Title: The Relationship Between Withdrawal Time and Intubation Time in Colonoscopy: Correlation with Adenoma Detection Rate (ADR): ACG Colorectal Cancer Prevention Award
Abstract: Purpose: ADR varies amongst endoscopists and may be, in part, dependent on time spent inspecting the colonic mucosa. In addition to measuring the ADR, the US Multi Society Task Force recommends monitoring cecal intubation rate and withdrawal time. However, mandating a minimum withdrawal time of seven minutes has not caused a major impact on ADR. These recommendations have not taken into account the cecal intubation time. Cecal intubation time and withdrawal time may be affected by a technically difficult procedure, patient tolerance, and polypectomy rates. Little is known regarding the relationship between insertion time and withdrawal time, and the association with ADR. Aim: To measure insertion time and withdrawal time for all screening outpatient colonoscopies, and correlate with ADR for each endoscopist. Methods: We reviewed a database of screening colonoscopies over a 12-month period (10/2010-9/2011) by 20 gastroenterologists at an academic medical center. For each endoscopist, we calculated ADR and PDR. Insertion time and withdrawal time were documented for each study, along with measures of patient tolerance characterized by the use of additional opioid medication following induction, a nurse's assessment of patient tolerance, and measures of procedure difficulty such as the use of patient repositioning or abdominal pressure maneuvers. Patient age and gender were also noted. Statistical analysis: Univariate and multivariable analysis. Results: 1,797 screening colonoscopies were performed. Average patient age was 59.1 years (SD± 9.1). Fifty-two percent were men. The overall mean ADR was 29.7% (SD±7.6) and the mean PDR was 47.6% (SD±11.7). Mean insertion time was 11.6 min (SD±7.4) and withdrawal time was 12.3 min (SD±7.2). When insertion times were longer, withdrawal times were shorter (9 vs. 15 min; p< 0.001). When withdrawal times were longer, insertion times were shorter (7.9 vs 15.8 min; p<0.001). Total procedure time was similar in both groups. ADR for each endoscopist is shown in Table 1. After controlling for patient's age and gender and for clustering of endoscopists, ADR was significantly increased if withdrawal time exceeded insertion time (OR 2.74; 95% CI, 2.19 to 3.43) (p <0.001). For every minute withdrawal time exceeded insertion time, an 8% increase in ADR was noted (OR 1.08; 95% CI 1.06 to 1.10) (p<0.001).Table: Relationship of withdrawal time compared to intubation time and ADRConclusion: For withdrawal time to be a quality indicator of screening colonoscopy, insertion time should be taken into account. Withdrawal time exceeding insertion time is associated with a significant increase in ADR, and may be an additional marker of quality in colonoscopy. Our data suggest that endoscopists may be compromising withdrawal time when insertion time is prolongued, negatively affecting ADR.
Publication Year: 2012
Publication Date: 2012-10-01
Language: en
Type: article
Indexed In: ['crossref']
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Cited By Count: 2
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