Systematic Review and Meta-Analysis Finds That 9-Minute Withdrawal Is Indeed Better Than 6 Minutes
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Systematic Review and Meta-Analysis Finds That 9-Minute Withdrawal Is Indeed Better Than 6 Minutes

Douglas K. Rex, MD, MASGE, reviewing Bhurwal A, et al. J Gastroenterol Hepatol 2021 Oct 7.

Very large retrospective studies of withdrawal time and colonoscopy yield have indicated that interval cancer prevention levels out with a withdrawal time of 8 to 9 minutes rather than 6 minutes. Studies have also found that improved adenoma and serrated lesion detection rates are associated with a withdrawal time of 9 minutes. 

This study identified 2 randomized clinical trials, 2 cancer registries, and 3 retrospective studies, with a total of 69,551 patients, relevant to the yield of colonoscopy at 6 versus 9 minutes. The odds ratio for any adenoma detection with a withdrawal time of ≥9 minutes was increased at 1.54. The odds ratio for advanced adenoma detection with the longer time was 1.38 but did not quite reach significance. Detection of at least one sessile serrated lesion was significantly higher with an odds ratio of 1.68.

Douglas K. Rex, MD, FASGE

COMMENT

These data indicate that performing colonoscopy carefully and maximizing detection takes an average of 9 minutes rather than 6 minutes in normal colons. This doesn’t change the observation that attempts to improve quality by prospectively lengthening withdrawal time have often failed. Efforts to improve quality should focus on the actual technique of performing colonoscopy carefully. With the performance of high-quality colonoscopy, including careful inspection of the proximal sides of all folds, clean up, and achievement of adequate distention, withdrawal times of ≥9 minutes follow naturally.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Bhurwal A, Rattan P, Sarkar A, et al. A comparison of 9-min colonoscopy withdrawal time and 6-min colonoscopy withdrawal time: a systematic review and meta-analysis. J Gastroenterol Hepatol 2021 Oct 7. (Epub ahead of print) (https://doi.org/10.1111/jgh.15701)

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