One or two operator technique and quality performance of colonoscopy: a randomised controlled trial.
BACKGROUND
The two-operator technique for colonoscopy, with the endoscopy assistant actively advancing and withdrawing the scope, is still commonly practiced in Europe. As uncontrolled data has suggested that the one-operator technique is associated with a higher adenoma detection rate, we tested the hypothesis that the two-operator-technique can achieve comparable performances in terms of adenoma detection.


METHODS
Non-inferiority trial in which consecutive adult outpatients were randomised to undergo colonoscopy by one (one-operator) or by four endoscopists. Each performed half the procedures by one-operator and half by two-operator technique independently of routine clinical practice. Main outcome measure was adenoma detection rate.


RESULTS
352 subjects (49% males, mean age 60 ± 12.1 years) were randomised to one (n=176) or to two-operator technique (n=176) colonoscopy. No significant differences were found in adenoma detection (33% vs. 30.7%, p=0.65), or cecal intubation rate, procedure times, and patient tolerability. No differences were found in the subgroup analysis according to routinely adopted colonoscopy technique.


CONCLUSIONS
This study does not confirm a higher adenoma detection rate for one-operator technique colonoscopy. Changing current practice to improve adenoma detection rate for endoscopists routinely using two-operator technique is not warranted.
Division of Gastroenterology, Valduce Hospital, Como, Italy.
Silvia
S
Paggi
Division of Gastroenterology, Valduce Hospital, Como, Italy.
Emanuele
E
Rondonotti
Division of Gastroenterology, Valduce Hospital, Como, Italy.
Arnaldo
A
Amato
Division of Gastroenterology, Valduce Hospital, Como, Italy.
Alessandra
A
Baccarin
Division of Gastroenterology, Valduce Hospital, Como, Italy.
Giancarlo
G
Spinzi
Division of Gastroenterology, Valduce Hospital, Como, Italy. Electronic address: francoradaelli@virgilio.it.
Franco
F
Radaelli
D000236:Adenoma / Q000175:diagnosis*; D002432:Cecum; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D061212:Memory, Episodic; D008875:Middle Aged; D061646:Operative Time; D011787:Quality of Health Care; D016037:Single-Blind Method
Adenoma detection rate; Colonoscopy technique; One operator; Two operators