4.7 Article

Modifiable endoscopic factors that influence the adenoma detection rate in colorectal cancer screening colonoscopies

Journal

GASTROINTESTINAL ENDOSCOPY
Volume 77, Issue 3, Pages 381-+

Publisher

MOSBY-ELSEVIER
DOI: 10.1016/j.gie.2012.09.027

Keywords

-

Funding

  1. Asociacion Espanola de Gastroenterologia
  2. Asociacion Espanola contra el Cancer (Fundacion Cientifica)
  3. Asociacion Espanola contra el Cancer (Junta de Barcelona)
  4. Instituto de Salud Carlos III [PI08/90717, PI08/0726, INT-09/208, PI11/2630]
  5. FEDER
  6. Agencia de Gestio d'Ajuts Universitaris i de Recerca [2009SGR849]
  7. Instituto de Salud Carlos III
  8. Obra Social de Kutxa
  9. Diputacion Foral de Gipuzkoa [DFG 07/5]
  10. Departamento de Sanidad del Gobierno Vasco
  11. EITB-Maratoia y Accion Transversal contra el Cancer del CIBERehd [BIO 07/CA/19]
  12. Direccion Xeral de Innovacion e Xestion da Saude Publica
  13. Conselleria de Sanidade
  14. Xunta de Galicia
  15. Fundacion de la Comunidad Valenciana para la Investigacion en el Hospital General Universitario de Alicante
  16. Instituto de Salud Carlos III (Rio-Hortega Grant) [CM11/00066]

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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. (Gastrointest Endosc 2013;77:381-9.)

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