Longer withdrawal time improves adenoma detection rate during colonoscopy

During colonoscopy, the 9-minute withdrawal time (WT) demonstrates better adenoma detection rate (ADR) and adenoma per colonoscopy (APC) than does the 6-minute WT, reports a study.

“Given the high-quality evidence, we recommend that clinicians at least perform a 9-minute withdrawal to achieve higher quality metrics including ADR to reduce interval colorectal cancer (CRC),” the investigators said.

A systematic review and meta-analysis was conducted to assess the impact of higher WT on ADR during colonoscopy. The databases of Embase, Medline, Cochrane, Web of Science, and Google Scholar were searched for eligible randomized controlled trials (RCTs) through 8 November 2022.

The investigators applied a random effects model using the DerSimonian Laird approach and calculated risk ratio (RR) for binary outcomes and mean difference (MD) for continuous outcomes.

Three RCTs with a total of 2,159 patients met the eligibility criteria. Of the patients (mean age range 53.6‒56.8 years, 50.7 percent male), 1,136 were included in the 9-minute WT and 1,023 in the 6-minute WT.

Patients in the 9-minute WT group showed a significantly higher overall ADR (RR, 1.23, 95 percent confidence interval [CI], 1.09‒1.40; p<0.001), as well as higher overall APC (MD, 0.14, 95 percent CI, 0.04‒0.25; p=0.008) relative to those in the 6-minute WT group.

“ADR is a quality metric that has been emphasized by multiple societies as improved ADR leads to reduced interval CRC,” the investigators said.