher rate of polyp detection. Attempts have been made to increase the WT; however, simply knowing that a quality measure, such as the WT, is being monitored, by itself, may improve the quality of an examination.
OBJECTIVE: To measure changes in the polyp detection rate associated with recording the WT.
DESIGN: Retrospective.
SETTING: Single tertiary care center.
PATIENTS: Patients undergoing colonoscopy within 5 months immediately before (group A) and after (group B) initiation of WT recording. Colonoscopies were excluded if procedure times were incomplete, missing, or nonsensical.
MAIN OUTCOME MEASUREMENTS: Polyp detection, compared by using the chi(2) test and logistic regression multivariate analyses; pathology manually reviewed from a sample of 200 consecutive polyp cases (100 per group).
RESULTS: The average WT in group B was 14.5 minutes (11.0 minutes in negative screening examinations). In group A, polyps were detected in 530 (37.7%) of 1405 colonoscopies compared with 571 (41.2%) of 1387 colonoscopies in group B (difference 3.5%; 95% CI, -0.2% to 7.1%), a nonsignificant 9.3% relative increase. Longer procedure time, age, sex, and indication were significant predictors; monitoring the WT was not. Nonsignificantly, more polyp examinations in group B found all nonadenomas compared with group A (36% vs 27%; P = .17), and polyps were nonsignificantly smaller (P = .30).
LIMITATIONS: Retrospective database data, pathology performed only on a subsample.
CONCLUSION: WT recording was associated with a nonsignificant increase in polyp detection, but this was likely attributable to a slight increase in the detection of (smaller) nonadenomatous polyps.
Andrew Taber; Joseph Romagnuolo
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  71     ISSN:  1097-6779     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-04-05     Completed Date:  2010-07-06     Revised Date:  2011-01-12    
Medline Journal Info:
Nlm Unique ID:  0010505     Medline TA:  Gastrointest Endosc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  782-6     Citation Subset:  IM    
Copyright Information:
Copyright 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
Digestive Diseases Center, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
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MeSH Terms
Adenoma / diagnosis*
Colonic Polyps / diagnosis*
Colonoscopy / standards*,  statistics & numerical data*
Colorectal Neoplasms / diagnosis*
Mass Screening / standards*,  statistics & numerical data*
Middle Aged
Multivariate Analysis
Odds Ratio
Retrospective Studies
Sensitivity and Specificity
Time and Motion Studies*
Comment In:
Gastrointest Endosc. 2010 Apr;71(4):787-8   [PMID:  20363419 ]
Gastrointest Endosc. 2010 Apr;71(4):789-91   [PMID:  20363420 ]
Gastrointest Endosc. 2011 Jan;73(1):189; author reply 189-90   [PMID:  21184888 ]

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