Impact of withdrawal time on adenoma detection rate: results from a prospective multicenter trial

Madhav Desai, Douglas K. Rex, Matthew E. Bohm, Perica Davitkov, John M. DeWitt, Monika Fischer, Gregory Faulx, Ryan Heath, Timothy D. Imler, Toyia N. James-Stevenson, Charles J. Kahi, William R. Kessler, Divyanshoo R. Kohli, Lee McHenry, Tarun Rai, Nicholas A. Rogers, Sashidhar V. Sagi, Anjana Sathyamurthy, Prashanth Vennalaganti, Suneha SundaramHarsh Patel, April Higbee, Kevin Kennedy, Rachel Lahr, Gjorgie Stojadinovikj, Carlissa Campbell, Chandra Dasari, Sravanthi Parasa, Ashley Faulx, Prateek Sharma

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background and Aims: Performing a high-quality colonoscopy is critical for optimizing the adenoma detection rate (ADR). Colonoscopy withdrawal time (a surrogate measure) of ≥6 minutes is recommended; however, a threshold of a high-quality withdrawal and its impact on ADR are not known. Methods: We examined withdrawal time (excluding polyp resection and bowel cleaning time) of subjects undergoing screening and/or surveillance colonoscopy in a prospective, multicenter, randomized controlled trial. We examined the relationship of withdrawal time in 1-minute increments on ADR and reported odds ratio (OR) with 95% confidence intervals. Linear regression analysis was performed to assess the maximal inspection time threshold that impacts the ADR. Results: A total of 1142 subjects (age, 62.3 ± 8.9 years; 80.5% men) underwent screening (45.9%) or surveillance (53.6%) colonoscopy. The screening group had a median withdrawal time of 9.0 minutes (interquartile range [IQR], 3.3) with an ADR of 49.6%, whereas the surveillance group had a median withdrawal time of 9.3 minutes (IQR, 4.3) with an ADR of 63.9%. ADR correspondingly increased for a withdrawal time of 6 minutes to 13 minutes, beyond which ADR did not increase (50.4% vs 76.6%, P < .01). For every 1-minute increase in withdrawal time, there was 6% higher odds of detecting an additional subject with an adenoma (OR, 1.06; 95% confidence interval, 1.02-1.10; P = .004). Conclusions: Results from this multicenter, randomized controlled trial underscore the importance of a high-quality examination and efforts required to achieve this with an incremental yield in ADR based on withdrawal time. (Clinical trial registration number: NCT03952611.)

Original languageEnglish (US)
Pages (from-to)537-543.e2
JournalGastrointestinal endoscopy
Issue number3
StatePublished - Mar 2023

Bibliographical note

Publisher Copyright:
© 2023 American Society for Gastrointestinal Endoscopy

PubMed: MeSH publication types

  • Randomized Controlled Trial
  • Multicenter Study
  • Journal Article


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