Impact of 9-Minute Withdrawal Time on the Adenoma Detection Rate: A Multicenter Randomized Controlled Trial

• Published in: Clinical gastroenterology and hepatology Vol. 20; no. 2; pp. e168 - e181
• Main Authors: Zhao, Shengbing, Yang, Xia, Wang, Shuling, Meng, Qianqian, Wang, Rundong, Bo, Lumin, Chang, Xin, Pan, Peng, Xia, Tian, Yang, Fan, Yao, Jun, Zheng, Jinghua, Sheng, Jianqiu, Zhao, Xiaojun, Tang, Shan, Wang, Yali, Wang, Yiping, Gong, Aixia, Chen, Weigang, Shen, Jianwei, Zhu, Xian, Wang, Shaofeng, Yan, Caiwen, Yang, Youlin, Zhu, Yangbei, Ma, Rui-Jun, Wang, Rong, Ma, Yingcai, Li, Zhaoshen, Bai, Yu
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2022
• Subjects: Adenoma - diagnosis; Adenoma Detection Rate; Colonic Polyps - diagnosis; Colonoscopy; Colonoscopy - methods; Colorectal Neoplasms - diagnosis; Humans; Polyps; Withdrawal Time; PP; SDR; APCS; BPQ; RCT; OR; CI; ITT; NWT; SSL; ADR; AADR; Withdrawal Time; Adenoma Detection Rate; APC; CRC; Colonoscopy; BBPS; WT; BMI; PDR
• ISSN: 1542-3565; 1542-7714
• DOI: 10.1016/j.cgh.2020.11.019

Although current quality indicators of colonoscopy recommend 6 minutes as the minimum standard for withdrawal time (WT), the impact of a WT longer than 6 minutes on neoplasia detection is unclear. A multicenter randomized controlled trial involving 1027 patients was conducted from January 2018 to July 2019. Participants were randomly divided into a 9-minute (n = 514) and 6-minute (n = 513) WT group, and a timer was used to adjust the withdrawal speed. The primary outcome was the adenoma detection rate (ADR). Intention-to-treat analysis showed a significantly higher ADR in the 9-minute versus 6-minute WT group (36.6% vs. 27.1%, P = .001). Prolonging WT from 6 to 9 minutes significantly increased ADR of the proximal colon (21.4% vs. 11.9%, P < .001) as well as of the less experienced colonoscopists (36.8% vs. 23.5%, P = .001). Improvements were also observed in the polyp detection rate (58.0% vs. 47.8%, P < .001), and mean number of polyps and adenomas detected per colonoscopy (1.1 vs. 0.9, P = .002; 0.5 vs. 0.4, P = .008, respectively). The higher ADRs in 9-minute WT were also confirmed by the per-protocol (PP) analysis and subgroup analyses, with an increased rate of sessile serrated lesion detection in the 9-minute WT by PP analysis (4.0% vs. 1.3%, P = .04). Multivariate logistic regression demonstrated that the 9-minute WT was independently associated with increased ADR (P = .005). Prolonging WT from 6 to 9 minutes significantly improved ADR, especially in the proximal colon and for less experienced colonoscopists. A 9-minute WT benchmark should be considered as one of the quality indicators of colonoscopy. ClinicalTrials.gov (identifier, NCT03399045) [Display omitted]