Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0033-1358831
Colonoscopic factors associated with adenoma detection in a national colorectal cancer screening program
Publication History
submitted 23 March 2013
accepted after revision 30 September 2013
Publication Date:
28 January 2014 (online)
![](https://www.thieme-connect.de/media/endoscopy/201403/lookinside/thumbnails/10.1055-s-0033-1358831-1.jpg)
Background and study aims: Adenoma detection is a key objective of colonoscopy, particularly in the context of colorectal cancer screening. The aim of this observational study was to identify the technical colonoscopy factors associated with adenoma detection.
Patients and methods: The study analyzed data from the English Bowel Cancer Screening Programme. The indication for all colonoscopies was a positive fecal occult blood test. The relationships between the following colonoscopy factors and adenoma detection (one or more adenomas, advanced adenomas, right-sided adenomas, and total number of adenomas) were examined in multivariable analyses: bowel preparation quality, cecal intubation, withdrawal time, rectal retroversion, colonoscopist experience, antispasmodic use, sedation use, and start time of procedure. The following patient factors were controlled for: age, sex, body mass index, smoking, alcohol, deprivation, and geographical location.
Results: A total of 31088 colonoscopies were analyzed. The following technical factors increased the relative risk of adenoma detection (P < 0.001 in multivariable analysis unless otherwise stated): cecal intubation, increased withdrawal time, higher quality bowel preparation, intravenous antispasmodic use, earlier procedure start time within a session (P = 0.018), and greater colonoscopist experience. Detection of advanced and right-sided adenomas also increased with these factors. Adenoma detection did not differ between sedated and unsedated colonoscopy (P = 0.143).
Conclusion: This study demonstrated important associations between colonoscopy practice and adenoma detection. Use of intravenous antispasmodic was associated with increased adenoma detection. The effect of the start time of colonoscopy suggests that endoscopist fatigue may have a deleterious impact on adenoma detection.
-
References
- 1 Office for National Statistics Mortality Statistics. Cause. England and Wales 2008. London: TSO; 2010
- 2 Morson B. President’s address: the polyp-cancer sequence in the large bowel. Proc R Soc Med 1974; 67: 451-457
- 3 Rex DK, Petrini JL, Baron TH et al. Quality indicators in colonoscopy. Gastrointest Endosc 2006; 63: 16-28
- 4 Kaminski MF, Regula J, Krasewska E et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 2010; 362: 1795-1803
- 5 Lieberman DA, Prindiville S, Weiss DG et al. Risk factors for advanced colonic neoplasia and hyperplastic polyps in asymptomatic individuals. JAMA 2003; 290: 2959-2967
- 6 Anderson JC, Attam R, Alpern Z et al. Prevalence of colorectal neoplasia in smokers. Am J Gastroenterol 2003; 98: 2777-2783
- 7 Reid ME, Marshall JR, Roe D et al. Smoking exposure as a risk factor for prevalent and recurrent colorectal adenomas. Cancer Epidemiol Biomarkers Prev 2003; 12: 1006-1011
- 8 Anderson JC, Alpern Z, Sethi G et al. Prevalence and risk of colorectal neoplasia in consumers of alcohol in a screening population. Am J Gastroenterol 2005; 100: 2049-2055
- 9 Martinez ME, McPherson RS, Annegers JF et al. Cigarette smoking and alcohol consumption as risk factors for colorectal adenomatous polyps. J Natl Cancer Inst 1995; 87: 274-279
- 10 Chen SC, Rex DK. Endoscopist can be more powerful than age and male gender in predicting adenoma detection at colonoscopy. Am J Gastroenterol 2007; 102: 856-861
- 11 Barclay RL, Vicari JJ, Doughty AS et al. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med 2006; 355: 2533-2541
- 12 Simmons DT, Harewood GC, Baron TH et al. Impact of endoscopist withdrawal speed on polyp yield: implications for optimal colonoscopy withdrawal time. Aliment Pharmacol Ther 2006; 24: 965-971
- 13 Lee TJW, Blanks RG, Rees CJ et al. Longer mean colonoscopy withdrawal time is associated with increased adenoma detection: evidence from the Bowel Cancer Screening Programme in England. Endoscopy 2013; 45: 20-26
- 14 Harewood GC, Sharma VK, de Garmo P. Impact of colonic preparation quality on detection of suspected colonic neoplasms. Gastrointest Endosc 2003; 58: 76-79
- 15 Froelich F, Wietlisbach V, Gonvers JJ et al. Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European Multicentre Study. Gastrointest Endosc 2005; 61: 378-384
- 16 Belsey J, Epstein O, Heresbach D. Systematic review: oral bowel preparation for colonoscopy. Aliment Pharmacol Ther 2007; 25: 373-384
- 17 de Brouwer EJ, Arbouw ME, van der Zwet WC et al. Hyoscine N-butylbromide does not improve polyp detection during colonoscopy: a double-blind, randomized, placebo-controlled, clinical trial. Gastrointest Endosc 2012; 75: 835-840
- 18 Mui L, Enders KWN, Kang-chung C et al. Randomized, double-blinded, placebo-controlled trial of intravenously administered hyoscine n-butyl bromide in patients undergoing colonoscopy with patient controlled sedation. Gastrointest Endosc 2004; 59: 22-27
- 19 Lee JM, Cheon JH, Park JJ et al. Effects of hyoscine n-butyl bromide on the detection of polyps during colonoscopy. Hepatogastroenterology 2010; 57: 90-94
- 20 Corte C, Dahlenburg L, Selby S et al. Hyoscine butylbromide administered at the cecum increases polyp detection: a randomized double-blind placebo-controlled trial. Endoscopy 2012; 44: 917-922
- 21 Hanson JM, Atkin WS, Cunliffe WJ et al. Rectal retroflexion: an essential part of lower gastrointestinal endoscopic examination. Dis Colon Rectum 2002; 45: 1120-1121
- 22 Saad A, Rex DK. Routine rectal retroflexion during colonoscopy has a low yield for neoplasia. World J Gastroenterol 2008; 14: 6503-6505
- 23 Chan MY, Cohen H, Spiegel BMR. Fewer polyps detected by colonoscopy as the day progresses at a veteran’s administration teaching hospital. Clin Gastroenterol Hepatol 2009; 7: 1217-1223
- 24 Long MD, Martin C, Sandler RS et al. Reduced polyp detection as endoscopy shift progresses: experience with screening colonoscopy at a tertiary-care hospital. J Clin Gastroenterol 2011; 45: 253-258
- 25 Radaelli F, Meucci G, Sgroi G et al. Technical performance of colonoscopy: the key role of sedation/analgesia and other quality indicators. Am J Gastroenterol 2008; 103: 1122-1130
- 26 Wang A, Hoda KM, Holub JL et al. Does level of sedation impact detection of advanced neoplasia. Dig Dis Sci 2010; 55: 2337-2343
- 27 Logan RF, Patnick J, Nickerson C et al. Outcomes of the Bowel Cancer Screening Programme (BCSP) in England after the first 1 million tests. Gut 2012; 61: 1439-1446
- 28 Lee TJW, Rutter MD, Blanks RG et al. Colonoscopy quality measures: experience from the NHS Bowel Cancer Screening Programme. Gut 2012; 61: 1050-1057
- 29 Lee TJW, Clifford GM, Rajasekhar P et al. High yield of colorectal neoplasia detected by colonoscopy following a positive faecal occult blood test in the NHS Bowel Cancer Screening Programme. J Med Screen 2011; 18: 82-86
- 30 Chilton A, Rutter MD. BCSP Quality Assurance Guidelines for Colonoscopy. Available at: http://www.cancerscreening.nhs.uk/bowel/publications/nhsbcsp06.html
- 31 Department of Communities and Local Government. Indices of Deprivation. 2007 Available at: http://webarchive.nationalarchives.gov.uk/+/http:/www.communities.gov.uk/communities/neighbourhoodrenewal/deprivation/deprivation07/
- 32 Chokshi RV, Hovis CE, Hollander T et al. Prevalence of missed adenomas in patients with inadequate bowel preparation on screening colonoscopy. Gastrointest Endosc 2012; 75: 1197-1203
- 33 Saunders BP, Williams CB. Premedication with intravenous antispasmodic speeds colonoscope insertion. Gastrointest Endosc 1996; 43: 209-211
- 34 Atkin W, Rogers P, Cardwell C et al. Wide variation in adenoma detection rates at screening flexible sigmoidoscopy. Gastroenterology 2004; 126: 1247-1256
- 35 Segnan N, Patnick J, von Karsa L et al. European guidelines for quality assurance in colorectal cancer screening and diagnosis- first edition. Luxemburg: Publications Office of the European Union; 2011
- 36 Jover R, Zapater P, Polania E et al. Modifiable endoscopic factors that influence the adenoma detection rate in colorectal cancer screening colonoscopies. Gastrointest Endosc 2013; 77: 381-389
- 37 Adler A, Wegscheider K, Lieberman D et al. Factors determining the quality of screening colonoscopy: a prospective study on adenoma detection rates from 12 134 examination (Berlin colonoscopy project 3, BECOP-3). Gut 2013; 52: 236-241
- 38 Liang J, Kalady MF, Church J et al. Serrated polyp detection rate during colonsocpy. Colorectal Dis 2012; 14: 1323-1327
- 39 De Wijkerslooth TR, Stoop EM, Bossuyt PM et al. Differences in proximal serrated polyp detection among endoscopists are associated with variability in withdrawal time. Gastrointest Endosc 2013; 77: 617-623
- 40 Rex DK. Colonoscopic withdrawal technique is associated with adenoma miss rates. Gastrointest Endosc 2000; 51: 33-36