Comparison of adenoma detection by colonoscopy between polypectomy performed during both insertion and withdrawal versus
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and Other Interventional Techniques
Comparison of adenoma detection by colonoscopy between polypectomy performed during both insertion and withdrawal versus during withdrawal only: a multicenter, randomized, controlled trial Tae‑Geun Gweon1 · Seung‑Woo Lee2 · Jeong‑Seon Ji1,4 · Jeong Rok Lee3 · Joon Sung Kim1 · Byung‑Wook Kim1 · Hwang Choi1 Received: 18 September 2019 / Accepted: 24 December 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background and aim In standard colonoscopy, the colonoscope is inserted into the cecum, and inspection of the colonic mucosa and polypectomy are performed during withdrawal. The colon configuration can differ between the insertion and withdrawal phases, and some polyps found in the insertion phase can be missed during withdrawal. A few single-center studies investigated whether detection of polyps during the insertion phase affects the adenoma detection rate (ADR). However, the effectiveness of this strategy is unknown because of conflicting results. We aimed to determine whether polypectomy together with careful inspection during insertion increases the ADR compared with standard colonoscopy. Methods A randomized, controlled, multicenter trial was conducted at three university hospitals. Patients aged 50 to 80 years were randomly assigned to the study group or control group. For patients in the study group, polypectomy was performed together with careful inspection during both colonoscope insertion and withdrawal. In the control group, polyps were inspected and removed only during colonoscope withdrawal. The primary endpoint was the ADR, which was defined as the percentage of patients with ≥ 1 adenoma. Results A total of 1142 patients were enrolled (study group, n = 571; control group, n = 571). The ADR was similar in the 2 groups (study group, 44.1%; control group, 43.1%; P = 0.72). In the control group, 12 polyps that had been detected during colonoscope insertion were not found during withdrawal (polyp miss rate: 2.1%, 12/571). Conclusion Polypectomy and careful inspection during both colonoscope insertion and withdrawal did not improve the overall ADR compared with standard colonoscopy (NCT01925833). Keywords Colonoscopy · Adenoma · Adenoma detection rate Colonoscopy is a standard modality for the diagnosis and treatment of colorectal polyps [1], and the use of this procedure can reduce the incidence and mortality of colorectal Tae-Geun Gweon and Seung-Woo Lee equally contributed this article as co-first authors. * Jeong‑Seon Ji [email protected] 1
Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
Department of Internal Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
2
cancer (CRC) [2, 3]. However, colonoscopists can miss 10–30% of adenomas during colonoscopy [4, 5], which can contribute to the development of interval CRC [6]. The adenoma detection rate (ADR)
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