title: Formal documentation of withdrawal time improves the quality of colonoscopic observation.
abstract: OBJECTIVE
  At least 6-10 min of withdrawal time is currently recommended to optimize polyp yield in screening colonoscopies in individual with intact colon. We aimed to assess whether formal documentation of withdrawal time could improve the quality of colonoscopy observation.
  
  
  METHODS
  During December 2006, we implemented withdrawal time as a mandatory field for formal colonoscopy report. Colonoscopy withdrawal time and adenoma detection rate was compared between periods before (Nov 2006) and after (Jan 2007) formal documentation. A total of 709 colonoscopic procedures, which were performed by 9 colonoscopists in training (fellows) were analyzed.
  
  
  RESULTS
  The median withdrawal time of 'negative colonoscopy' increased from 6m06s to 6m36s (p=0.045). The number of adenoma detected in each colonoscopy between the two periods was 0.66 and 0.81 (p=0.813). Two out of 9 colonoscopists increased withdrawal time significantly (6 m 11 s to 7 m 52 s, p=0.001) after formal documentation of withdrawal time and demonstrated higher detection rate for adenoma smaller than 10 mm (0.34 per colonoscopy vs. 0.83 per colonoscopy; p=0.012).
  
  
  CONCLUSIONS
  Formal documentation of withdrawal time forced colonoscopists to lengthen actual withdrawal time. Routinization of formal documentation of withdrawal time might be helpful in improving quality of colonoscopy.
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Dong Hyun
authors.initials: DH
authors.lastname: Sinn
authors.forename: Dong Kyung
authors.initials: DK
authors.lastname: Chang
authors.forename: Won-Seok
authors.initials: WS
authors.lastname: Choi
authors.forename: Jin Yong
authors.initials: JY
authors.lastname: Kim
authors.forename: Jun Haeng
authors.initials: JH
authors.lastname: Lee
authors.forename: Young-Ho
authors.initials: YH
authors.lastname: Kim
authors.forename: Hee Jung
authors.initials: HJ
authors.lastname: Son
authors.forename: Poong-Lyul
authors.initials: PL
authors.lastname: Rhee
authors.forename: Jae J
authors.initials: JJ
authors.lastname: Kim
authors.forename: Jong Chul
authors.initials: JC
authors.lastname: Rhee
mesh_terms: D000236:Adenoma / Q000175:diagnosis; D000328:Adult; D000368:Aged; D003110:Colonic Neoplasms / Q000175:diagnosis; D003113:Colonoscopy / Q000592:standards*; D004282:Documentation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors