Background Colonoscopy is commonly used to screen for neoplasia.To assess the performance of screening colonoscopy in everydaypractice, we conducted a study of the rates of detection ofadenomas and the amount of time taken to withdraw the colonoscopeamong endoscopists in a large community-based practice.
Methods During a 15-month period, 12 experienced gastroenterologistsperformed 7882 colonoscopies, of which 2053 were screening examinationsin subjects who had not previously undergone colonoscopy. Werecorded the numbers, sizes, and histologic features of theneoplastic lesions detected during screening, as well as theduration of insertion and of withdrawal of the colonoscope duringthe procedure. We compared rates of detection of neoplasticlesions among gastroenterologists who had mean colonoscopicwithdrawal times of less than 6 minutes with the rates of thosewho had mean withdrawal times of 6 minutes or more. Accordingto experts, 6 minutes is the minimum length of time to allowadequate inspection during instrument withdrawal.
Results Neoplastic lesions (mostly adenomatous polyps) weredetected in 23.5% of screened subjects. There were large differencesamong gastroenterologists in the rates of detection of adenomas(range of the mean number of lesions per subject screened, 0.10to 1.05; range of the percentage of subjects with adenomas,9.4 to 32.7%) and in their times of withdrawal of the colonoscopefrom the cecum to the anus (range, 3.1 to 16.8 minutes for proceduresduring which no polyps were removed). As compared with colonoscopistswith mean withdrawal times of less than 6 minutes, those withmean withdrawal times of 6 minutes or more had higher ratesof detection of any neoplasia (28.3% vs. 11.8%, P<0.001)and of advanced neoplasia (6.4% vs. 2.6%, P=0.005).
Conclusions In this large community-based gastroenterology practice,we observed greater rates of detection of adenomas among endoscopistswho had longer mean times for withdrawal of the colonoscope.The effect of variation in withdrawal times on lesion detectionand the prevention of colorectal cancer in the context of widespreadcolonoscopic screening is not known. Ours was a preliminarystudy, so the generalizability and implications for clinicalpractice need to be determined by future studies.
Source Information
From Rockford Gastroenterology Associates (R.L.B., J.J.V., J.F.J., R.L.G.) and the University of Illinois College of Medicine at Rockford (R.L.B., J.J.V., A.S.D., J.F.J., R.L.G.) — both in Rockford.
Address reprint requests to Dr. Barclay at Rockford Gastroenterology Associates, 401 Roxbury Rd., Rockford, IL 61107, or at drbarclay{at}rockfordgi.com.
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