Adenoma and polyp detection rates during insertion versus withdrawal phase of colonoscopy: a systematic review and meta-analysis of randomized controlled trials - 24/09/20

Doi : 10.1016/j.gie.2020.06.015

Saurabh Chandan, MD ^1,^{^{∗
Drs Chandan and Mohan contributed equally to this article.}}, Babu P. Mohan, MD ^2,^{^{∗
Drs Chandan and Mohan contributed equally to this article.}}, Shahab R. Khan, MBBS ³, Neil Bhogal, MD ¹, Daryl Ramai, MD ⁴, Mohammad Bilal, MD ⁵, Muhammad Aziz, MD ⁶, Aun R. Shah, MD ⁷, Harmeet S. Mashiana, MD ¹, Lokesh K. Jha, MD ⁸, Ishfaq Bhat, MD ¹, Shailender Singh, MD ¹, Douglas G. Adler, MD, FACG, AGAF, FASGE ^9,^⁎
¹ Gastroenterology & Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
² Internal Medicine, University of Arizona, Banner University Medical Center, Tucson, Arizona, USA
³ Gastroenterology, Rush University Medical Center, Chicago, Illinois, USA
⁴ Internal Medicine, The Brooklyn Hospital Center, Brooklyn, New York, USA
⁵ Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
⁶ Internal Medicine, University of Toledo, Toledo, Ohio, USA
⁷ Internal Medicine, Metro Health, Cleveland, Ohio, USA
⁸ Gastroenterology, Parkview Health, Fort Wayne, Indiana, USA
⁹ Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA

^∗Reprint requests: Douglas G. Adler, MD, FACG, AGAF, FASGE, Gastroenterology and Hepatology, University of Utah School of Medicine, Huntsman Cancer Center, 30 N 1900 E, 4R118, Salt Lake City, UT 84132.Gastroenterology and HepatologyUniversity of Utah School of MedicineHuntsman Cancer Center30 N 1900 E4R118Salt Lake CityUT84132

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 24 September 2020

Abstract

Background and Aims

Colonoscopy is the preferred modality for colorectal cancer screening because it has both diagnostic and therapeutic capabilities. Current consensus states that colonoscopy should be performed with initial rapid passage of the instrument to the cecum, followed by thorough evaluation for and removal of all polyps during a deliberate slow withdrawal. Reports have suggested that polyps that are seen but not removed during insertion are sometimes quite difficult to find during withdrawal.

Methods

We performed a comprehensive literature search of several major databases (from inception to March 2020) to identify randomized controlled trials comparing inspection and polypectomy during the insertion phase as opposed to the traditional practice of inspection and polypectomy performed entirely during the withdrawal phase. We examined differences in terms of adenoma detection rate (ADR), polyps detected per patient (PDPP), cecal intubation time (CIT), withdrawal time, and total procedure time.

Results

Seven randomized controlled trials, including 3834 patients, were included in our final analysis. The insertion/withdrawal cohort had 1951 patients and the withdrawal-only cohort 1883 patients. Pooled odds of adenoma detection in the insertion/withdrawal cohort was .99 (P = .8). ADR was 47.2% in the insertion/withdrawal cohort and 48.6% in the withdrawal-only cohort. Although total procedure and withdrawal times were shorter in the insertion/withdrawal cohort, PDPP in both cohorts were not statistically significant (1.4 vs 1.5, P = .7).

Conclusions

Additional inspection and polypectomy during the insertion and withdrawal phases of colonoscopy offer no additional benefit in terms of ADR or PDPP.

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Abbreviations : ADR, CI, CIT, PDPP, TPT, WT

Plan

Methods

Search strategy

Study selection

Data abstraction and quality assessment

Outcomes

Statistical analysis

Results

Search results and population characteristics

Characteristics and quality of included studies

Meta-analysis outcomes

Validation of meta-analysis results

Discussion

DISCLOSURE: The following author disclosed financial relationships: D. G. Adler: Consultant for Boston Scientific. All other authors disclosed no financial relationships.