Recommendation of a withdrawal time of at least 6 min and introduction of report recording in colonoscopy

Abstract

[Objective] Sufficient withdrawal time is an indicator of high quality for colonoscopy. The present study was aimed at investigating the effects on the withdrawal time and polyp detection rate (PDR) following a withdrawal time recommendation of at least 6 min and report the recording of withdrawal times.

[Participants and Methods] This study examined the withdrawal time and PDR from 1,231 opportunistic colonoscopy screening procedures undertaken between October 2017 and March 2019. Data on outcome measures were collected before the recommendation of the withdrawal time, after the recommendation of the withdrawal time, and after the withdrawal time recording had begun.

[Results] Endoscopist A had a mean withdrawal time (MWT) in normal colonoscopy of 3 min 13 s before the recommendation of the withdrawal time, which extended to 3 min 48 s and 4 min 19 s after the recommendation of the withdrawal time and after the withdrawal time recording had begun, respectively. Endoscopist B had a significantly extended MWT from 4 min 0 s before the recommendation to 5 min 49 s after the recommendation. Endoscopists C-E and F had MWTs of 6 and 8 min before the recommendation, respectively. They showed no significant MWT change. Endoscopist G had a significantly shortened MWT from 9 min 13 s before the recommendation to 7 min 22 s after the recommendation. Overall, endoscopists had a significantly extended MWT from 5 min 35 s before the recommendation to 6 min 26 s after the recommendation. The PDR did not increase significantly for any endoscopist.

[Conclusions] The effect of the recommendation of a minimum withdrawal time of 6 min was limited, and the PDR did not improve. To improve the colonoscopy quality, different measures, such as careful observation techniques, longer withdrawal time (up to 10 min), and feedback to endoscopists, should be implemented.