Prolonged cecal insertion time is associated with decreased adenoma detection

Area of Science:

• Gastroenterology
• Endoscopy
• Cancer Prevention

Background:

• Adenoma detection rate (ADR) is a key colonoscopy quality metric.
• Longer withdrawal times correlate with higher adenoma detection.
• The impact of cecal insertion time on adenoma detection remains unclear.

Purpose of the Study:

• To investigate the association between cecal insertion time and adenoma detection during colonoscopy.
• To determine if cecal insertion time influences the number of adenomas and advanced adenomas found.

Main Methods:

• Analysis of data from 1043 patients (50-89 years old) undergoing elective colonoscopy.
• Primary outcome: adjusted mean number of adenomas per patient across quartiles of insertion time.
• Secondary outcomes: mean advanced adenomas, ADR, and advanced ADR; adjusted regression analysis used.

Main Results:

• Cecal insertion time was not associated with withdrawal time (P=.950).
• Mean adenomas per patient decreased by 11% per quartile of increasing insertion time (P=.031).
• Mean advanced adenomas per patient decreased by 7% per quartile (P=.013).

Conclusions:

• Increased cecal insertion time is associated with decreased adenoma and advanced adenoma detection.
• Long insertion times may signal a more difficult colonoscopy, necessitating longer withdrawal times for adequate examination.
• Findings highlight the importance of insertion time in colonoscopy quality assessment.