AimsThere are no studies looking at the relationship between colonoscopy withdrawal time (CWT) and adenoma detection rate (ADR) in non-screening patients. Our aim is to explore the relationship between CWT and ADR, particularly in the proximal colon where colonoscopy is shown to be less protective for the development of cancers.MethodsThis is a retrospective study during November 2015 to December 2016 of non-screening colonoscopies done at a large teaching hospital. Incomplete and therapeutic procedures were excluded. The 39 endoscopists included were 15 gastroenterologists, 10 colorectal surgeons and 14 trainee colonoscopists. CWT was calculated by reviewing caecal intubation and rectal retroflexion images.Results783 colonoscopies were included, with mean patient age of 58.51 years (SD 15.5). The mean ADR was 21.45% in the study. The CWT could be calculated for 62.83% of the cases (n=492). 80% (393) of colonoscopies had CWT of ≥6 min. Mean CWT was 9.15 min (SD 4.4). The ADR positively correlated with longer CWT (r=0.31, p=0.0001). The ADR was significantly higher when CWT was ≥8 min compared with CWT <6 min or CWT of 6–8 min (p=0.0001). More polyps were detected in the proximal colon when CWT ≥8 min (p=0.078). Mean CWT of gastroenterologists was 9.8 min (SD 4.5), similar to the trainee group (10.3 min, SD 3.8), while mean CWT for colorectal surgeons was 5.7 min (SD 3.2). The ADR for gastroenterologists was 25.9% versus 17.5% for colorectal surgeons and 17.8% for trainees.ConclusionsThere is a moderately strong positive correlation between longer CWT and ADR in non-screening colonoscopies. CWT can differ between different endoscopists. Meticulous colonoscopy withdrawal may improve polyp detection in the proximal colon.

Background and study aims: Gastric cancer is known to reside in some gastric ulcers but what predicts this association is still unclear. Historically it has been thought that the increasing size of gastric ulcers may be a predictor for harbouring malignancy. Giant gastric ulcers are arbitrarily defined as 3 cm. The aim of this retrospective study was to examine patients with giant gastric ulcers within a single tertiary centre over a 10-year period. Our primary outcomes included the malignancy yield in giant gastric ulcers and to determine if any demographic, clinical or endoscopic predictors for malignancy exist. Secondary outcomes included the 30-day and 12-month mortality. Method: Patients with giant gastric ulcers 3 cm presenting from September 2005 to December 2015 were included in the study. Malignancy yield was obtained by looking at histology reports. Predictors for malignancy were tested using binary logistic regression, after demographic, clinical and endoscopic variables were tested using univariate analysis and for collinearity. Results: A cohort of 111 patients was included for the final analysis. Forty-two giant gastric ulcers were malignant, equating to a yield of 37.8% (95% CI 28.8-46.8). Binary logistic regression revealed predictors for malignancy included: ulcer location being within the fundus, cardia or incisura (odds ratio (OR) 4.417; 95% CI 1.10-17.76; P ¼ 0.036); younger age of patient (OR 0.202; 95% CI 0.06-0.71; P ¼ 0.013); and endoscopic 'non-suspicion' (OR 0.138; 95% CI 0.049-0.39; P < 0.001). Patient's 12-month mortality for giant gastric ulcer was 61.9% (26/42) for malignant and 21.9% (11/73) for benign histology. Conclusion: We have shown a high malignancy yield of 37.8% (95% CI 28.8-46.8) and a 12-month mortality of 61.9% for malignant giant gastric ulcers and 21.9% for benign giant gastric ulcers. Predictors for malignancy in patients with giant gastric ulcers include ulcer location, patient's age and endoscopist's 'suspicion' during endoscopy.

IntroductionSeveral studies have shown that, in screening colonoscopies, ADR is significantly related to endoscopists with a colonoscopy withdrawal time (CWT).1 A CWT of more than than 6 minutes is recommended. Studies have also demonstrated that if the endoscopists aware of being monitored they might increase their CWT (the Hawthorne effect). The bowel cancer screening program actively monitors the CWT of endoscopists to ensure that all colonoscopies are of adequate quality but non-screening colonoscopies are not routinely monitored in the same way.MethodsWe prospectively looked at 19 endoscopists’ practice of colonoscopy of 210 procedures. This included 10 gastroenterologists and 9 non-gastroenterologists. We calculated their withdrawal time by looking at time duration between caecal and rectal retroflexion images. Exclusion criteria included procedures that were incomplete, poor preparation, screening patients, patients in whom polyps were found and planned therapeutic procedures.In order to avoid ‘Hawthorne effect’, endoscopists were unaware that they were being monitored. Subsequent to that we did a statistical analysis to see if withdrawal time correlated with adenoma detection rate. The ADR was available from the unit’s annual endoscopy audit.ResultsCWT was less than 6 minutes in 20% of procedures. The mean CWT varied greatly among endoscopists. The mean CWT was significantly longer where the endoscopist was a gastroenterologist rather than a non-gastroenterologist (p = 0.0003). All of the endoscopists that had a mean CWT less than 6 minutes were part of the non-gastroenterologist group.Although we found ADR levels lower in mean CWT of less than 6 minutes and a positive correlation, this however did not reach statistical significance(p = 0.62).ConclusionIn our study we found in majority of the non-screening colonoscopies, withdrawal time was more than the recommended 6 minutes. Statistically significant correlation between ADR and withdrawal in non-screening colonoscopies may be achieved by participating in large multi-centred studies.Reference1 Lee TJ, Blanks RG, Rees CJ, Wright KC, Nickerson C, Moss SM, Chilton A, Goddard AF, Patnick J, McNally RJ, Rutter MD. Longer mean colonoscopy withdrawal time is associated with increased adenoma detection: evidence from the Bowel cancer screening programme in England. Endoscopy 2013;45(1):20–6.Disclosure of InterestNone Declared

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