Title: Utility of colonoscopy withdrawal time measurement in the setting of an adequate adenoma detection rate
Abstract: I have reviewed Drs Taber and Romagnuolo's recent article1Taber A. Romagnuolo J. Effect of simply recording colonoscopy withdrawal time on polyp and adenoma detection rates.Gastrointest Endosc. 2010; 71: 782-786Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar and the accompanying editorial by Dr Vicari.2Vicari J. Performing a quality colonoscopy: just slow down!.Gastrointest Endosc. 2010; 71: 787-788Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar The use of colonoscopy withdrawal time as a metric for “quality colonoscopy” has been promulgated by many, yet I remain skeptical from one major perspective.Studies that have been published broadly suggest that, for colonoscopists who have a lower adenoma detection rate, this “primary” measure of quality (and I would argue, it is perhaps the most important one) can be improved by ensuring that the average colonoscopy withdrawal time is sufficiently long. I would contend that routinely measuring colonoscopy withdrawal time lacks utility if the colonoscopist consistently displays an adenoma detection rate above recommended benchmarks (>15% for females and >25% for males, in average-risk individuals undergoing screening colonoscopy). I would, however, endorse the transient measurement of colonoscopy withdrawal time as one potential factor that may be contributing to a substandard/inadequate adenoma detection rate, if such is identified for a particular endoscopist.In summary, I fail to appreciate the value of routinely measuring this “secondary” quality metric (colonoscopy withdrawal time) in an endoscopy unit in which there is prospective, ongoing monitoring of colonoscopy-associated complication rates, colonoscopy completion rates, indication monitoring, and adenoma detection rate measurement. I would be interested in the authors' thoughts in this regard. I have reviewed Drs Taber and Romagnuolo's recent article1Taber A. Romagnuolo J. Effect of simply recording colonoscopy withdrawal time on polyp and adenoma detection rates.Gastrointest Endosc. 2010; 71: 782-786Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar and the accompanying editorial by Dr Vicari.2Vicari J. Performing a quality colonoscopy: just slow down!.Gastrointest Endosc. 2010; 71: 787-788Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar The use of colonoscopy withdrawal time as a metric for “quality colonoscopy” has been promulgated by many, yet I remain skeptical from one major perspective. Studies that have been published broadly suggest that, for colonoscopists who have a lower adenoma detection rate, this “primary” measure of quality (and I would argue, it is perhaps the most important one) can be improved by ensuring that the average colonoscopy withdrawal time is sufficiently long. I would contend that routinely measuring colonoscopy withdrawal time lacks utility if the colonoscopist consistently displays an adenoma detection rate above recommended benchmarks (>15% for females and >25% for males, in average-risk individuals undergoing screening colonoscopy). I would, however, endorse the transient measurement of colonoscopy withdrawal time as one potential factor that may be contributing to a substandard/inadequate adenoma detection rate, if such is identified for a particular endoscopist. In summary, I fail to appreciate the value of routinely measuring this “secondary” quality metric (colonoscopy withdrawal time) in an endoscopy unit in which there is prospective, ongoing monitoring of colonoscopy-associated complication rates, colonoscopy completion rates, indication monitoring, and adenoma detection rate measurement. I would be interested in the authors' thoughts in this regard. Effect of simply recording colonoscopy withdrawal time on polyp and adenoma detection ratesGastrointestinal EndoscopyVol. 71Issue 4PreviewAccording to national recommendations, colonoscopy withdrawal time (WT) on negative screening examinations should average more than 6 minutes because this time is associated with a higher rate of polyp detection. Attempts have been made to increase the WT; however, simply knowing that a quality measure, such as the WT, is being monitored, by itself, may improve the quality of an examination. Full-Text PDF Performing a quality colonoscopy: just slow down!Gastrointestinal EndoscopyVol. 71Issue 4PreviewColorectal cancer is the third leading type of cancer and the third leading cause of cancer death in the United States. The incidence of colon cancer is declining in the United States, in large part because of colonoscopic polypectomy. Colonoscopy and polypectomy are prominent tools in both the diagnosis and prevention of colorectal cancer.1 Full-Text PDF Response:Gastrointestinal EndoscopyVol. 73Issue 1PreviewI agree with Dr. Yarze's comment that one of the most important scenarios in which to review withdrawal time (WT) is a low adenoma detection rate (ADR) when investigating the reason why the ADR is low or exploring the kind of intervention that might be helpful. I also agree that WT is, at this point, more a predictor of a quality metric rather than necessarily a metric itself. WT also has less relevance if one gets to the cecum less than 80% of the time, for example; so there is an apparent hierarchy to the metrics. Full-Text PDF
Publication Year: 2011
Publication Date: 2011-01-01
Language: en
Type: letter
Indexed In: ['crossref', 'pubmed']
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Cited By Count: 1
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