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Longer observation time increases adenoma detection in the proximal colon - a prospective study.

ABSTRACT: Background and study aims?:Longer observation times are associated with increased adenoma detection rates (ADR) in the entire colon. However, adenomas in the proximal colon are at risk of being missed during colonoscopy. The aim of this study was to investigate the impact of observation time on detection of adenomatous polyps in the proximal colon. Patients and methods?:This was a prospective study at a university hospital in Germany. Colonoscopies were conducted using magnetic endoscope imaging (MEI) in order to determine the exact position of the scope. Exact observation times spent for the detection of polyps in the proximal and distal colon segments were assessed. The primary outcome was adenoma detection in the proximal colon. ROC curves were generated in order to test the correlation between observation time and adenoma detection. Logistic regression analysis was used to check for interfering factors. Results:?A total 480 procedures with 538 polyps were available for analysis. The overall adenoma detection rate was 38.5?%. ADR in the proximal colon was 28.0?%. There was a significant association between observation time in the proximal colon and the detection of proximal adenomas ( P ?

SUBMITTER: Klare P

PROVIDER: S-EPMC5718907 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature

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Longer observation time increases adenoma detection in the proximal colon - a prospective study.

Klare Peter P Phlipsen Henrik H Haller Bernhard B Einwächter Henrik H Weber Andreas A Abdelhafez Mohamed M Bajbouj Monther M Brown Hayley H Schmid Roland M RM von Delius Stefan S

Endoscopy international open 20171206 12

<h4>Background and study aims</h4>Longer observation times are associated with increased adenoma detection rates (ADR) in the entire colon. However, adenomas in the proximal colon are at risk of being missed during colonoscopy. The aim of this study was to investigate the impact of observation time on detection of adenomatous polyps in the proximal colon.<h4>Patients and methods</h4>This was a prospective study at a university hospital in Germany. Colonoscopies were conducted using magnetic endo ...[more]

PMID: 29218322

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Project description:ObjectivesAlthough screening colonoscopy is effective in preventing distal colon cancers, effectiveness in preventing right-sided colon cancers is less clear. Previous studies have reported that retroflexion in the right colon improves adenoma detection. We aimed to determine whether a second withdrawal from the right colon in retroflexion vs. forward view alone leads to the detection of additional adenomas.MethodsPatients undergoing screening or surveillance colonoscopy were invited to participate in a parallel, randomized, controlled trial at two centers. After cecal intubation, the colonoscope was withdrawn to the hepatic flexure, all visualized polyps removed, and endoscopist confidence recorded on a 5-point Likert scale. Patients were randomized to a second exam of the proximal colon in forward (FV) or retroflexion view (RV), and adenoma detection rates (ADRs) compared. Logistic regression analysis was used to evaluate predictors of identifying adenomas on the second withdrawal from the proximal colon.ResultsA total of 850 patients (mean age 59.1±8.3 years, 59% female) were randomly assigned to FV (N=400) or RV (N=450). Retroflexion was successful in 93.5%. The ADR (46% FV and 47% RV) and numbers of adenomas per patient (0.9±1.4 FV and 1.1±2.1 RV) were similar (P=0.75 for both). At least one additional adenoma was detected on second withdrawal in similar proportions (10.5% FV and 7.5% RV, P=0.13). Predictors of identifying adenomas on the second withdrawal included older age (odds ratio (OR)=1.04, 95% confidence interval (CI)=1.01-1.08), adenomas seen on initial withdrawal (OR=2.8, 95% CI=1.7-4.7), and low endoscopist confidence in quality of first examination of the right colon (OR=4.8, 95% CI=1.9-12.1). There were no adverse events.ConclusionsRetroflexion in the right colon can be safely achieved in the majority of patients undergoing colonoscopy for colorectal cancer screening. Reexamination of the right colon in either retroflexed or forward view yielded similar, incremental ADRs. A second exam of the right colon should be strongly considered in patients who have adenomas discovered in the right colon, particularly when endoscopist confidence in the quality of initial examination is low.

Dataset Information

Longer observation time increases adenoma detection in the proximal colon - a prospective study.

Publications

Longer observation time increases adenoma detection in the proximal colon - a prospective study.

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