Reduced Adenoma Miss Rate With 9-Minute vs 6-Minute Withdrawal Times for Screening Colonoscopy: A Multicenter Randomized Tandem Trial

医学 结肠镜检查 退出时间 腺瘤 无症状的 随机对照试验 病变 内科学 胃肠病学 外科 结直肠癌 癌症
作者
Shengbing Zhao,Yi-Hang Song,Shuling Wang,Rong Wang,Zhijie Feng,Aixia Gong,Xianghong Yang,Peng Pan,Di Yao,Jingwen Zhang,Yueyong Zhu,Tao Li,Junhua Bi,Xu Dong Ren,Xiufen Tang,Qiang Li,Dan Yu,Jinghua Zheng,Bo Song,Ping Wang,Weigang Chen,Guochen Shang,Yanqiu Xu,Ping Xu,Yuexing Lai,Haiyun Xu,Xiaomin Yang,Jian-qiu Sheng,Yurong Tao,Xinghua Li,Yangbei Zhu,Xiaofeng Zhang,Haikang Shen,Yussanne Ma,Fangyu Wang,Lin Wu,Xianfei Wang,Zhao-Shen Li,Yu Bai
出处
期刊:The American Journal of Gastroenterology [Lippincott Williams & Wilkins]
卷期号:118 (5): 802-811 被引量:3
标识
DOI:10.14309/ajg.0000000000002055
摘要

Although the 9-minute mean withdrawal time (m-WT) is often reported to be associated with the optimal adenoma detection rate (ADR), no randomized trials of screening colonoscopy have confirmed the impact of a 9-minute m-WT on adenoma miss rate (AMR) and ADR.A multicenter tandem trial was conducted in 11 centers. Seven hundred thirty-three asymptomatic participants were randomized to receive segmental tandem screening colonoscopy with a 9-minute withdrawal, followed by a 6-minute withdrawal (9-minute-first group, 9MF, n = 366) or vice versa (6-minute-first group, 6MF, n = 367). The primary outcome was the lesion-level AMR.The intention-to-treat analysis revealed that 9MF significantly reduced the lesion-level (14.5% vs 36.6%, P < 0.001) and participant-level AMR (10.9% vs 25.9%, P < 0.001), advanced adenoma miss rate (AAMR, 5.3% vs 46.9%, P = 0.002), multiple adenomas miss rate (20.7% vs 56.5%, P = 0.01), and high-risk adenomas miss rate (14.6% vs 39.5%, P = 0.01) of 6MF without compromising detection efficiency ( P = 0.79). In addition, a lower false-negative rate for adenomas ( P = 0.002) and high-risk adenomas ( P < 0.05), and a lower rate of shortening surveillance schedule ( P < 0.001) were also found in 9MF, accompanying with an improved ADR in the 9-minute vs 6-minute m-WT (42.3% vs 33.5%, P = 0.02). The independent inverse association between m-WT and AMR remained significant even after adjusting ADR, and meanwhile, 9-minute m-WT was identified as an independent protector for AMR and AAMR.In addition to increasing ADR, 9-minute m-WT also significantly reduces the AMR and AAMR of screening colonoscopy without compromising detection efficiency.
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