BACKGROUND:Adenoma detection rate (ADR) has become the most important quality indicator for colonoscopy. OBJECTIVE: The aim of this study was to investigate which modifiable factors, directly related to the endoscopic procedure, influenced the ADR in screening colonoscopies. DESIGN: Observational, nested study. SETTING: Multicenter, randomized, controlled trials. PATIENTS: Asymptomatic people aged 50 to 69 years were eligible for a multicenter, randomized, controlled trial designed to compare colonoscopy and fecal immunochemical testing in colorectal cancer screening. A total of 4539 individuals undergoing adirect screening colonoscopy were included in this study. INTERVENTION: Colonoscopy. MAIN OUTCOME MEASUREMENTS: Bowel cleansing, sedation, withdrawal time in normal colonoscopies, and cecal intubation were analyzed as possible predictors of adenoma detection by using logistic regression analysis, adjusted for age and sex. RESULTS: In multivariate analysis, after adjustment for age and sex, factors independently related to the ADR were a mean withdrawal time longer than 8 minutes (odds ratio [OR] 1.51; 95% CI, 1.17-1.96) in normal colonoscopies and split preparation (OR 1.26; 95% CI, 1.01-1.57). For advanced adenomas, only withdrawal time maintained statistical significance in the multivariate analysis. For proximal adenomas, withdrawal time and cecal intubation maintained independent statistical significance, whereas only withdrawal time longer than 8 minutes and a <10-hour period between the end of preparation and colonoscopy showed independent associations for distal adenomas. LIMITATIONS: Only endoscopic variables have been analyzed. CONCLUSION: Withdrawal time was the only modifiable factor related to the ADR in colorectal cancer screening colonoscopies associated with an increased detection rate of overall, advanced, proximal, and distal adenomas.
RCT Entities:
BACKGROUND:Adenoma detection rate (ADR) has become the most important quality indicator for colonoscopy. OBJECTIVE: The aim of this study was to investigate which modifiable factors, directly related to the endoscopic procedure, influenced the ADR in screening colonoscopies. DESIGN: Observational, nested study. SETTING: Multicenter, randomized, controlled trials. PATIENTS: Asymptomatic people aged 50 to 69 years were eligible for a multicenter, randomized, controlled trial designed to compare colonoscopy and fecal immunochemical testing in colorectal cancer screening. A total of 4539 individuals undergoing a direct screening colonoscopy were included in this study. INTERVENTION: Colonoscopy. MAIN OUTCOME MEASUREMENTS: Bowel cleansing, sedation, withdrawal time in normal colonoscopies, and cecal intubation were analyzed as possible predictors of adenoma detection by using logistic regression analysis, adjusted for age and sex. RESULTS: In multivariate analysis, after adjustment for age and sex, factors independently related to the ADR were a mean withdrawal time longer than 8 minutes (odds ratio [OR] 1.51; 95% CI, 1.17-1.96) in normal colonoscopies and split preparation (OR 1.26; 95% CI, 1.01-1.57). For advanced adenomas, only withdrawal time maintained statistical significance in the multivariate analysis. For proximal adenomas, withdrawal time and cecal intubation maintained independent statistical significance, whereas only withdrawal time longer than 8 minutes and a <10-hour period between the end of preparation and colonoscopy showed independent associations for distal adenomas. LIMITATIONS: Only endoscopic variables have been analyzed. CONCLUSION: Withdrawal time was the only modifiable factor related to the ADR in colorectal cancer screening colonoscopies associated with an increased detection rate of overall, advanced, proximal, and distal adenomas.
Authors: Joaquín Cubiella; Antoni Castells; Montserrat Andreu; Luis Bujanda; Fernando Carballo; Rodrigo Jover; Ángel Lanas; Juan Diego Morillas; Dolores Salas; Enrique Quintero Journal: United European Gastroenterol J Date: 2016-07-20 Impact factor: 4.623
Authors: Michal F Kaminski; Siwan Thomas-Gibson; Marek Bugajski; Michael Bretthauer; Colin J Rees; Evelien Dekker; Geir Hoff; Rodrigo Jover; Stepan Suchanek; Monika Ferlitsch; John Anderson; Thomas Roesch; Rolf Hultcranz; Istvan Racz; Ernst J Kuipers; Kjetil Garborg; James E East; Maciej Rupinski; Birgitte Seip; Cathy Bennett; Carlo Senore; Silvia Minozzi; Raf Bisschops; Dirk Domagk; Roland Valori; Cristiano Spada; Cesare Hassan; Mario Dinis-Ribeiro; Matthew D Rutter Journal: United European Gastroenterol J Date: 2017-03-16 Impact factor: 4.623
Authors: Timothy D Imler; Justin Morea; Charles Kahi; Eric A Sherer; Jon Cardwell; Cynthia S Johnson; Huiping Xu; Dennis Ahnen; Fadi Antaki; Christopher Ashley; Gyorgy Baffy; Ilseung Cho; Jason Dominitz; Jason Hou; Mark Korsten; Anil Nagar; Kittichai Promrat; Douglas Robertson; Sameer Saini; Amandeep Shergill; Walter Smalley; Thomas F Imperiale Journal: Am J Gastroenterol Date: 2015-03-10 Impact factor: 10.864
Authors: Hassan Siddiki; Sreya Ravi; Mohanad T Al-Qaisi; Ayman R Fath; Francisco Ramirez; Michael D Crowell; Rahul Pannala; Douglas O Faigel; Suryakanth R Gurudu Journal: Dig Dis Sci Date: 2018-05-07 Impact factor: 3.199
Authors: Eduardo Coghlan; Luis Laferrere; Elisa Zenon; Juan Manuel Marini; German Rainero; Alberto San Roman; Maria Lourdes Posadas Martinez; Angel Nadales Journal: Surg Endosc Date: 2019-05-29 Impact factor: 4.584