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

doi:10.1016/j.gie.2012.09.027

Gastrointestinal Endoscopy

Volume 77, Issue 3, March 2013, Pages 381-389.e1

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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.

Section snippets

Study population

A total of 5059 individuals underwent a direct colonoscopy in the COLONPREV STUDY,⁸ a randomized trial aimed at comparing the efficacy of 1-time colonoscopy and biennial fecal immunochemical testing for reducing CRC-related mortality. Asymptomatic men and women aged 50 to 69 years were eligible for enrollment into this study. Exclusion criteria were personal history of CRC, adenoma or inflammatory bowel disease, family history of hereditary or familial CRC (ie, >2 first-degree relatives with

Results

A total of 4539 screening colonoscopies were included. Adenoma or CRC was diagnosed in 1446 patients (31.7%), and advanced adenoma or CRC was found in 576 patients (12.7%). A total of 710 patients (15.6%) had proximal adenomas and 729 (16.1%) only distal adenomas. The mean number of adenomas was 0.57 (range 0-10). A total of 2210 individuals were male (48.7%). The mean age was 59.0 (± 5.5) years, and 2446 participants (53.9%) were aged between 50 and 59 years. The mean withdrawal time in normal

Discussion

In this study, different factors were related to the ADR, but only withdrawal time >8 minutes was associated with a higher ADR as well as advanced, proximal, and distal ADRs. Therefore, in this study, withdrawal time was the main modifiable factor related to detection of adenomas in CRC screening colonoscopies. Other modifiable factors, such as use of sedation, bowel preparation, or bowel cleansing, did not have a constant relationship with the detection of adenomas in screening colonoscopies.

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Cited by (109)

Development and Validation of an Automated, Real-time Adenoma Detection Rate and Colonoscopy Quality Metrics Calculator
2024, Techniques and Innovations in Gastrointestinal Endoscopy
High-quality colonoscopy reduces the risk of death from colorectal cancer. The adenoma detection rate (ADR) is the principal measure of colonoscopy quality but is onerous to calculate. We report the development of a fully automated platform for calculation of the ADR and other key colonoscopy quality indicators without the need for manual data entry.
Endoscopy and pathology reports from 6 centers were collected over a 3-month period and collated using a novel data transfer interface. Text-based classification parameters were developed to identify average-risk screening colonoscopies, adenomatous pathology, cecal intubation, and withdrawal time. Automated quality metrics calculators based on these classifications were built into a web-based reporting platform, and the resulting quality metrics were benchmarked against those produced through a manual record review. Confirmation of the calculator's performance was performed in a validation cohort with data collected over a 1-month period, 6 months after the initial study.
The study included 3809 colonoscopies (mean age 56.1 ± 6.40 years, 53.7% female, 38 endoscopists). The automated calculator yielded an ADR of 45.1% compared with 44.3% on manual review. Correct classification of ADR-qualifying screening colonoscopies was achieved with high predictive value, with a sensitivity of 0.918 and specificity of 1.0. The cecal intubation rate was 95.8%, and the average withdrawal time was 10:05 minutes.
We demonstrate the feasibility and performance of a colonoscopy quality reporting platform capable of calculating the ADR and other key metrics using novel, fully automated pathology report integration and a text query-based classification accessible in a wide range of practice settings.
Withdrawal Time: Is Nine the New Six?
2022, Clinical Gastroenterology and Hepatology
Delays in colonoscopy start time are associated with reductions in adenoma detection rates
2020, Digestive and Liver Disease
Prior investigations of the impact of case delays on adenoma detection rates have not found a significant association, though these studies included modest delays, with few cases delayed by more than one hour.
The aim of this study was to measure the impact of prolonged case delays on the colonoscopy outcome measures of adenoma detection rate and withdrawal time.
We performed a single center cohort study including patients aged ≥50 years undergoing screening colonoscopy during a 4.5 year period. Using multivariate regression, we measured the impact of delays on adenoma detection rate and withdrawal time, adjusting for age, gender, endoscopist, time of day of the procedure, and bowel preparation quality.
Of 7905 screening colonoscopies, 2503 (32%) were delayed by >1 h. On multivariable analysis, cases delayed 1–2 h were associated with a significant decrease in adenoma detection rate relative to cases delayed ≤1 h (OR 0.88, 95% CI 0.78–1.00, p = 0.049). Withdrawal time was not significantly associated with case delays.
Prolonged case delays over 1 h are associated with reduced adenoma detection rates. Future research on factors underlying prolonged delays may help mitigate these barriers to care and improve quality outcomes.
The effectiveness of walking exercise on the bowel preparation before colonoscopy: a single blind randomized clinical trial study
2023, BMC Gastroenterology
Optimization of colonoscopy quality: Comprehensive review of the literature and future perspectives
2023, Digestive Endoscopy
Reduced Adenoma Miss Rate With 9-Minute vs 6-Minute Withdrawal Times for Screening Colonoscopy: A Multicenter Randomized Tandem Trial
2023, American Journal of Gastroenterology

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: DISCLOSURE: This work was supported by grants from Asociación Española de Gastroenterología, Asociación Española contra el Cáncer (Fundación Científica and Junta de Barcelona), the Instituto de Salud Carlos III (PI08/90717, PI08/0726, INT-09/208, PI11/2630), FEDER funds, and Agència de Gestió d'Ajuts Universitaris i de Recerca (2009SGR849). CIBERehd is funded by the Instituto de Salud Carlos III. In the Basque Country, the study received additional support with grants from Obra Social de Kutxa, Diputación Foral de Gipuzkoa (DFG 07/5), Departamento de Sanidad del Gobierno Vasco, EITB-Maratoia (BIO 07/CA/19) y Acción Transversal contra el Cáncer del CIBERehd (2008). In Galicia, this work was supported by Dirección Xeral de Innovación e Xestión da Saúde Pública, Conselleria de Sanidade, Xunta de Galicia. OC-Micro instruments and fecal immunochemical tests were kindly provided by Eiken Chemical Co, Ltd, Japan and its Spanish representatives, Palex Medical and Biogen Diagnóstica; none of them were involved in the design of the study nor in the analysis or interpretation of results. Maria Rodríguez-Soler received a grant from Fundación de la Comunidad Valenciana para la Investigación en el Hospital General Universitario de Alicante and the Instituto de Salud Carlos III (Río-Hortega Grant CM11/00066). No other financial relationships relevant to this publication were disclosed.

: If you would like to chat with an author of this article, you may contact Dr Jover at [email protected].

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Original articleClinical endoscopyModifiable endoscopic factors that influence the adenoma detection rate in colorectal cancer screening colonoscopies

Background

Objective

Design

Setting

Patients

Intervention

Main Outcome Measurements

Results

Limitations

Conclusion

Section snippets

Study population

Results

Discussion

Lancet

Gastrointest Endosc

Clin Gastroenterol Hepatol

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Am J Gastroenterol

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastroenterology

Gastrointest Endosc

Reducing mortality from colorectal cancer by screening for fecal occult bloodMinnesota Colon Cancer Control Study

N Engl J Med

Colorectal-cancer incidence and mortality with screening flexible sigmoidoscopy

N Engl J Med

Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths

N Engl J Med

Original article
Clinical endoscopy
Modifiable endoscopic factors that influence the adenoma detection rate in colorectal cancer screening colonoscopies