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Does the withdrawal time affect adenoma detection in non-screening colonoscopies?
  1. Ammar Al-Rifaie1,
  2. Mohammed El-Feki1,
  3. Ismaeel Al-Talib1,
  4. Maysam Abdulwahid2,
  5. Andrew Hopper3,
  6. Mo Thoufeeq1
  1. 1 Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  2. 2 Center for Urgent and Emergency Care Research, Sheffield, UK
  3. 3 Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield, UK
  1. Correspondence to Dr Ammar Al-Rifaie, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK;{at}


Aims There are no studies looking at the relationship between colonoscopy withdrawal time (CWT) and adenoma detection rate (ADR) in non-screening patients. Our aim is to explore the relationship between CWT and ADR, particularly in the proximal colon where colonoscopy is shown to be less protective for the development of cancers.

Methods This is a retrospective study during November 2015 to December 2016 of non-screening colonoscopies done at a large teaching hospital. Incomplete and therapeutic procedures were excluded. The 39 endoscopists included were 15 gastroenterologists, 10 colorectal surgeons and 14 trainee colonoscopists. CWT was calculated by reviewing caecal intubation and rectal retroflexion images.

Results 783 colonoscopies were included, with mean patient age of 58.51 years (SD 15.5). The mean ADR was 21.45% in the study. The CWT could be calculated for 62.83% of the cases (n=492). 80% (393) of colonoscopies had CWT of ≥6 min. Mean CWT was 9.15 min (SD 4.4). The ADR positively correlated with longer CWT (r=0.31, p=0.0001). The ADR was significantly higher when CWT was ≥8 min compared with CWT <6 min or CWT of 6–8 min (p=0.0001). More polyps were detected in the proximal colon when CWT ≥8 min (p=0.078). Mean CWT of gastroenterologists was 9.8 min (SD 4.5), similar to the trainee group (10.3 min, SD 3.8), while mean CWT for colorectal surgeons was 5.7 min (SD 3.2). The ADR for gastroenterologists was 25.9% versus 17.5% for colorectal surgeons and 17.8% for trainees.

Conclusions There is a moderately strong positive correlation between longer CWT and ADR in non-screening colonoscopies. CWT can differ between different endoscopists. Meticulous colonoscopy withdrawal may improve polyp detection in the proximal colon.

  • colonic polyps
  • colonoscopy
  • colorectal adenomas
  • endoscopic polypectomy

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  • Contributors AA-R, ME-F, AH and MT planned and designed the study. AA-R, ME-F and IA-T collected data. MA and AA-R analysed the results. All authors revised the manuscript critically and approved the final version submitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available upon request.

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