Withdrawal Time Policy Not Linked to Polyp Discovery

After endoscopists devoted at least seven minutes during colonoscopy, polyp detection didn't rise
By Eric Metcalf
HealthDay Reporter

TUESDAY, Dec. 30 (HealthDay News) -- A policy calling for endoscopists to devote at least seven minutes to withdrawal time during colonoscopies failed to increase colon polyp detection, according to research published in the December issue of Gastroenterology.

Mandeep S. Sawhney, of the Beth Israel Deaconess Medical Center in Boston, and colleagues analyzed data obtained during a 16-month period in which the institute's endoscopists were expected to perform colonoscopy withdrawals of at least seven minutes. Compliance was regularly encouraged, and nurses recorded the times during non-therapeutic colonoscopies.

During this time, nearly 24,000 colonoscopies were performed, the report indicates. At the start, the polyp detection ratio -- the number detected divided by the number of colonoscopies performed -- was 0.48. Although the providers reached nearly total compliance during the study, the investigators found no increase in polyp detection, whether for total polyps or different size categories of polyps.

"Endoscopists with longer withdrawal times may find more polyps because they spend more time examining the colon mucosa, or perhaps because they use a more rigorous technique to examine the colon mucosa, which happens to take longer. The results of our study suggest that it is the latter and that withdrawal technique may be more important than withdrawal time," the authors write. "Substantial differences between colonoscopy withdrawal techniques with regard to examining proximal haustral folds, flexures and rectal valves; removing fluid and feces; and distending the lumen are known to exist between endoscopists."

The study was supported by the American Society for Gastrointestinal Endoscopy.

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