Difference in Adenoma Detection Rates according to Colonoscopic Withdrawal Times and the Level of Expertise

Young Doo Kim; Won Ki Bae; Yun Ho Choi; Yoon Jung Jwa; Sang Kyung Jung; Bu Hyun Lee; Woo Hyun Paik; Jong Wook Kim; Nam-Hoon Kim; Kyung-Ah Kim; June Sung Lee

doi:10.4166/kjg.2014.64.5.278

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Kim, Bae, Choi, Jwa, Jung, Lee, Paik, Kim, Kim, Kim, and Lee: Difference in Adenoma Detection Rates according to Colonoscopic Withdrawal Times and the Level of Expertise

Original Article

Korean J Gastroenterol 2014;64(5):278-283.

Published online: 4 October 2014

DOI: https://doi.org/10.4166/kjg.2014.64.5.278

Difference in Adenoma Detection Rates according to Colonoscopic Withdrawal Times and the Level of Expertise

Young Doo Kim, Won Ki Bae, Yun Ho Choi, Yoon Jung Jwa, Sang Kyung Jung, Bu Hyun Lee, Woo Hyun Paik, Jong Wook Kim, Nam-Hoon Kim, Kyung-Ah Kim, June Sung Lee

Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea

Correspondence to: Won Ki Bae, Department of Gastroenterology, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang 411-706, Korea. Tel: +82- 31-910-7269, Fax: +82-31-910-7219, E-mail: mdbae@paik.ac.kr

Received 25 June 201415 September 2014 Accepted 16 September 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Adequate screening colonoscopy in the general population decreases the mortality associated with colorectal cancer through detection and removal of adenomatous polyps. Prolonged colonoscopic withdrawal times (>6 min) are reportedly beneficial for adenoma detection rates (ADRs). However, the quality of the endoscopist compared with colonoscopic withdrawal times is not known. The aims of this study were to investigate the difference in ADRs between trainees and experienced examiners.

Methods

A total of 967 consecutive patients who underwent screening colonoscopy in a single University hospital from June 2010 to November 2011 were enrolled in this prospective observational study. Colonoscopy was performed by four experienced staff and seven gastroenterology fellows.

Results

Seven gastroenterology fellows performed 633 colonoscopies and four experienced staff performed 334 colonoscopies. The overall detection rates of colorectal adenoma were 31.5% with ADRs of fellows and staff of 29.4% and 35.6%, respectively (p=0.047). Fellows also showed lower advanced ADRs (5.7% vs. 9.9%, p=0.016), and fellows had longer mean withdrawal times than staff (12.4±4.9 min vs. 8.2±4.1 min, p<0.001). Multivariate analysis showed significantly increased ADRs and advanced ADRs for staff compared with fellows (adjusted OR 2.41, 95% CI 1.70-3.43; adjusted OR 2.55, 95% CI 1.47-4.45, respectively).

Conclusions

ADRs were significantly lower when colonoscopy was performed by trainees, although withdrawal times were longer than those of staff. Our results demonstrated that the quality of colonoscopy, as measured by ADRs, may be improved by experienced examiners.

Keywords: Colonoscopy, Adenoma

References

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Fig. 1.

Study enrollment. Listed exclusions include prior colonoscopy, poor bowel preparation, history of inflam matory bowel disease (IBD), occurrence of complication, history of prior colonic resection, and inability to reach the cecum.

Fig. 2.

Withdrawal time according to endoscopists.

Fig. 3.

Adenoma detection rate according to endoscopist, stratified by withdrawal time.

Table 1.

Variables Influencing Adenoma Detection

Variable	Procedures with adenoma detection, n (%)	OR (95% CI)	p-value
Age (yr, ≤50/>50)	127 (22.8)/178 (43.5)	2.63 (1.99-3.48)	<0.001
Male/female	207 (35.6)/98 (25.5)	1.62 (1.22-2.16)	0.01
BMI (kg/m², <25/≥25)	182 (28.4)/123 (37.7)	1.53 (1.15-2.03)	0.003
Family history of colon cancer
Present/absent	14 (31.8)/291 (31.6)	1.009 (0.53-1.93)	0.979
Bowel preparation
Excellent	122 (28.6)	1.16 (0.76-1.76)	0.497
Good	140 (34.7)	1.33 (0.99-1.78)	0.060
Fair	43 (31.6)		0.170
Smoker/nonsmoker	103 (36.8)/202 (29.4)	1.39 (1.04-1.86)	0.025
Staff/fellow	119 (35.6)/186 (29.4)	1.32 (1.00-1.75)	0.047

Table 2.

Results of a Logistic Regression Model Predicting Adenoma Detection and Advanced Adenoma Detection

Variable	Adenoma		Advanced adenoma
Variable	OR (95% CI)	p-value	OR (95% CI)	p-value
Male	1.34 (0.95-1.89)	0.099	2.62 (1.44-4.77)	0.002
Age ≥50 yr	2.31 (1.71-3.13)	<0.001	2.80 (1.63-4.81)	<0.001
BMI ≥25 kg/m²	1.32 (0.97-1.80)	0.075
Smoker	1.44 (1.00-2.06)	0.047
Staff	2.41 (1.70-3.43)	<0.001	2.55 (1.47-4.45)	0.001
Withdrawal time	1.14 (1.10-1.19)	<0.001	1.08 (1.03-1.12)	<0.001

Table 3.

Comparison of Study Factors by Staff vs. Fellows

	Staff	Fellow	p-value
No. of colonoscopies	334 (34.5)	633 (65.5)
Gender (male)	190 (56.9)	392 (61.9)	0.128
Age (yr)	50.80±12.88	49.24±10.33	0.056
BMI (kg/m²)	23.41±3.18	23.97±3.04	0.007
<25	234 (70.1)	407 (64.3)	0.071
≥25	100 (29.9)	226 (35.7)	0.013
History of abdominal surgery	67 (20.1)	98 (15.5)	0.072
Family history of colon cancer	15 (4.5)	29 (4.6)	0.937
Smoker	80 (24.0)	200 (31.6)	0.076
Bowel preparation			0.174
Excellent	161 (48.2)	266 (42.0)
Good	131 (39.2)	273 (43.1)
Fair	42 (12.6)	94 (14.8)
Withdrawal time (min)	8.24±4.13	12.40±4.89	<0.001
Adenoma detection rate	119 (35.6)	186 (29.4)	0.047
Advanced adenoma detection rate	33 (9.9)	36 (5.7)	0.016

Values are presented as n (%) or mean±SD.

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