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Number of significant polyps detected per six-minute withdrawal time at colonoscopy (SP6): a new measure of colonoscopy efficiency and quality
  1. Rajaratnam Rameshshanker1,2,
  2. Brian P Saunders1,2
  1. 1 Wolfson Unit for Endoscopy, St Mark’s Hospital, Harrow, London, UK
  2. 2 Department of Surgery and Cancer, Imperial College London, London, UK
  1. Correspondence to Dr Rajaratnam Rameshshanker, St Mark's Hospital, Wolfson Unit for Endoscopy, Harrow, London HA1 3UJ, UK; r.rameshshanker{at}

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Quality assessment of the colon consists of detailed, systematic and meticulous inspection of the entire colonic mucosa. A thorough and careful mucosal inspection is essential to prevent colorectal cancer (CRC) and cancer-related mortality.1 The detection and resection of precancerous polyps is the primary goal of screening colonoscopy. Recently, there has been a focus on quality and safety of colonoscopy. Worldwide, the demand for colonoscopy is increasing, and with a limited workforce, efficient working is of paramount importance.2

Quest for a colonoscopy efficiency marker

We performed an extensive search in the literature for the definition of colonoscopic efficiency (CE); however, no clear definition was found. We propose the following working definition as ‘the ability to detect clinically significant pathologies within acceptable time limits without compromising the quality or safety of the examination’.

CE is augmented by the following factors: optimal bowel preparation, technical ease of the procedure, technique of the endoscopist, high-definition and high-quality video imaging, and uninterrupted panoramic view of mucosal surface.

Although mucosal views may be improved with dynamic position changes and routine retroflexion in the rectum, these manoeuvres may not be effective in narrower colonic segments and flexures.3

Recent technological developments in the field of colonoscopy such as wide-angle view colonoscopes and disposable distal attachments (Endocuff Vision, transparent cap and Endorings) helped to improve the lateral and backward view of the mucosal folds.4–9

These advancements demonstrated an improvement in the quality and performance of the procedure. However, none of the studies explored the impact on CE of the technologies. We aimed to assess the performance of a new marker of colonoscopic efficiency. We propose SP6 (number of significant polyps detected per 6 min withdrawal time during colonoscopy) as …

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  • Contributors RR contributed in design, data collection, analysis of data and manuscript preparation. BS contributed in design and preparation and editing of manuscript

  • 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 RR received educational support from Aquilant Pvt Ltd. BPS is paid speaker for Norgine and Olympus UK (Key Med) Pvt Ltd.

  • Patient consent for publication Not required.

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