Colonoscopic withdrawal technique is associated with adenoma miss rates

doi:10.1016/S0016-5107(00)70383-X

Gastrointestinal Endoscopy

Volume 51, Issue 1, January 2000, Pages 33-36

https://doi.org/10.1016/S0016-5107(00)70383-X Get rights and content

Abstract

Background: Clinical studies have documented differences in detection rates of colorectal cancers and adenomas between experienced colonoscopists, the basis of which is unknown. The aim of this study was to determine whether colonoscopic withdrawal technique varies between 2 colonoscopists with known differences in adenoma detection rates. Methods: Ten consecutive colonoscopic withdrawals by each of the 2 colonoscopists were videotaped and then assessed according to specific criteria by 4 experts blinded to who had performed the colonoscopies. Results: Each of the 4 experts scored the colonoscopist with the lower miss rate significantly higher (p < 0.001) for each of 4 quality criteria: (1) examining the proximal sides of flexures, folds and valves, (2) cleaning and suctioning, (3) adequacy of distention, and (4) adequacy of time spent viewing. Conclusion: Higher quality colonoscopic withdrawal technique as determined by expert observers was associated with a colonoscopist with a previously documented lower miss rate for adenomas. Colonoscopic withdrawal technique should be subjected to further study and standards for withdrawal technique should be developed. (Gastrointest Endosc 2000;51:33-6.)

Section snippets

Methods

The 2 endoscopists were both experienced (each more than 10,000 colonoscopies performed). In a tandem colonoscopy study,⁶ they were found to have miss rates for adenomas of 17% and 48% (odds ratio for a miss 0.23: 95% CI [0.09, 0.60]). In a screening colonoscopy study⁹ the prevalence of adenomas in patients who underwent colonoscopy by the endoscopist with the lower miss rate was significantly higher than the prevalence of adenomas in patients who had their colonoscopies performed by the

Results

The mean quality scores for the 2 examiners are shown in Table 1. The colonoscopist with the lower miss rate had higher quality scores for each of the 4 criteria (Table 1). The mean overall percentage of colonic mucosa visualized, as estimated by the 4 reviewers, was 90.8% for the colonoscopist with the lower miss rate and 63.3% for the colonoscopist with the higher miss rate (p < 0.001). Each of the 4 experts evaluating the videotapes scored the colonoscope withdrawals of the colonoscopist

Discussion

This is the first study to demonstrate that the quality of withdrawal technique during colonoscopy is associated with a lower miss rate for adenomas. Specifically, several features of withdrawal technique were judged by experts to have been performed in a higher quality manner by a colonoscopist with a known lower miss rate for adenomas compared with these same features as performed by a colonoscopist known to have a higher miss rate for adenomas.

Although this study established an association

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Both computer-aided detection (CADe)-assisted and Endocuff-assisted colonoscopy have been found to increase adenoma detection. We investigated the performance of the combination of the 2 tools compared with CADe-assisted colonoscopy alone to detect colorectal neoplasias during colonoscopy in a multicenter randomized trial.
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From July 1, 2021 to May 31, 2022, there were 1316 subjects randomized and eligible for analysis; 660 to the ECV group, 656 to the control group). The adenoma detection rate was significantly higher in the ECV group (49.6%) than in the control group (44.0%) (relative risk, 1.12; 95% CI, 1.00–1.26; P = .04). Adenomas detected per colonoscopy were significantly higher in the ECV group (mean ± SD, 0.94 ± 0.54) than in the control group (0.74 ± 0.21) (incidence rate ratio, 1.26; 95% CI, 1.04–1.54; P = .02). The 2 groups did not differ in term of detection of advanced adenomas and serrated lesions. There was no significant difference between groups in mean ± SD withdrawal time (9.01 ± 2.48 seconds for the ECV group vs 8.96 ± 2.24 seconds for controls; P = .69) or proportion of subjects undergoing unnecessary polypectomies (relative risk, 0.89; 95% CI, 0.69–1.14; P = .38).
The combination of CADe and ECV during colonoscopy increases adenoma detection rate and adenomas detected per colonoscopy without increasing withdrawal time compared with CADe alone. ClinicalTrials.gov, Number: NCT04676308.
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^☆: Reprint requests: Douglas K. Rex, MD, Indiana University School of Medicine, 550 N. University, Room 2300, Indianapolis, IN 46202.

^☆☆: 0016-5107/2000/$12.00 + 0 37/1/101046

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Colonoscopic withdrawal technique is associated with adenoma miss rates☆,☆☆

Abstract

Section snippets

Methods

Results

Discussion

Gastroenterology

Gastroenterology

Gastrointest Endosc

Gastrointest Endosc

Prevention of colorectal cancer by colonoscopic polypectomy

N Engl J Med

A prospective study of diagnostic methods in polyp follow-up

Endoscopy

Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps

N Engl J Med

Polypoid colonic lesions undetected by endoscopy

Radiology