Chen Xujin, Xu Bingxin, Wei Bingni, Ji Lin, Yang Cheng, Zhan Qiang
Department of Gastroenterology The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University Wuxi Jiangsu China.
Department of Digestive Endoscopy Center The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University Wuxi Jiangsu China.
JGH Open. 2025 Jan 8;9(1):e70095. doi: 10.1002/jgh3.70095. eCollection 2025 Jan.
The 6-min withdrawal time for colonoscopy is widely considered the standard of care. However, there may not be appropriate if the 6-min is equally divided into various colon segments. Since the adenoma detection in each colon segment is not the same, there may be differences with the withdrawal time in different colon segments. Our objective was to evaluate the relationships between adenoma detection rate (ADR) and respective withdrawal time in different colon segments.
Outpatients, age range 18-75 years, undertaking complete colonoscopy were enrolled in this study from November 2019 to November 2020 in the digestive endoscopy center. The entire colon was divided into four different segments: ascending colon, transverse colon, descending colon and rectosigmoid colon. The respective withdrawal time and ADR in each colon segment were recorded respectively.
A total of 586 outpatients (279 males, 307 females) enrolled in this study and the general ADR was 38.2%. The positive withdrawal time (adenomas detected) was longer than negative withdrawal time (non-adenomas detected) (334.04 ± 24.21 s vs. 303.65 ± 5.20 s, t = 1.26, < 0.001). ADR in ascending colon, transverse colon, descending colon and rectosigmoid colon were respectively 30.5%, 2.9%, 3.1% and 7.5%. While all of their positive withdrawal time were longer than negative withdrawal time (94.34 ± 33.76 s vs. 70.40 ± 41.84 s, = 3.31, = 0.001; 85.40 ± 49.76 s vs. 71.66 ± 36.87 s, = 1.95, = 0.025; 80.29 ± 39.85 s vs. 69.73 ± 35.96 s, = 1.40, = 0.016;100.95 ± 55.92 s vs. 80.96 ± 42.87 s, = 3.61; < 0.001, respectively). The withdrawal time threshold in the ascending colon, transverse colon, descending colon, rectosigmoid colon determined by receiver operating characteristic (ROC) curve were 77, 61, 56 and 109 s, respectively. In the ascending colon, ADR was significantly higher (47.0% vs. 33.1%, < 0.001) when the colonoscopy withdrawal time was ≥ 77 s. When the withdrawal time was ≥ 61 s in the transverse colon (42.7% vs. 32.7%, = 0.013), ≥ 59 s in the descending colon (42.3% vs. 29.9%, = 0.004) and ≥ 109 s in rectosigmoid colon (52.2% vs. 33.9%, < 0.001), ADR was also significantly higher. After adjusting for age, sex and BMI, Logistic regression analysis showed that withdrawal time ≥ 77 s in the ascending colon (OR, 1.796; 95% CI, 1.273-2.532; < 0.001), ≥ 61 s in the transverse colon (OR, 1.535; 95% CI, 1.094-2.155; = 0.013), ≥ 56 s in the descending colon (OR, 1.722; 95% CI, 1.193-2.486; = 0.004) and ≥ 109 s in the rectosigmoid colon (OR, 2.134; 95% CI, 1.446-2.350; < 0.001) were independent risk factors for the increase of ADR.
ADR and withdrawal time are all various in individual colon segments. During the operation of colonoscopy, withdrawal time in the ascending colon may be shortened appropriately. The adenomas in the rectosigmoid colon are more likely to be detected and do not take longer withdrawal times. We need to choose the appropriate time according to different colon segments.
结肠镜检查6分钟退镜时间被广泛认为是标准的操作规范。然而，如果将这6分钟平均分配到各个结肠段，可能并不合适。由于每个结肠段腺瘤的检出情况不同，不同结肠段的退镜时间可能存在差异。我们的目的是评估不同结肠段腺瘤检出率（ADR）与各自退镜时间之间的关系。
2019年11月至2020年11月，在消化内镜中心纳入年龄在18 - 75岁、接受全结肠镜检查的门诊患者。整个结肠被分为四个不同的段：升结肠、横结肠、降结肠和直肠乙状结肠。分别记录每个结肠段的退镜时间和ADR。
本研究共纳入586例门诊患者（男性279例，女性307例），总体ADR为38.2%。阳性退镜时间（检测到腺瘤）长于阴性退镜时间（未检测到腺瘤）（334.04 ± 24.21秒 vs. 303.65 ± 5.20秒，t = 1.26，P < 0.001）。升结肠、横结肠、降结肠和直肠乙状结肠的ADR分别为30.5%、2.9%、3.1%和7.5%。并且它们所有的阳性退镜时间均长于阴性退镜时间（94.34 ± 33.76秒 vs. 70.40 ± 41.84秒，P = = 3.31，P = 0.001；85.40 ± 49.76秒 vs. 71.66 ± 36.87秒，P = = 1.95，P = 0.025；80.29 ± 39.85秒 vs. 69.73 ± 35.96秒，P = = 1.40，P = 0.016；100.95 ± y55.92秒 vs. 80.96 ± 42.87秒，P = = 3.61；P < 0.001，分别）。通过受试者工作特征（ROC）曲线确定的升结肠、横结肠、降结肠和直肠乙状结肠的退镜时间阈值分别为77秒、61秒、56秒和109秒。在升结肠，当结肠镜退镜时间≥77秒时，ADR显著更高（47.0% vs. 33.1%，P < 0.001）。当横结肠退镜时间≥61秒（42.7% vs. 32.7%，P = = 0.013）、降结肠退镜时间≥59秒（42.3% vs. 29.9%，P = = 0.004）以及直肠乙状结肠退镜时间≥109秒（52.2% vs. 33.9%，P < 0.001）时，ADR也显著更高。在调整年龄、性别和BMI后，Logistic回归分析显示，升结肠退镜时间≥77秒（OR，1.796；95%CI，1.273 - 2.532；P < 0.001）、横结肠退镜时间≥61秒（OR，1.535；95%CI，1.094 - ......（此处原文可能有误，推测应为2.155；P = = 0.013）、降结肠退镜时间≥56秒（OR，1.722；95%CI，1.193 - 2.486；P = = 0.004）以及直肠乙状结肠退镜时间≥109秒（OR，2.134；95%CI，1.446 - 2.350；P < 0.001）是ADR增加的独立危险因素。
各结肠段的ADR和退镜时间各不相同。在结肠镜操作过程中，升结肠的退镜时间可适当缩短。直肠乙状结肠的腺瘤更易被检测到，且无需较长的退镜时间。我们需要根据不同结肠段选择合适的时间。
