Adenoma detection at colonoscopy by polypectomy in withdrawal only versus both insertion and withdrawal: a randomized controlled trial

Abstract

Clinicaltrials.gov, #NCT01025960.

Comparison of polyp detection during both insertion and withdrawal versus only withdrawal of colonoscopy: A prospective randomized trial

“…However, no control arm was included, and the MAP (0.37) was low in that study. In two published follow‐up prospective RCTs, inspection during both insertion and withdrawal did not make a significant additional contribution to adenoma detection compared with traditional detection of polyps performed during slow withdrawal . The overall ADR and MAP did not differ significantly between the two groups in these studies, and their findings were similar to the current study.…”

“…Sanaka et al . reported that the proportion of patients classified as high risk was significantly higher in the study arm compared with the control arm . However, we found that the proportion of patients classified as high risk was similar in both groups.…”

“…The primary aim of the study was to evaluate whether there was a difference in the ADR between the two study groups. We calculated the required sample size using the assumption of a 40% ADR in the control group . For the study to have 85% power to detect a 15% increase in ADR with a 5% significance level, 211 participants per group were needed to achieve significance (two sided).…”

“…Some studies have shown that inspection and polypectomy during insertion reduced the colorectal polyp/adenoma miss rate . However, others found that inspection and polypectomy during insertion offered no additional benefit on adenoma detection …”

“…7,8 However, others found that inspection and polypectomy during insertion offered no additional benefit on adenoma detection. [9][10][11] The adenoma detection rate (ADR) has become a validated quality indicator for colonoscopy; the higher the ADR of colonoscopists, the lower the risk of post-colonoscopy CRC and the lower the risk of dying from CRC. 12,13 However, a recent study has shown that the standard ADR cannot distinguish high versus low endoscopist performance.…”