Department of Gastroenterology, Hospital Universitario Austral, Buenos Aires, Argentina.
Department of Pathology, Hospital Universitario Austral, Buenos Aires, Argentina.
Surg Endosc. 2020 Mar;34(3):1200-1205. doi: 10.1007/s00464-019-06873-0. Epub 2019 May 29.
Missed adenomas are likely to be located in the proximal colon and failure to detect these lesions might explain the occurrence of a certain percentage of interval carcinomas. Though studies have demonstrated increased detection of significant neoplastic lesions in colonoscopic examinations where the withdrawal time is 6 min or more, there are no recommendations on how much time to spend in each colonic segment. The aim of the trial was to find ways to reduce the number of lesions missed in the proximal segments of the colon assessing the difference in adenoma detection rate (ADR) between two colonoscopic withdrawal timed techniques.
This was a randomized trial in a university hospital. Population was composed of patients referred for screening colonoscopy. The Main Outcome measurements was ADRs for patients subjected to a timed colonoscopy with specific withdrawal times, with special interest in the proximal colon, and implying a minimum of 2-min withdrawal delay in the cecum and right colon, a 1-min delay time in the transverse colon, and a minimum additional 3-min delay time in the left colon, as compared to a standard timed colonoscopy with free withdrawal delay time of at least 6 min.
A total of 1160 patients were included. Eleven were initially excluded due to incomplete colonoscopies. Of the remaining 1149 patients, 573 were randomized to the group with fixed withdrawal times (Group A) and 576 to conventional withdrawal (Group B). Median age was 57 years (SD 6), a total of 634 (55.2%) were male patients and the mean withdrawal time was 7:05 min (SD 1 min). Seven hundred and eighty-one adenomas/serrated lesions were found in 470 patients (1.66 per patient), with 28 advanced lesions and 3 adenocarcinomas. Global ADR was 41% with no significant statistical differences between the two groups (42.1% vs 39.8%, p 0.43), respectively. A multivariate analysis showed clear relation between the finding of adenomas and higher BBPS ratings (Adjusted Odds Ratio [aOR] 0.92, p 0.05), age (aOR 1.03, p 0.01), male sex (aOR 1.51, p 0.001), and time of withdrawal (aOR 1.17, p 0.001), while no association was observed with either withdrawal technique (aOR 0.89, IC 95% 0.70-1.03, p 0.32). There was no statistical significant difference between the two groups concerning the finding of proximal lesions (cOR 0.93, CI 95% 0.71-1.20, p 0.56) (aOR 0.89, CI 95% 0.69-1.17, p 0.41) or serrated polyps (cOR 0.81, CI 95% 0.51-1.27, p 0.35) (aOR 0.81, IC 95% 0.51-1.28, p 0.36).
Fixed withdrawal times did not prove to lead to an increase in the number of detected adenomas. Nevertheless, our study supports previous reports stating that longer withdrawal times are indeed associated with better proximal and distal adenoma detection.
可能会遗漏近端结肠的腺瘤，如果未能发现这些病变，可能会解释一定比例的间隔性癌的发生。虽然研究表明，在结肠镜检查中，当退镜时间为 6 分钟或更长时间时，显著的肿瘤性病变的检出率会增加，但目前还没有关于在每个结肠段花费多少时间的建议。本试验的目的是找到减少近端结肠病变遗漏的方法，评估两种结肠镜退镜时间技术的腺瘤检测率（ADR）差异。
这是一项在大学医院进行的随机试验。研究人群由接受筛查结肠镜检查的患者组成。主要观察指标是接受定时结肠镜检查的患者的 ADR，退镜时间特定，特别关注近端结肠，并意味着回盲部和右半结肠的退镜时间至少延迟 2 分钟，横结肠的退镜时间延迟 1 分钟，左半结肠的退镜时间至少额外延迟 3 分钟，与至少 6 分钟自由退镜延迟时间的标准定时结肠镜检查相比。
共纳入 1160 例患者。最初有 11 例因结肠镜检查不完全而被排除。在剩余的 1149 例患者中，573 例随机分配至固定退镜时间组（A 组），576 例分配至常规退镜组（B 组）。中位年龄为 57 岁（标准差 6），共有 634 例（55.2%）为男性患者，平均退镜时间为 7：05 分钟（标准差 1 分钟）。470 例患者中发现 781 个腺瘤/锯齿状病变（每位患者 1.66 个），其中 28 个为高级病变，3 个为腺癌。总的 ADR 为 41%，两组间无显著统计学差异（42.1%比 39.8%，p 0.43）。多变量分析显示，腺瘤的发现与更高的 BBPS 评分（调整后的优势比[aOR]0.92，p 0.05）、年龄（aOR 1.03，p 0.01）、男性（aOR 1.51，p 0.001）和退镜时间（aOR 1.17，p 0.001）有关，而与退镜技术无关（aOR 0.89，95%置信区间[CI]0.70-1.03，p 0.32）。两组近端病变的检出率（cOR 0.93，95%CI 0.71-1.20，p 0.56）（aOR 0.89，95%CI 0.69-1.17，p 0.41）或锯齿状息肉（cOR 0.81，95%CI 0.51-1.27，p 0.35）（aOR 0.81，95%CI 0.51-1.28，p 0.36）无统计学差异。
固定退镜时间并不能证明会增加腺瘤的检出数量。然而，我们的研究支持先前的报告，即更长的退镜时间确实与近端和远端腺瘤的检出率增加有关。
