• Gastrointest. Endosc. · Jan 2021

    Review Meta Analysis

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

    • Saurabh Chandan, Babu P Mohan, Shahab R Khan, Neil Bhogal, Daryl Ramai, Mohammad Bilal, Muhammad Aziz, Aun R Shah, Harmeet S Mashiana, Lokesh K Jha, Ishfaq Bhat, Shailender Singh, and Douglas G Adler.
    • Gastroenterology & Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA.
    • Gastrointest. Endosc. 2021 Jan 1; 93 (1): 68-76.e2.

    Background And AimsColonoscopy 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.MethodsWe 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.ResultsSeven 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).ConclusionsAdditional inspection and polypectomy during the insertion and withdrawal phases of colonoscopy offer no additional benefit in terms of ADR or PDPP.Copyright © 2021. Published by Elsevier Inc.

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