Withdrawal time as a quality indicator for colonoscopy - a nationwide analysis

Area of Science:

• Gastroenterology
• Endoscopy Quality Assurance
• Clinical Research

Background:

• A minimum withdrawal time of 6 minutes is recommended for colonoscopy quality.
• Previous studies have yielded conflicting results due to single-center designs and limited endoscopists.
• The validity of withdrawal time as a quality measure remains uncertain.

Purpose of the Study:

• To investigate the value of individual withdrawal time as a quality indicator in a nationwide colonoscopy analysis.
• To determine if visual withdrawal time (VWT) predicts polyp detection during colonoscopy.

Main Methods:

• Prospective cohort study using data from 19 Norwegian centers (Jan-Sep 2009).
• Included 4429 outpatient colonoscopies from the Norwegian Gastronet Quality Assurance program.
• Compared polyp detection rates (≥ 5 mm) for endoscopists with median VWT < 6 min versus ≥ 6 min using logistic regression.

Main Results:

• The adjusted odds ratio for detecting polyps ≥ 5 mm was 1.21 (95% CI 0.94-1.56, P=0.14) for endoscopists with VWT ≥ 6 min compared to those with VWT < 6 min.
• This difference was not statistically significant, indicating VWT is not a strong predictor.

Conclusions:

• Withdrawal time, using a 6-minute threshold, is not a strong predictor of polyp detection.
• The current recommendation for withdrawal time as a quality indicator should be reconsidered.
• Further research may be needed to identify more robust colonoscopy quality metrics.