Impact of 9-minute Withdrawal Time on the Adenoma Detection Rate: A Multicenter Randomized Controlled Trial.

Nov 23, 2020

Contributor: Shengbing Zhao,Xia Yang,Shuling Wang,Qianqian Meng,Rundong Wang,Lumin Bo,Xin Chang,Peng Pan,Tian Xia,Fan Yang,Jun Yao,Jinghua Zheng,Jianqiu Sheng,Xiaojun Zhao,Shan Tang,Yali Wang,Yiping Wang,Aixia Gong,Weigang Chen,Jianwei Shen,Xian Zhu,Shaofeng Wang,Caiwen Yan,Youlin Yang,Yangbei Zhu,Rui-Jun Ma,Rong Wang,Yincai Ma,Zhaoshen Li,Yu Bai

Impact of 9-minute Withdrawal Time on the Adenoma Detection Rate: A Multicenter Randomized Controlled Trial.

Although current quality indicators of colonoscopy recommend 6 minutes as the minimum standard for withdrawal time (WT), the impact of a WT longer than 6 minutes on neoplasia detection is unclear.
A multicenter randomized controlled trial involving 1027 patients was conducted from January 2018 to July 2019. Participants were randomly divided into a 9-minute (n=514) and 6-minute (n=513) WT group, and a timer was used to adjust the withdrawal speed. The primary outcome was the adenoma detection rate (ADR).
Intention-to-treat analysis showed a significantly higher ADR in the 9-minute versus 6-minute WT group (36.6% vs. 27.1%, P=0.001). Prolonging WT from 6 to 9 minutes significantly increased ADR of the proximal colon (21.4% vs. 11.9%, P<0.001) as well as of the less experienced colonoscopists (36.8% vs. 23.5%, P=0.001). Improvements were also observed in the polyp detection rate (58.0% vs. 47.8%, P<0.001), and mean number of polyps and adenomas detected per colonoscopy (1.1 vs. 0.9, P=0.002; 0.5 vs. 0.4, P=0.008, respectively). The higher ADRs in 9-minute WT were also confirmed by the per-protocol (PP) analysis and subgroup analyses, with an increased rate of sessile serrated lesion detection in the 9-minute WT by PP analysis (4.0% vs. 1.3%, P=0.04). Multivariate logistic regression demonstrated that the 9-minute WT was independently associated with increased ADR (P=0.005).
Prolonging WT from 6 to 9 minutes significantly improved ADR, especially in the proximal colon and for less experienced colonoscopists. A 9-minute WT benchmark should be considered as one of the quality indicators of colonoscopy.

Copyright © 2020 AGA Institute. Published by Elsevier Inc. All rights reserved.

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About The Expert

Shengbing Zhao

Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China; Digestive Endoscopy Center, Changhai Hospital, Naval/Second Military Medical University, Shanghai, China; National Clinical Research Center for Digestive Diseases, Shanghai, China; National Quality Control Center of Digestive Endoscopy, Shanghai, China.

Xia Yang

Department of Gastroenterology, 905th hospital of PLA NAVY, Shanghai, China.

Shuling Wang

Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China; Digestive Endoscopy Center, Changhai Hospital, Naval/Second Military Medical University, Shanghai, China; National Clinical Research Center for Digestive Diseases, Shanghai, China; National Quality Control Center of Digestive Endoscopy, Shanghai, China.

Qianqian Meng

Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China; Digestive Endoscopy Center, Changhai Hospital, Naval/Second Military Medical University, Shanghai, China; National Clinical Research Center for Digestive Diseases, Shanghai, China; National Quality Control Center of Digestive Endoscopy, Shanghai, China.

Rundong Wang

Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China; Digestive Endoscopy Center, Changhai Hospital, Naval/Second Military Medical University, Shanghai, China; National Clinical Research Center for Digestive Diseases, Shanghai, China; National Quality Control Center of Digestive Endoscopy, Shanghai, China.

Lumin Bo

Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China; Digestive Endoscopy Center, Changhai Hospital, Naval/Second Military Medical University, Shanghai, China; National Clinical Research Center for Digestive Diseases, Shanghai, China; National Quality Control Center of Digestive Endoscopy, Shanghai, China.

Xin Chang

Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China; Digestive Endoscopy Center, Changhai Hospital, Naval/Second Military Medical University, Shanghai, China; National Clinical Research Center for Digestive Diseases, Shanghai, China; National Quality Control Center of Digestive Endoscopy, Shanghai, China.

Peng Pan

Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China; Digestive Endoscopy Center, Changhai Hospital, Naval/Second Military Medical University, Shanghai, China; National Clinical Research Center for Digestive Diseases, Shanghai, China; National Quality Control Center of Digestive Endoscopy, Shanghai, China.

Tian Xia

Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China; Digestive Endoscopy Center, Changhai Hospital, Naval/Second Military Medical University, Shanghai, China; National Clinical Research Center for Digestive Diseases, Shanghai, China; National Quality Control Center of Digestive Endoscopy, Shanghai, China.

Fan Yang

Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China; Digestive Endoscopy Center, Changhai Hospital, Naval/Second Military Medical University, Shanghai, China; National Clinical Research Center for Digestive Diseases, Shanghai, China; National Quality Control Center of Digestive Endoscopy, Shanghai, China.

Jun Yao

Department of Gastroenterology, The Second Clinical Medical College, Jinan University, Shenzhen, China.

Jinghua Zheng

Department of Gastroenterology, Yantaishan Hospital of Yantai City, Yantai, Shandong, China.

Jianqiu Sheng

Department of Gastroenterology, The Seventh Medical Center of PLA General Hospital, Beijing, China.

Xiaojun Zhao

Department of Gastroenterology, The Seventh Medical Center of PLA General Hospital, Beijing, China.

Shan Tang

Department of Gastroenterology, The Seventh Medical Center of PLA General Hospital, Beijing, China.

Yali Wang

Department of Gastroenterology, The Third People’s Hospital of Datong, Datong, Shanxi, China.

Yiping Wang

Department of Gastroenterology, The Third People’s Hospital of Datong, Datong, Shanxi, China.

Aixia Gong

Department of Gastroenterology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.

Weigang Chen

Department of Gastroenterology, The First Affiliated Hospital, The School Medical College, Shihezi University, Shihezi, Xinjiang, China.

Jianwei Shen

Department of Gastroenterology, Ningbo Medical Center Lihuili Eastern Hospital, Ningbo, Zhejiang, China.

Xian Zhu

Department of Gastroenterology, Ningbo Medical Center Lihuili Eastern Hospital, Ningbo, Zhejiang, China.

Shaofeng Wang

Department of Gastroenterology, Changzhi People’s Hospital, Changzhi, Shanxi, China.

Caiwen Yan

Department of Gastroenterology, Changzhi People’s Hospital, Changzhi, Shanxi, China.

Youlin Yang

Department of Gastroenterology, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.

Yangbei Zhu

Department of Gastroenterology, Shanghai Eighth People’s Hospital, Shanghai, China.

Rui-Jun Ma

Center for Gastrointestinal Endoscopy, Shanxi Provincial People’s Hospital, Taiyuan, Shanxi, China.

Rong Wang

Center for Gastrointestinal Endoscopy, Shanxi Provincial People’s Hospital, Taiyuan, Shanxi, China.

Yincai Ma

Department of Gastroenterology, Qinghai Provincial People’s Hospital, Xining, Qinghai, China.

Zhaoshen Li

Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China; Digestive Endoscopy Center, Changhai Hospital, Naval/Second Military Medical University, Shanghai, China; National Clinical Research Center for Digestive Diseases, Shanghai, China; National Quality Control Center of Digestive Endoscopy, Shanghai, China. Electronic address: li.zhaoshen@hotmail.com.

Yu Bai

Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China; Digestive Endoscopy Center, Changhai Hospital, Naval/Second Military Medical University, Shanghai, China; National Clinical Research Center for Digestive Diseases, Shanghai, China; National Quality Control Center of Digestive Endoscopy, Shanghai, China.

References

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