Segmental Withdrawal During Screening Colonoscopy Does Not Increase Adenoma Detection Rate.

Area of Science:

• Gastroenterology
• Endoscopy
• Cancer Screening

Background:

• Screening colonoscopy is crucial for colorectal cancer prevention.
• Adenoma detection rate (ADR) is a key quality indicator for colonoscopy.
• Optimizing colonoscopy withdrawal time is essential for improving ADR.

Purpose of the Study:

• To compare standard versus segmental withdrawal techniques during screening colonoscopy.
• To evaluate the impact of these techniques on adenoma detection rate (ADR).

Main Methods:

• A single-center clinical trial randomized 311 average-risk patients (≥50 years) into four groups.
• Groups involved standard withdrawal (6 or 8 min) or segmental withdrawal (≥3 or ≥4 min for right colon, ≥6 or ≥8 min total).

Main Results:

• No significant difference in ADR between standard and segmental withdrawal groups (RR 0.91, P=0.50).
• Increased continuous withdrawal time in the standard group correlated with higher ADR (RR 1.08, P<0.001) and adenomas per patient (RR 1.12, P<0.001).
• A withdrawal time of ≥8 minutes was associated with more adenomas per colonoscopy (RR 1.86, P=0.04) in the standard group, but not the segmental group.

Conclusions:

• Segmental withdrawal did not improve overall ADR in this study, potentially due to design limitations.
• Sensitivity analysis indicated segmental withdrawal may enhance adenoma and polyp detection per colonoscopy.
• Further research with larger sample sizes is required to validate these findings.