Gastroenterology

Gastroenterology

Volume 135, Issue 6, December 2008, Pages 1892-1898
Gastroenterology

Clinical—Alimentary Tract
Effect of Institution-Wide Policy of Colonoscopy Withdrawal Time ≥7 Minutes on Polyp Detection

https://doi.org/10.1053/j.gastro.2008.08.024Get rights and content

Background & Aims

Practice guidelines recommend that endoscopists spend at least 7 minutes examining the colonic mucosa during colonoscopy withdrawal to optimize polyp yield. The aim of this study was to determine if the implementation of an institution-wide policy of colonoscopy withdrawal time ≥7 minutes was associated with an increase in colon polyp detection.

Methods

All 42 endoscopists at our institute were asked to attain a colonoscopy withdrawal time of at least 7 minutes. Compliance with 7-minute withdrawal time was recorded for all nontherapeutic colonoscopies. Polyp detection ratio (number of polyps detected divided by number of colonoscopies performed) was computed. Regression models were used to assess the association between compliance with 7-minute withdrawal time and polyp detection.

Results

During the study period, 23,910 colonoscopies were performed. The average age of patients was 56.8 years, and 54% were female. Colon cancer screening or surveillance was the indication for 42.5% of colonoscopies. At the beginning of the study, the polyp detection ratio was 0.48. Compliance with 7-minute withdrawal time for nontherapeutic procedures increased from 65% at the beginning of the initiative to almost 100%. However, no increase in polyp detection ratio was noted over the same period for all polyps (slope, 0.0006; P = .45) or for polyps 1–5 mm (slope, 0.001; P = .26), 6–9 mm (slope, 0.002; P = .43), or ≥10 mm (slope, 0.006; P = .13). No association was detected when only colonoscopies performed for screening or surveillance were analyzed.

Conclusions

An institution-wide policy of colonoscopy withdrawal time ≥7 minutes had no effect on colon polyp detection.

Section snippets

Patients and Methods

In February 2006, the Gastroenterology Division at Beth Israel Deaconess Medical Center in Boston, Massachusetts, started using colonoscopy withdrawal time as a marker of colonoscopy quality. Available literature on colonoscopy withdrawal time was reviewed and discussed at a staff meeting, and all endoscopists were asked to aim for a colonoscopy withdrawal time of at least 7 minutes. Colonoscopy withdrawal times for colonoscopies at which no polypectomy or biopsies were performed

Results

During the 16-month study period (February 2006 to June 2007), 23,910 colonoscopies were performed at our institution, with an average of 1407 colonoscopies performed per month (range, 1237–1674). The average age of patients undergoing colonoscopy was 56.8 years (range, 19–101 years), and 54% were female. Common indications for performing colonoscopy were colon cancer screening and surveillance (42.5%), gastrointestinal bleeding (16.3%), and change in bowel habits (4.7%). Table 1 shows baseline

Discussion

The US Multi-Society Task Force on Colorectal Cancer recommends that the colonoscopy withdrawal phase last for at least 6–10 minutes.14 This recommendation was based mainly on expert opinion but also on the withdrawal time of an examiner with the lowest polyp miss rate among 26 colonoscopists who participated in a tandem colonoscopy study. Based on this and other studies, we initiated a policy of requiring all endoscopists at our institution to spend at least 7 minutes examining the colon

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Supported by a grant from the American Society for Gastrointestinal Endoscopy.

The authors disclose the following: No conflicts.

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