title: Modifiable endoscopic factors that influence the adenoma detection rate in colorectal cancer screening colonoscopies.
abstract: BACKGROUND
  Adenoma detection rate (ADR) has become the most important quality indicator for colonoscopy.
  
  
  OBJECTIVE
  The aim of this study was to investigate which modifiable factors, directly related to the endoscopic procedure, influenced the ADR in screening colonoscopies.
  
  
  METHODS
  Observational, nested study.
  
  
  METHODS
  Multicenter, randomized, controlled trials.
  
  
  METHODS
  Asymptomatic people aged 50 to 69 years were eligible for a multicenter, randomized, controlled trial designed to compare colonoscopy and fecal immunochemical testing in colorectal cancer screening. A total of 4539 individuals undergoing a direct screening colonoscopy were included in this study.
  
  
  METHODS
  Colonoscopy.
  
  
  METHODS
  Bowel cleansing, sedation, withdrawal time in normal colonoscopies, and cecal intubation were analyzed as possible predictors of adenoma detection by using logistic regression analysis, adjusted for age and sex.
  
  
  RESULTS
  In multivariate analysis, after adjustment for age and sex, factors independently related to the ADR were a mean withdrawal time longer than 8 minutes (odds ratio [OR] 1.51; 95% CI, 1.17-1.96) in normal colonoscopies and split preparation (OR 1.26; 95% CI, 1.01-1.57). For advanced adenomas, only withdrawal time maintained statistical significance in the multivariate analysis. For proximal adenomas, withdrawal time and cecal intubation maintained independent statistical significance, whereas only withdrawal time longer than 8 minutes and a <10-hour period between the end of preparation and colonoscopy showed independent associations for distal adenomas.
  
  
  CONCLUSIONS
  Only endoscopic variables have been analyzed.
  
  
  CONCLUSIONS
  Withdrawal time was the only modifiable factor related to the ADR in colorectal cancer screening colonoscopies associated with an increased detection rate of overall, advanced, proximal, and distal adenomas.
authors.affiliation: Unidad de Gastroenterología, Hospital General Universitario de Alicante, Alicante, Spain. jover_rod@gva.es
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Jover
authors.forename: Pedro
authors.initials: P
authors.lastname: Zapater
authors.forename: Eduardo
authors.initials: E
authors.lastname: Polanía
authors.forename: Luis
authors.initials: L
authors.lastname: Bujanda
authors.forename: Angel
authors.initials: A
authors.lastname: Lanas
authors.forename: José A
authors.initials: JA
authors.lastname: Hermo
authors.forename: Joaquín
authors.initials: J
authors.lastname: Cubiella
authors.forename: Akiko
authors.initials: A
authors.lastname: Ono
authors.forename: Yanira
authors.initials: Y
authors.lastname: González-Méndez
authors.forename: Antonio
authors.initials: A
authors.lastname: Peris
authors.forename: María
authors.initials: M
authors.lastname: Pellisé
authors.forename: Agustín
authors.initials: A
authors.lastname: Seoane
authors.forename: Alberto
authors.initials: A
authors.lastname: Herreros-de-Tejada
authors.forename: Marta
authors.initials: M
authors.lastname: Ponce
authors.forename: José C
authors.initials: JC
authors.lastname: Marín-Gabriel
authors.forename: María
authors.initials: M
authors.lastname: Chaparro
authors.forename: Guillermo
authors.initials: G
authors.lastname: Cacho
authors.forename: Servando
authors.initials: S
authors.lastname: Fernández-Díez
authors.forename: Juan
authors.initials: J
authors.lastname: Arenas
authors.forename: Federico
authors.initials: F
authors.lastname: Sopeña
authors.forename: Luisa
authors.initials: L
authors.lastname: de-Castro
authors.forename: Pablo
authors.initials: P
authors.lastname: Vega-Villaamil
authors.forename: María
authors.initials: M
authors.lastname: Rodríguez-Soler
authors.forename: Fernando
authors.initials: F
authors.lastname: Carballo
authors.forename: Dolores
authors.initials: D
authors.lastname: Salas
authors.forename: Juan D
authors.initials: JD
authors.lastname: Morillas
authors.forename: Montserrat
authors.initials: M
authors.lastname: Andreu
authors.forename: Enrique
authors.initials: E
authors.lastname: Quintero
authors.forename: Antoni
authors.initials: A
authors.lastname: Castells
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000368:Aged; D002400:Cathartics / Q000008:administration & dosage; D002432:Cecum; D003113:Colonoscopy / Q000592:standards*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D013997:Time Factors
chemical_list: D002400:Cathartics