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Adenoma detection at colonoscopy by polypectomy in withdrawal only versus both insertion and withdrawal: a randomized controlled trial

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Abstract

Colonic configuration during insertion phase (IP) and withdrawal phase (WP) is different and some polyps seen during IP are difficult to find during WP and vice versa. To determine if polypectomy performed during both IP and WP of colonoscopy (study arm) increases adenoma detection rate (ADR) compared to WP only (control arm). In this prospective randomized controlled trial, adults undergoing out-patient colonoscopy were enrolled. The primary outcome was mean number of adenomas detected per patient. Secondary outcomes were ADR, defined as the proportion of colonoscopies with at least one adenoma, polyp detection rates (PDR), number of patients classified as high-risk group (presence of ≥3 adenomas of any size, any adenoma ≥1 cm in size, or adenoma with villous component, or high grade dysplasia), procedural times, patients discomfort, and ease of procedure. Among 772 patients enrolled, 610 were included (329 in study arm and 281 in control arm). In both arms, mean number of adenomas detected per patient were similar, 0.78 ± 1.4 vs. 0.74 ± 1.5, P = 0.75. Also, ADR (39.2 vs. 38.1 %, P = 0.77) and PDR (57.1 and 54.1 %, P = 0.45) were similar. Mean insertion time was significantly higher in study arm (10.2 ± 5.8 vs. 9.3 ± 5.6 min, p = 0.046). Proportion of patients identified as high-risk group were significantly higher in study arm (18.8 vs. 11.7 %, P = 0.016). Conclusions: Polypectomy performed during both IP and WP compared to the WP only, did not improve ADR or mean number of adenomas detected per patient. Trial registration: Clinicaltrials.gov, #NCT01025960.

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Abbreviations

ADR:

Adenoma detection rate

PDR:

Polyp detection rate

IP:

Insertion phase

WP:

Withdrawal phase

WT:

Withdrawal time

IT:

Insertion time

RCT:

Randomized controlled trial

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Acknowledgments

The study was presented as oral presentation at the Digestive Disease Week at Chicago, IL, USA in May 2012. The study was registered at ClinicalTrials.Gov # NCT01025960. There was no external funding for this study. Madhusudhan R. Sanaka and Lopez Rocio have full access to all of the data in the study and take full responsibility for the integrity of the data and the accuracy of the data analysis.

Disclosure

All authors declared no financial conflicts of interest pertaining to this study.

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Authors and Affiliations

  1. Departments of Gastroenterology, Desk Q3-1, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44136, USA

    Madhusudhan R. Sanaka, Mansour A. Parsi, Carol A. Burke, David Barnes, Maged Rizk, Nizar Zein, Rajesh Joseph & Prashanthi N. Thota

  2. Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA

    James Church & Ravi P. Kiran

  3. Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA

    Rocio Lopez

Authors
  1. Madhusudhan R. Sanaka
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  2. Mansour A. Parsi
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  3. Carol A. Burke
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  6. Maged Rizk
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  10. Rocio Lopez
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Correspondence to Madhusudhan R. Sanaka.

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Sanaka, M.R., Parsi, M.A., Burke, C.A. et al. Adenoma detection at colonoscopy by polypectomy in withdrawal only versus both insertion and withdrawal: a randomized controlled trial. Surg Endosc 29, 692–699 (2015). https://doi.org/10.1007/s00464-014-3723-3

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  • DOI: https://doi.org/10.1007/s00464-014-3723-3

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