title: Should Assessment of Quality Indicator of Colonoscopy Be Varied Depending on the Colonoscopic Technique Level?
abstract: OBJECTIVE
  The purpose of this research was to evaluate if withdrawal time is a useful index in spite of differences in gastroenterologists' ability and if there are other quality indicators of colonoscopy.
  
  
  METHODS
  A total of 665 consecutive, asymptomatic individuals of average risk between 50 and 75 years of age who underwent screening colonoscopies performed by 12 gastroenterologists were included in this study. The endoscopists were classified to either the experienced group (group A, N = 6) or the under-experienced group (group B, N = 6). The endoscopists were unaware that they were being studied during the two-month study period.
  
  
  RESULTS
  In group A, adenoma detection rate was 0.56, while in group B it was 0.43 (P = 0.048). The mean withdrawal time ranged widely from 4.2 to 10.3 min per patient with a mean value of 6.83 for group A and 6.54 for group B. There was a significantly positive relationship between the number of adenomas detected and the withdrawal time for group B (r = 0.827, P = 0.005), but not for group A (r = -0.152, P = 0.584). In the case of group A, the ratio of cecal intubation time to withdrawal time (I/E ratio) less than 1 showed significantly correlated adenoma detection rate compared to I/E ratio greater than 1 (r = -0.308, P = 0.036). In the case of group B, mean I/E ratio was 1.7 and all endoscopists' I/E ratios were greater than 1.
  
  
  CONCLUSIONS
  For experienced endoscopists, a useful supplementary quality indicator of colonoscopy is to keep intubation/withdrawal time ratio less than 1 and it is necessary for under-experienced endoscopists to try to keep enough withdrawal time.
authors.affiliation: Department of Internal Medicine, Jeonju Hospital, Jeonju, South Korea.
authors.forename: Bum Su
authors.initials: BS
authors.lastname: Choung
authors.affiliation: Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, 634-18 Keumam-dong, Dukjin-gu, Jeonju, Jeonbuk, 561-712, South Korea.
authors.forename: Seong Hun
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, 634-18 Keumam-dong, Dukjin-gu, Jeonju, Jeonbuk, 561-712, South Korea.
authors.forename: Kyung Bo
authors.initials: KB
authors.lastname: Yoo
authors.affiliation: Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, 634-18 Keumam-dong, Dukjin-gu, Jeonju, Jeonbuk, 561-712, South Korea.
authors.forename: Seung Young
authors.initials: SY
authors.lastname: Seo
authors.affiliation: Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, 634-18 Keumam-dong, Dukjin-gu, Jeonju, Jeonbuk, 561-712, South Korea.
authors.forename: In Hee
authors.initials: IH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, 634-18 Keumam-dong, Dukjin-gu, Jeonju, Jeonbuk, 561-712, South Korea.
authors.forename: Seung Ok
authors.initials: SO
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, 634-18 Keumam-dong, Dukjin-gu, Jeonju, Jeonbuk, 561-712, South Korea.
authors.forename: Soo Teik
authors.initials: ST
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, 634-18 Keumam-dong, Dukjin-gu, Jeonju, Jeonbuk, 561-712, South Korea. clickm@jbnu.ac.kr.
authors.forename: Sang Wook
authors.initials: SW
authors.lastname: Kim
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000368:Aged; D002432:Cecum; D002983:Clinical Competence; D003113:Colonoscopy / Q000592:standards*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer; D005260:Female; D005762:Gastroenterology / Q000592:standards*; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011785:Quality Assurance, Health Care / Q000379:methods; D019984:Quality Indicators, Health Care
keywords: Adenoma detection rates; Colonoscopy; Quality assurance; Withdrawal time