Retrospective Study
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World J Gastrointest Endosc. May 16, 2014; 6(5): 186-192
Published online May 16, 2014. doi: 10.4253/wjge.v6.i5.186
Withdrawal time in excellent or very poor bowel preparation qualities
David Widjaja, Manoj Bhandari, Vivian Loveday-Laghi, Mariela Glandt, Bhavna Balar
David Widjaja, Manoj Bhandari, Vivian Loveday-Laghi, Mariela Glandt, Bhavna Balar, Division of Gastroenterology, Department of Medicine, Bronx Lebanon Hospital Center, Bronx, NY 10456, United States
Author contributions: Widjaja D, Bhandari M, Loveday-Laghi V, Glandt M and Balar B contributed equally to this work; Widjaja D, Glandt M and Balar B conceived the study and designed the research; Bhandari M and Loveday-Laghi V gathered the data; Widjaja D and Balar B conducted data analysis; Widjaja D, Bhandari M, Loveday-Laghi V, Glandt M and Balar B prepared, edited and finalized the manuscript.
Correspondence to: David Widjaja, MD, Division of Gastroenterology, Department of Medicine, Bronx Lebanon Hospital Center, 1650 Selwyn Ave, 10th Floor, Bronx, NY 10457, United States. medicine.nyc@gmail.com
Telephone: +1-718-5185550 Fax: +1-718-5185111
Received: December 1, 2013
Revised: February 7, 2014
Accepted: April 17, 2014
Published online: May 16, 2014
Processing time: 169 Days and 12.6 Hours
Abstract

AIM: To evaluate association(s) between withdrawal time and polyp detection in various bowel preparation qualities.

METHODS: Retrospective cohort analysis of screening colonoscopies performed between January 2005 and June 2011 for patients with average risk of colorectal cancer. Exclusion criteria included patients with a personal history of adenomatous polyps or colon cancer, prior colonic resection, significant family history of colorectal cancer, screening colonoscopy after other abnormal screening tests such as flexible sigmoidoscopy or barium enema, and screening colonoscopies during in-patient care. All procedures were performed or directly supervised by gastroenterologists. Main measurements were number of colonic segments with polyps and total number of colonic polyps.

RESULTS: Multivariate analysis of 8331 colonoscopies showed longer withdrawal time was associated with more colonic segments with polyps in good (adjusted OR = 1.16; 95%CI: 1.13-1.19), fair (OR = 1.13; 95%CI: 1.10-1.17), and poor (OR = 1.18; 95%CI: 1.11-1.26) bowel preparation qualities. A higher number of total polyps was associated with longer withdrawal time in good (OR = 1.15; 95%CI: 1.13-1.18), fair (OR = 1.13; 95%CI: 1.10-1.16), and poor (OR = 1.20; 95%CI: 1.13-1.29) bowel preparation qualities. Longer withdrawal time was not associated with more colonic segments with polyps or greater number of colonic polyps in bowel preparations with excellent (OR = 1.07, 95%CI: 0.99-1.26; OR = 1.11, 95%CI: 0.99-1.24, respectively) and very poor (OR = 1.02, 95%CI: 0.99-1.12; OR = 1.05, 95%CI: 0.99-1.10, respectively) qualities.

CONCLUSION: Longer withdrawal time is not associated with higher polyp number detected in colonoscopies with excellent or very poor bowel preparation quality.

Keywords: Bowel preparation quality; Withdrawal time; Polyp detection; Screening colonoscopy

Core tip: This study revealed the merit of a novel finding that longer withdrawal time was not associated with higher polyp number detected in colonoscopies with excellent or very poor bowel preparation quality. The conclusion of this study may change the way we perform screening colonoscopy with excellent or very poor bowel preparation qualities, especially in those with high risk to develop complications related to prolonged sedation.