Cecal Insertion Time and the ADR: Patience Is Good for Patients

• Published in: Digestive diseases and sciences Vol. 63; no. 11; pp. 2823 - 2825
• Main Authors: Hsieh, Yu-Hsi, Koo, Malcolm
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.11.2018; Springer; Springer Nature B.V
• Subjects: Adenoma; Biochemistry; Cecum; Clinical trials; Colonoscopy; Colorectal cancer; Editorial; Gastroenterology; Hepatology; Humans; Medical colleges; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Oncology; Transplant Surgery
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-018-5166-5

Given that most published studies found that a longer insertion time had a detrimental effect on ADR, the report by Fritz et al. in this issue of Digestive Diseases and Sciences appears to be an exceptional finding. The authors conducted a retrospective analysis of 1303 patients enrolled in four RCTs to evaluate the association between cecal insertion time and adenoma detection. In contrast to the aforementioned studies, they found that a prolonged cecal insertion time was not associated with a decreased ADR or a decreased mean number of detected adenomas or advanced adenomas. Withdrawal time increased when the mean cecal insertion time increased (p < 0.001), which is in stark contrast to the inverse association observed in previous studies, and may partly explain why longer insertion time was not associated with a lower ADR in the current study. It appears that the issue of reduced ADR by a longer insertion time could be overcome by a relatively longer withdrawal time— that is to say, all you need is patience. Moreover, the current study found that when cecal insertion times were longer than withdrawal times, i.e., insertion time/withdrawal time > 1, the number of detected adenomas and advanced adenomas decreased. By incorporating the insertion time into the equation, the ratio takes the association between withdrawal time and ADR one step further. It may be possible to improve ADR by decreasing the ratio through either decreasing the insertion time or increasing the withdrawal time; additional studies are warranted to confirm this finding.