Longer mean colonoscopy withdrawal time is associated with increased adenoma detection: evidence from the Bowel Cancer Screening Programme in England

T. J. W. Lee; R. G. Blanks; C. J. Rees; K. C. Wright; C. Nickerson; S. M. Moss; A. Chilton; A. F. Goddard; J. Patnick; R. J. Q. McNally; M. D. Rutter

doi:10.1055/s-0032-1325803

Endoscopy, Table of Contents

Endoscopy 2013; 45(01): 20-26
DOI: 10.1055/s-0032-1325803

Original article

Longer mean colonoscopy withdrawal time is associated with increased adenoma detection: evidence from the Bowel Cancer Screening Programme in England

Authors

T. J. W. Lee

¹Tees Bowel Cancer Screening Centre, University Hospital of North Tees, Stockton on Tees, UK

²Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
R. G. Blanks

³Cancer Epidemiology Unit, Richard Doll Building, Oxford University, UK
C. J. Rees

⁴South of Tyne Bowel Cancer Screening Centre, South Tyneside District Hospital, South Shields, UK

⁵University of Durham, County Durham, UK
K. C. Wright

⁶ICON Clinical Research, Hampshire, UK
C. Nickerson

⁷NHS Cancer Screening Programmes, Sheffield, UK
S. M. Moss

⁸Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
A. Chilton

⁹Leicester, Northants and Rutland Bowel Cancer Screening Centre, Kettering General Hospital, Kettering, UK
A. F. Goddard

¹⁰Derbyshire Bowel Cancer Screening Centre, Derby City General Hospital, Derby, UK
J. Patnick

⁷NHS Cancer Screening Programmes, Sheffield, UK
R. J. Q. McNally

²Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
M. D. Rutter

¹Tees Bowel Cancer Screening Centre, University Hospital of North Tees, Stockton on Tees, UK

⁵University of Durham, County Durham, UK

Abstract

Background and study aims: Increasing colonoscopy withdrawal time (CWT) is thought to be associated with increasing adenoma detection rate (ADR). Current English guidelines recommend a minimum CWT of 6 minutes. It is known that in the Bowel Cancer Screening Programme (BCSP) in England there is wide variation in CWT. The aim of this observational study was to examine the relationship between CWT and ADR.

Patients and methods: The study examined data from 31 088 colonoscopies by 147 screening program colonoscopists. Colonoscopists were grouped in four levels of mean CWT ( < 7, 7 – 8.9, 9 – 10.9, and ≥ 11 minutes). Univariable and multivariable analysis (binary logistic and negative binomial regression) were used to explore the relationship between CWT, ADR, mean number of adenomas and number of right-sided and advanced adenomas.

Results: In colonoscopists with a mean CWT < 7 minutes, the mean ADR was 42.5 % compared with 47.1 % in the ≥ 11-minute group (P < 0.001). The mean number of adenomas detected per procedure increased from 0.77 to 0.94, respectively (P < 0.001). The increase in adenoma detection was mainly of subcentimeter or proximal adenomas; there was no increase in the detection of advanced adenomas. Regression models showed an increase in ADR from 43 % to 46.5 % for mean CWT times ranging from 6 to 10 minutes.

Conclusions: This study demonstrates that longer mean withdrawal times are associated with increasing adenoma detection, mainly of small or right-sided adenomas. However, beyond 10 minutes the increase in ADR is minimal. Mean withdrawal times longer than 6 minutes are not associated with increased detection of advanced adenomas. Withdrawal time remains an important quality metric of colonoscopy.

Full Text

References

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