Relationship between the endoscopic withdrawal time and adenoma/polyp detection rate in individual colonic segments: a KASID multicenter study

Jung, Yunho; Joo, Young‐Eun; Kim, Hyun Gun; Jeon, Seong Ran; Myung, Jae; Yang, Hyo‐Joon; Kim, Jong Wook; Lee, Jun; Kim, Kyeong Ok; Song, Hye Kyung; Hwangbo, Young; Shin, Jeong Eun

doi:10.1016/j.gie.2018.09.016

Cited by 50 publications

(34 citation statements)

References 28 publications

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“…Fourth, we originally planned to include a control group wherein the subjects were not to be administered SIM; however, the control group was not included due to inadequate bowel preparation in the previous trial. Fifth, the withdrawal time was distinctly more than 6 min, which may significantly increase the ADR . Sixth, all colonoscopy procedures were scheduled in the morning; however, whether these results were reproducible in patients scheduled for afternoon procedures should be further studied.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of low‐dose versus high‐dose simethicone with polyethylene glycol for bowel preparation: A prospective randomized controlled trial

Luo

et al. 2020

J of Gastro and Hepatol

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Li-sheng Wang and Jun Yao were responsible for design of the study and reviewed the manuscript. De-Feng Li, Ming-han Luo and Feng Xiong drafted the manuscript. Qing-qing Du, Hai-yang Zhang, Ting-ting Liu and Rui-yue Shi recorded the data. Ming-guang Lai, Ying-xue Li, Yan-hui Tian, Ben-hua Wu and Su Luo performed the data analysis. De-feng Li, Yang Song, Zheng-lei Xu and Ding-guo Zhang performed colonoscopy.

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Section: Discussionmentioning

confidence: 99%

Efficacy of low‐dose versus high‐dose simethicone with polyethylene glycol for bowel preparation: A prospective randomized controlled trial

Luo

et al. 2020

J of Gastro and Hepatol

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“…In our review, the supine and tiltdown positions without sedation during colonoscopy decreased the cecal insertion time compared with the left lateral starting position without sedation [20,25]. However, adequate withdrawal time was more important for ADR [30]. Colonoscopy without sedation decreases the AEs [31].…”

Section: Discussionmentioning

confidence: 77%

Efficacy and safety of the starting position during colonoscopy: a systematic review and meta-analysis

Watanabe

Park

Kakehi³

et al. 2020

Endosc Int Open

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Background and study aims We aimed to assess the efficacy and safety of the starting position during colonoscopy. Patients and methods We searched CENTRAL, MEDLINE, EMBASE, and the WHO International Clinical Trials Registry Platform through February 2019 to identify studies reporting the comparison between the right/supine/prone/tilt-down and left lateral starting position during colonoscopy. The primary outcomes were mean cecal insertion time and adverse events requiring medication. Two reviewers performed study selection and risk of bias assessment. We determined the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation method. This study was registered in PROSPERO (CRD42019124360). Results We identified 10 randomized controlled trials (RCTs) (2083 participants), including three trials on right/tilt-down versus left, two trials on supine/prone versus left, respectively. Mean difference in mean cecal insertion time in supine versus left was –41.0 s (95 % confidence interval [CI] –57.3 to –24.7) in one study and in tilt-down versus left was – 37.3 s (95 % CI –72.1 to –2.4; I2 = 58 %) in three studies; however, there were no statistically significant differences in prone/right versus left position (very low certainty of evidence). Four of eight studies noted adverse effects requiring medication (moderate certainty of evidence). One RCT applying the tilt-down position was terminated because of increased occurrence of oxygen desaturation. Conclusion We could not conclusively determine the efficacy and safety of the starting position during colonoscopy because of low certainty of evidence. Further studies are needed to confirm the efficacy and safety of the starting potion during colonoscopy.

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“…The observation time in the proximal colon was a significant predictor for the detection of proximal adenomas and a minimum time span of at least 4 min was found to be sufficient for proximal adenoma detection [33]. Another prospective observational study reported a significant association between increased ADR and a withdrawal time of ≥2 min in the right-sided colon (OR 2.98, 95%-CI 1.72–5.15, p < 0.001) and ≥ 4 min in the proximal colon (OR 4.48, 95%-CI 3.15–6.36, p < 0.001) [34]. Interestingly, re-examination of the right-sided colon yielded a higher proximal ADR than a single examination with extended withdrawal time (33.1% vs. 23.6%, p = 0.045) in another study while total proximal withdrawal times were similar between both groups (4.29 ± 1.23 min vs. 4.34 ± 1.36 min, p = 0.74) [35].…”

Section: Discussionmentioning

confidence: 99%

Ileal intubation is not associated with higher detection rate of right-sided conventional adenomas and serrated polyps compared to cecal intubation after adjustment for overall adenoma detection rate

et al. 2019

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BackgroundHigh cecal intubation rate (CIR) is associated with significant improved adenoma detection rate (ADR), however, self-reported CIR may be overestimated and inadequate documentation of cecal intubation is associated with a lower polyp detection rate compared to clear documentation. We aimed to investigate if ileal intubation may be associated with higher detection rates (DR) for right-sided conventional adenomas (cAD) and serrated polyps (SP) compared to cecal intubation in a large screening colonoscopy cohort.Material and methodsRetrospective analysis of individuals ≥50 years with average risk for colorectal cancer (CRC) who underwent screening colonoscopy between 01/01/2012 and 14/12/2016 at a tertiary academic hospital and six community-based private practices. Exclusion criteria were conditions with increased risk for CRC (e.g. inflammatory bowel disease, history of CRC, hereditary cancer syndromes), previous colonoscopy at the same institution, and incomplete procedures. Right-sided colon was defined as caecum and ascending colon.Results4.138 individuals were analysed (mean age 62 years, 52.1% female). DR for right-sided cADs and SPs were significantly higher after ileal compared to cecal intubation in univariate (12.5% vs. 6.8%, p < 0.001, and 6.3% vs. 3.3%, p < 0.001), but not in multivariate analysis (OR 1.025, 95%-CI 0.639–1.646, p = 0.918, and OR 0.937, 95%-CI 0.671–1.309, p = 0.704). DRs did not differ between ileal and cecal intubation for endoscopists with ADR ≥25 and < 25%, respectively. ADR ≥25% was significantly associated with ileal intubation (OR 21.862, 95%-CI 18.049–26.481, p < 0.001).ConclusionIleal intubation may not provide any benefit over cecal intubation concerning the detection of cADs and SPs in the right-sided colon.

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Relationship between the endoscopic withdrawal time and adenoma/polyp detection rate in individual colonic segments: a KASID multicenter study

Cited by 50 publications

References 28 publications

Efficacy of low‐dose versus high‐dose simethicone with polyethylene glycol for bowel preparation: A prospective randomized controlled trial

Efficacy of low‐dose versus high‐dose simethicone with polyethylene glycol for bowel preparation: A prospective randomized controlled trial

Efficacy and safety of the starting position during colonoscopy: a systematic review and meta-analysis

Ileal intubation is not associated with higher detection rate of right-sided conventional adenomas and serrated polyps compared to cecal intubation after adjustment for overall adenoma detection rate

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