Impact of sedation type on adenoma detection rate by colonoscopy

Tarhini, Hawraa; Alrazim, Ayman; Ghusn, Wissam; Mohammad, Hosni; Kerbage, Anthony; Assaad, Soweid; Sharara, Ala I; Fadi, Mourad; Francis, Fadi; Shaib, Yasser H.; Kassem, Barada; Daniel, Fady

doi:10.1016/j.clinre.2022.101981

Cited by 2 publications

(1 citation statement)

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“…However, a recent meta-analysis (47) (not including the above 2 latest reports (45,46)) reported similar ADRs between propofol sedation vs opioid/benzodiazepine sedation. Presumably, the difference of using sedation or not using might actually be the critical factor, whereas the choice of sedation type would not affect ADR and inspecting quality (48). The lower AMR of sedated colonoscopy in our trial supported the speculation, and further validation is needed.…”

Section: Discussionmentioning

confidence: 99%

Reduced Adenoma Miss Rate With 9-Minute vs 6-Minute Withdrawal Times for Screening Colonoscopy: A Multicenter Randomized Tandem Trial

et al. 2022

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INTRODUCTION: Although the 9-minute mean withdrawal time (m-WT) is often reported to be associated with the optimal adenoma detection rate (ADR), no randomized trials of screening colonoscopy have confirmed the impact of a 9-minute m-WT on adenoma miss rate (AMR) and ADR. METHODS:A multicenter tandem trial was conducted in 11 centers. Seven hundred thirty-three asymptomatic participants were randomized to receive segmental tandem screening colonoscopy with a 9-minute withdrawal, followed by a 6-minute withdrawal (9-minute-first group, 9MF, n 5 366) or vice versa (6-minute-first group, 6MF, n 5 367). The primary outcome was the lesion-level AMR. RESULTS:The intention-to-treat analysis revealed that 9MF significantly reduced the lesion-level (14.5% vs 36.6%, P < 0.001) and participant-level AMR (10.9% vs 25.9%, P < 0.001), advanced adenoma miss rate (AAMR, 5.3% vs 46.9%, P 5 0.002), multiple adenomas miss rate (20.7% vs 56.5%, P 5 0.01), and high-risk adenomas miss rate (14.6% vs 39.5%, P 5 0.01) of 6MF without compromising detection efficiency (P 5 0.79). In addition, a lower false-negative rate for adenomas (P 5 0.002) and high-risk adenomas (P < 0.05), and a lower rate of shortening surveillance schedule (P < 0.001) were also found in 9MF, accompanying with an improved ADR in the 9-minute vs 6-minute m-WT (42.3% vs 33.5%, P 5 0.02). The independent inverse association between m-WT and AMR remained significant even after adjusting ADR, and meanwhile, 9-minute m-WT was identified as an independent protector for AMR and AAMR.

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Section: Discussionmentioning

confidence: 99%