title: Quality of colonoscopy withdrawal technique and variability in adenoma detection rates (with videos).
abstract: BACKGROUND
  Studies suggest that endoscopist-related factors such as colonoscopy withdrawal time are important in determining the adenoma detection rate (ADR).
  
  
  OBJECTIVE
  To determine the importance of withdrawal technique in differentiating among endoscopists with varying ADRs.
  
  
  METHODS
  Prospective, multicenter study.
  
  
  METHODS
  Five academic tertiary-care medical centers.
  
  
  METHODS
  This study involved 11 gastroenterology faculty endoscopists.
  
  
  METHODS
  A retrospective review of screening colonoscopies was performed to categorize endoscopists into low, moderate, and high ADR groups. Video recordings were randomly obtained for each endoscopist on 20 (10 real, 10 sham) withdrawals during colonoscopies performed for average-risk colorectal cancer screening. Three blinded reviewers assigned withdrawal technique scores (total of 75 points) on 110 video recordings. A separate reviewer recorded withdrawal times.
  
  
  METHODS
  Withdrawal technique scores and withdrawal times.
  
  
  RESULTS
  Mean (± standard deviation [SD]) withdrawal technique scores were higher in the moderate (62 ± 2.5) and high (59.5 ± 3) ADR groups compared with the low (40.8±3) ADR group (P = .002). Mean (± SD) withdrawal times were 6.3 ± 1.8 minutes (low ADR), 10.2 ± 1.5 minutes (moderate ADR), and 8.2 ± 1.8 minutes (high ADR) (P = .29). A comparison of the withdrawal times and technique scores of the two individual endoscopists with the lowest and highest ADRs did not find a significant difference in withdrawal times (6.6 ± 1.7 vs 7.4 ± 1.7 minutes) (P = .36) but did find a nearly 2-fold difference in technique scores (36.2 ± 9 vs 62.8 ± 9.9) (P = .0001).
  
  
  CONCLUSIONS
  Not adequately powered to detect small differences in withdrawal times.
  
  
  CONCLUSIONS
  Withdrawal technique is an important indicator that differentiates between endoscopists with varying ADRs. It is possible that withdrawal technique is equal to, if not more important than, withdrawal time in determining ADRs.
authors.affiliation: Division of Gastroenterology, University of California Irvine, Irvine, California, USA; Gastroenterology Section, Veterans Affairs Long Beach Health Care System, Long Beach, California, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Lee
authors.forename: Raymond S
authors.initials: RS
authors.lastname: Tang
authors.forename: V Raman
authors.initials: VR
authors.lastname: Muthusamy
authors.forename: Samuel B
authors.initials: SB
authors.lastname: Ho
authors.forename: Nimeesh K
authors.initials: NK
authors.lastname: Shah
authors.forename: Laura
authors.initials: L
authors.lastname: Wetzel
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Bain
authors.forename: Erin E
authors.initials: EE
authors.lastname: Mackintosh
authors.forename: Aeri M
authors.initials: AM
authors.lastname: Paek
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Crissien
authors.forename: Lida Jafari
authors.initials: LJ
authors.lastname: Saraf
authors.forename: Denise M
authors.initials: DM
authors.lastname: Kalmaz
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Savides
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D003113:Colonoscopy / Q000379:methods / Q000592:standards*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors