Clinical—Alimentary TractEffect of Institution-Wide Policy of Colonoscopy Withdrawal Time ≥7 Minutes on 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
References (15)
- et al.
The National Polyp StudyPatient and polyp characteristics associated with high-grade dysplasia in colorectal adenomas
Gastroenterology
(1990) - et al.
Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies
Gastroenterology
(1997) - et al.
Prevalence of polyps greater than 9 mm in a consortium of diverse clinical practice settings in the United States
Clin Gastroenterol Hepatol
(2005) - et al.
Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: recommendations of the U.S. Multi-Society Task Force on Colorectal Cancer
Am J Gastroenterol
(2002) Colonoscopic withdrawal technique is associated with adenoma miss rates
Gastrointest Endosc
(2000)- et al.
Cancer statistics, 2005
CA Cancer J Clin
(2005) - et al.
Effect of fecal occult blood testing on mortality from colorectal cancer: a case control study
Ann Intern Med
(1993)
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Supported by a grant from the American Society for Gastrointestinal Endoscopy.
The authors disclose the following: No conflicts.