Endoscopy cornerEffect of a Time-Dependent Colonoscopic Withdrawal Protocol on Adenoma Detection During Screening Colonoscopy
Section snippets
Methods
We conducted this study during routine clinical practice in a large, community-based gastroenterology practice. The physicians in this practice have clinical appointments at the University of Illinois College of Medicine at Rockford but their day-to-day functions closely resemble a private community-based gastroenterology practice. The University of Illinois institutional review board approved the study. Because the focus of this project was on the quality-improvement measures that we already
Study Population
Table 1 shows the characteristics of the study endoscopists and patients, displayed as baseline and postintervention screening cohorts for the 12 physicians labeled A to L. Of 8356 colonoscopies performed during the study period, 5005 were for diagnostic indications and 2888 were for screening. Of the screening cases, 349 had undergone prior colonoscopy, 127 had a history of colorectal cancer, 56 were hospital-based, and 31 had inflammatory bowel disease. Excluding these 563 patients left 2325
Relationships Between Postintervention Lesion-Detection Rates, Withdrawal Times, and Adherence to 8-Minute Withdrawal Time
Figure 3 shows the relationship between neoplasia detection rates and withdrawal times for procedures without polyps among postintervention subjects. There were positive correlations between rates of detection of total adenomas and advanced adenomas and withdrawal times. Figure 4 shows the relationship between postintervention lesion detection rates and adherence to the 8-minute withdrawal time, measured by the percentage of no-polyp procedures for which withdrawal time was equal to or greater
Discussion
Screening can reduce the incidence of and mortality from colorectal cancer.17, 18, 19, 20 In recent years there has been a trend toward preferential use of colonoscopy over other screening tests for colorectal neoplasia.21 Because the detection of cancer in asymptomatic individuals undergoing screening colonoscopy is rare, one of the purported advantages of this procedure compared with competing screening tests is the long-term reduction in the risk of colorectal cancer by removal of adenomas
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