Modifiable endoscopic factors that influence the adenoma detection rate in colorectal cancer screening colonoscopies

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• 作者：Rodrigo Jover ; MD ; PhD¹ ; ; Pedro Zapater ; MD ; PhD² ; Eduardo Polaní ; a ; MD¹ ; Luis Bujanda ; MD ; PhD³ ; Angel Lanas ; MD ; PhD⁴ ; José ; A. Hermo ; MD⁵ ; Joaquí ; n Cubiella ; MD ; PhD⁶ ; Akiko Ono ; MD⁷ ; Yanira Gonzá ; lez-Mé ; ndez ; MD⁸ ; Antonio Peris ; MD⁹ ; Marí ; a Pellisé ; MD ; PhD¹⁰ ; Agustí ; n Seoane ; MD¹¹ ; Alberto Herreros-de-Tejada ; MD¹² ; Marta Ponce ; MD ; PhD¹³ ; José ; C. Marí ; n-Gabriel ; MD¹⁴ ; Marí ; a Chaparro ; MD¹⁵ ; Guillermo Cacho ; MD¹⁶ ; Servando Ferná ; ndez-Dí ; ez ; MD¹⁷ ; Juan Arenas ; MD¹⁸ ; Federico Sopeñ ; a ; MD⁴ ; Luisa de-Castro ; MD⁵ ; Pablo Vega-Villaamil ; MD⁶ ; Marí ; a Rodrí ; guez-Soler ; MD¹ ; Fernando Carballo ; MD ; PhD⁷ ; Dolores Salas ; MD ; PhD¹⁹ ; Juan D. Morillas ; MD ; PhD¹⁷ ; Montserrat Andreu ; MD ; PhD¹¹ ; Enrique Quintero ; MD ; PhD⁸ ; Antoni Castells ; MD ; PhD¹⁰ ; COLONPREV study investigators
• 关键词：ADR ; adenoma detection rate ; CRC ; colorectal cancer ; PEG ; polyethylene glycol
• 刊名：Gastrointestinal Endoscopy
• 出版年：2013
• 出版时间：March, 2013
• 年：2013
• 卷：77
• 期：3
• 页码：381-389.e1
• 全文大小：395 K

文摘

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Background

Adenoma detection rate (ADR) has become the most important quality indicator for colonoscopy.

Objective

The aim of this study was to investigate which modifiable factors, directly related to the endoscopic procedure, influenced the ADR in screening colonoscopies.

Design

Observational, nested study.

Setting

Multicenter, randomized, controlled trials.

Patients

Asymptomatic people aged 50 to 69 years were eligible for a multicenter, randomized, controlled trial designed to compare colonoscopy and fecal immunochemical testing in colorectal cancer screening. A total of 4539 individuals undergoing a direct screening colonoscopy were included in this study.

Intervention

Colonoscopy.

Main Outcome Measurements

Bowel cleansing, sedation, withdrawal time in normal colonoscopies, and cecal intubation were analyzed as possible predictors of adenoma detection by using logistic regression analysis, adjusted for age and sex.

Results

In multivariate analysis, after adjustment for age and sex, factors independently related to the ADR were a mean withdrawal time longer than 8 minutes (odds ratio [OR] 1.51; 95 % CI, 1.17-1.96) in normal colonoscopies and split preparation (OR 1.26; 95 % CI, 1.01-1.57). For advanced adenomas, only withdrawal time maintained statistical significance in the multivariate analysis. For proximal adenomas, withdrawal time and cecal intubation maintained independent statistical significance, whereas only withdrawal time longer than 8 minutes and a <10-hour period between the end of preparation and colonoscopy showed independent associations for distal adenomas.

Limitations

Only endoscopic variables have been analyzed.

Conclusion

Withdrawal time was the only modifiable factor related to the ADR in colorectal cancer screening colonoscopies associated with an increased detection rate of overall, advanced, proximal, and distal adenomas.