Colorectal Cancer Prevention

5 - Examination of the Right Colon for Three Minutes or More Significantly Increases Adenoma Detection Rate: A Multi-Center Prospective Randomized Controlled Trial

Monday, October 8
8:48 AM - 9:00 AM
Location: Terrace Ballroom (level 400)

Category: Colorectal Cancer Prevention
Fahad F. Mir, MD, MSc1, Hasan Badar, MD2, Muhammad Shafiq, MD2, Jamie Varghese2, Wendell Clarkston, MD3, Donald Campbell, MD4, Rajiv Chhabra, MD4, Fadi Hamid, MD4, Susana Escalante-Glorsky, MD4, James Kim, MD4, John Helzberg, MD4, Laura Alba, MD4, Sakher Albadarin, MD4, Hiliary Bownik, MD4, Sreenivasa S. Jonnalagadda, MD3
1University of Missouri, Mission, KS; 2University of Missouri, Kansas City, MO; 3St. Luke's Health System, Kansas City, MO; 4St. Luke's Hospital, Kansas City, MO

Award: ACG Governors Award for Excellence in Clinical Research

Introduction: Adenoma detection rate (ADR) is a quality measure for colonoscopies. Miss rate for adenomas can be as high as 30% and lesions on the right-side of the colon are particularly high risk of getting missed. Careful examination of the right colon is recommended but the ideal withdrawal time examining the right colon is unknown.

Methods: Patients above the age of 45 (or if screening was indicated prior to that), who underwent colonoscopy for screening for colon cancer as an indication, were included. Based on ADRR (Adenoma detection rate in the right colon), patients in whom the right colon withdrawal time (RWT) (cecum to hepatic flexure) was more than 3 minutes were compared to patients in whom less than 3 minutes were spent in the right colon. Chi square, t tests and Linear Regression were used for analysis.

Results: 405 patients were randomized, with 197 patients (52%) in the < 3mins withdrawal group and 179 patients (48%) in the ≥ 3mins group. Mean age was 60 years SD ± 9.9 years. 77% patients were Caucasian and 19% were African American. 55% patients were female. Median ASA score was 2, Median total withdrawal time was 11mins, and median right colon withdrawal time (RWT) was 3.5mins. There were no significant differences between groups in age, sex, indication p=0.4, family history of colon cancer p=0.6, or retroflexion performed p=0.2. Overall adenoma detection rate was 47%.

ADRR was significantly higher if the RWT was ≥ 3mins (35%) vs. if it was < 3 mins (12%) p<.0001. The ADRR was also significantly higher when the modified right colon withdrawal time (withdrawal time excluding polypectomy time, MADRR) was used in ≥ 3mins group (34%) vs. <3mins group (14%) p<.0001. 73% of the adenomas detected were when ≥ 3 mins were spent examining the right colon. When consider average risk screening population (n=252), ADRR was significantly higher in the ≥ 3mins group (35%) vs. 13% in the <3 mins group p<.0001). Total ADR was also higher in the ≥ 3 mins group (59%) compared to the < 3 mins group (36%) p<0.0001. Logistic regression analysis yielded an Odds Ratio of 0.27 and hence examining the right colon for ≥ 3 minutes was 4.3 times more likely to find adenomas (p<.0001). There was no difference in based on fellow involvement (p=0.3).

Discussion: Adenoma detection rate in the right colon was significantly higher when three minutes or more were spent examining the right colon during withdrawal.


Disclosures:
Fahad Mir indicated no relevant financial relationships.
Hasan Badar indicated no relevant financial relationships.
Muhammad Shafiq indicated no relevant financial relationships.
Jamie Varghese indicated no relevant financial relationships.
Wendell Clarkston indicated no relevant financial relationships.
Donald Campbell indicated no relevant financial relationships.
Rajiv Chhabra indicated no relevant financial relationships.
Fadi Hamid indicated no relevant financial relationships.
Susana Escalante-Glorsky indicated no relevant financial relationships.
James Kim indicated no relevant financial relationships.
John Helzberg indicated no relevant financial relationships.
Laura Alba indicated no relevant financial relationships.
Sakher Albadarin indicated no relevant financial relationships.
Hiliary Bownik: AbbVie – Speaker's Bureau. Takeda – Speaker's Bureau.
Sreenivasa Jonnalagadda indicated no relevant financial relationships.

Fahad F. Mir

University of Missouri Kansas City
Mission, Kansas

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5 - Examination of the Right Colon for Three Minutes or More Significantly Increases Adenoma Detection Rate: A Multi-Center Prospective Randomized Controlled Trial



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