Quality of colonoscopy withdrawal technique and variability in adenoma detection rates (with videos)

Proficiency in the Diagnosis of Nonpolypoid Colorectal Neoplasm Yields High Adenoma Detection Rates

“…Endoscopist-related factors other than the training in NP-CRN may have accounted for at least part of the difference observed, and we did not directly assess adenoma detection rates of endoscopists before and after the training intervention, which would limit the confounding effects. For example, the endoscopists in our study did not record withdrawal time prior to 2008, a measure shown to be correlated with adenoma detection [27][28][29][30]. In addition, significantly more patients had poor quality or unreported bowel preparation in the control group, though subanalysis did not affect the results.…”

Improving protection against proximal colon cancer by colonoscopy

“…Indeed, the difference in protection between gastroenterologists and other specialists can only be considered indirect evidence that training is the underlying factor, since other elements could underlie the differences. The withdrawal techniques associated with high-level detection have been studied by video recording and include taking adequate time, meticulous inspection of the proximal sides of haustral folds, adequate cleaning of retained debris and suctioning of retained fluid, and adequate lumenal distention [22][23][24]. These elements should form the basis of teaching colonoscope manipulation during withdrawal, but they may not ensure lesion recognition.…”

Effectiveness of a simplified “patient friendly” split dose polyethylene glycol colonoscopy prep in Veterans Health Administration patients

“…[4][5][6][7] The reasons for the non-adherence to screening guidelines and success of screening are multi-factorial and likely includes failure to refer patients, patient refusal, avoidance of colonoscopy and/or intolerance of the bowel preparation, as well as perceived ineffectiveness of the screening methods themselves. Factors responsible for the reduced effectiveness of colonoscopy for prevention of right sided colon cancers include the higher rate of "flat" polyps in the right colon, 8 the use of poor colonoscopy technique, 9 and the presence of poor bowel cleansing. Kazarian et al demonstrated the rate of inadequate bowel preparation to be 30.2% and the rate of poor bowel preparation that absolutely precluded an exam to be 9.9% in a large community based health system in Denver .…”