title: The association between cecal insertion time and colorectal neoplasm detection.
abstract: BACKGROUND
  Information on the impact of cecal insertion time on colorectal neoplasm detection is limited. Our objective was to determine the association between cecal insertion time and colorectal neoplasm detection rate in colonoscopy screening.
  
  
  METHODS
  We performed a cross-sectional study of 12,679 consecutive subjects aged 40-79 years undergoing screening colonoscopy in routine health check-ups at the Center for Health Promotion of the Samsung Medical Center from December 2007 to June 2009. Fixed effects logistic regression conditioning on colonoscopist was used to eliminate confounding due to differences in technical ability and other characteristics across colonoscopists.
  
  
  RESULTS
  The mean cecal insertion time was 5.9 (SD, 4.4 minutes). We identified 4,249 (33.5%) participants with colorectal neoplasms, of whom 1,956 had small single adenomas (<5 mm), 595 had medium single adenomas (5-9 mm), and 1,699 had multiple adenomas or advanced colorectal neoplasms. The overall rates of colorectal neoplasm detection by quartiles of cecal insertion time were 36.8%, 33.4%, 32.7%, and 31.0%, respectively (p trend <0.001).The odds for small single colorectal adenoma detection was 16% lower (adjusted OR 0.84; 95% CI 0.71 to 0.99) in the fourth compared to the first quartile of insertion time (p trend 0.005). Insertion time was not associated with the detection rate of single adenomas ≥5 mm, multiple adenomas or advanced colorectal neoplasms.
  
  
  CONCLUSIONS
  Shorter insertion times were associated with increased rates of detection of small colorectal adenomas <5 mm. Cecal insertion time may be clinically relevant as missed small colorectal adenomas may progress to more advanced lesions.
authors.forename: Moon Hee
authors.initials: MH
authors.lastname: Yang
authors.forename: Juhee
authors.initials: J
authors.lastname: Cho
authors.forename: Sanjay
authors.initials: S
authors.lastname: Rampal
authors.forename: Eun Kyung
authors.initials: EK
authors.lastname: Choi
authors.forename: Yoon-Ho
authors.initials: YH
authors.lastname: Choi
authors.forename: Jun Haeng
authors.initials: JH
authors.lastname: Lee
authors.forename: Young-Ho
authors.initials: YH
authors.lastname: Kim
authors.forename: Dong Kyung
authors.initials: DK
authors.lastname: Chang
authors.forename: Poong-Lyul
authors.initials: PL
authors.lastname: Rhee
authors.forename: Jae J
authors.initials: JJ
authors.lastname: Kim
authors.forename: Eliseo
authors.initials: E
authors.lastname: Guallar
authors.forename: Jong Chul
authors.initials: JC
authors.lastname: Rhee
authors.forename: Hee Jung
authors.initials: HJ
authors.lastname: Son
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D002432:Cecum; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors
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