Original Article

Segmental Withdrawal During Screening Colonoscopy Does Not Increase Adenoma Detection Rate

Authors: Danny J. Avalos, MD, Yi Jia, MD, PhD, Marc J. Zuckerman, MD, Majd Michael, MD, Jose Gonzalez-Martinez, MD, Antonio Mendoza-Ladd, MD, Cesar J. Garcia, MD, Joseph Sunny, MD, Veronica C. Delgado, RN, Berenice Hernandez, RN, Alok K. Dwivedi, PhD, Indika V. Mallawaarachchi, MS, Christopher Dodoo, MS, Mohamed O. Othman, MD

Abstract

Objectives: The aim of this study was to compare a standard versus segmental withdrawal during screening colonoscopy and its effect on the adenoma detection rate (ADR).

Methods: We performed a single-center clinical trial of average-risk patients 50 years of age and older undergoing screening colonoscopy. Patients were randomized into four groups: a standard withdrawal of at least 6 or 8 minutes and a segmental withdrawal, in which ≥3 or ≥4 minutes were dedicated to the right side of the colon, with a minimum withdrawal time of at least 6 or 8 minutes, respectively.

Results: There were 311 patients in the study. There was no difference in ADR between the standard and segmental groups (relative ratio [RR] 0.91, P = 0.50), even after stratifying for right-sided adenomas. During standard withdrawal, an increased continuous withdrawal time was associated with a higher ADR (RR 1.08, P <0.001) and total adenomas per patient (RR 1.12, P < 0.001). A binary analysis of ≥8 minutes or <8 minutes withdrawal was associated with an increased adenomas per colonoscopy (RR 1.86, P = 0.04). These differences were not observed in the segmental group.

Conclusions: Overall, there was no benefit from a segmental withdrawal protocol on ADR, but this may have been the result of the inherent limitations in the study design. After sensitivity analysis, a segmental withdrawal protocol led to an improvement in the detection of adenomas per colonoscopy and polyps per colonoscopy. A larger sample size is needed to confirm these findings.
Posted in: Gastroenterology44

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