Goldman Adam, Lang Alon, Levartovsky Asaf, Levy Idan, Laish Ido, Ben-Horin Shomron, Kopylov Uri
Department of Gastroenterology, Sheba Medical Center, Derech Sheba 2, Ramat Gan, Tel Hashomer 5262100, Israel.
Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Therap Adv Gastroenterol. 2025 May 28;18:17562848251341752. doi: 10.1177/17562848251341752. eCollection 2025.
BACKGROUND: Longer cecal withdrawal time has been linked to a higher adenoma detection rate (ADR), with a minimum duration of 6 min recommended. Therefore, we developed the cecal withdrawal vocal timer (CWVT), a novel software tool that is command-activated at cecal intubation and vocally informs the endoscopist of the withdrawal duration every minute. OBJECTIVES: Evaluating the efficacy of the CWVT in enhancing adenoma detection. DESIGN: A retrospective, single-center study of screening colonoscopies with adequate preparation and documented cecal intubation. METHODS: The primary endpoint was the change in the department's ADR before (2022) and after the CWVT introduction (January 2023-February 2024). Secondary endpoints included the ADR change between procedures with and without CWVT after its introduction and the ADR change among individual endoscopists. RESULTS: The study included 1098 and 1330 eligible colonoscopies pre- and post-CWVT introduction, respectively. Following CWVT introduction, 67.3% of colonoscopies were performed with activated CWVT, with a median withdrawal time of 8.7 (interquartile range: 6.9-11.8) min. The department ADR was 25.5% following CWVT introduction, without a significant difference compared to the year before (26.2%, = 0.71). During the post-CWVT implementation period, colonoscopies with activated CWVT had higher ADR than those without (28.4% vs 19.5%, respectively, < 0.001). The improvement was mainly driven by the detection of adenomas smaller than 10 mm and was consistent across 11 out of 12 months in this period and among most endoscopists. CONCLUSION: While an overall ADR improvement was not achieved with the CWVT, the ADR was higher in post-CWVT procedures that utilized the CWVT than those that did not, warranting further prospective studies to evaluate CWVT's contribution to screening colonoscopy performance.
背景:盲肠退镜时间延长与较高的腺瘤检出率(ADR)相关,建议最短持续时间为6分钟。因此,我们开发了盲肠退镜语音定时器(CWVT),这是一种新型软件工具,在盲肠插管时通过指令激活,并每分钟语音告知内镜医师退镜持续时间。 目的:评估CWVT在提高腺瘤检出率方面的疗效。 设计:一项回顾性、单中心研究,纳入准备充分且有盲肠插管记录的筛查结肠镜检查。 方法:主要终点是引入CWVT之前(2022年)和之后(2023年1月至2024年2月)科室ADR的变化。次要终点包括引入CWVT后使用和未使用CWVT的检查之间的ADR变化以及个体内镜医师的ADR变化。 结果:该研究分别纳入了引入CWVT之前和之后的1098例和1330例符合条件的结肠镜检查。引入CWVT后,67.3%的结肠镜检查在激活CWVT的情况下进行,中位退镜时间为8.7(四分位间距:6.9 - 11.8)分钟。引入CWVT后科室ADR为25.5%,与前一年(26.2%)相比无显著差异(P = 0.71)。在引入CWVT后的实施期间,激活CWVT的结肠镜检查的ADR高于未激活的(分别为28.4%和19.5%,P < 0.001)。这种改善主要由小于10毫米的腺瘤检出所驱动,在此期间的12个月中有11个月以及大多数内镜医师中均保持一致。 结论:虽然CWVT未实现整体ADR的改善,但在引入CWVT后使用该工具的检查中ADR高于未使用者,需要进一步进行前瞻性研究以评估CWVT对筛查结肠镜检查性能的贡献。
Therap Adv Gastroenterol. 2025-5-28
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