CoChat
Sign Up
Cited by 111Colorectal Cancer Screening and DetectionColorectal Cancer Surgical TreatmentsLung Cancer Diagnosis and Treatment

Colonoscopic factors associated with adenoma detection in a national colorectal cancer screening program

Open access
Lee, Thomas, Rees, Colin, Blanks, Roger, Moss, Sue, Nickerson, Claire, Wright, Karen, James, Peter, McNally, Richard +2 more·2014·Endoscopy
DOI 10.1055/s-0033-1358831
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND AND STUDY AIMS: Adenoma detection is a key objective of colonoscopy, particularly in the context of colorectal cancer screening. The aim of this observational study was to identify the technical colonoscopy factors associated with adenoma detection. PATIENTS AND METHODS: The study analyzed data from the English Bowel Cancer Screening Programme. The indication for all colonoscopies was a positive fecal occult blood test. The relationships between the following colonoscopy factors and adenoma detection (one or more adenomas, advanced adenomas, right-sided adenomas, and total number of adenomas) were examined in multivariable analyses: bowel preparation quality, cecal intubation, withdrawal time, rectal retroversion, colonoscopist experience, antispasmodic use, sedation use, and start time of procedure. The following patient factors were controlled for: age, sex, body mass index, smoking, alcohol, deprivation, and geographical location. RESULTS: A total of 31088 colonoscopies were analyzed. The following technical factors increased the relative risk of adenoma detection (P < 0.001 in multivariable analysis unless otherwise stated): cecal intubation, increased withdrawal time, higher quality bowel preparation, intravenous antispasmodic use, earlier procedure start time within a session (P = 0.018), and greater colonoscopist experience. Detection of advanced and right-sided adenomas also increased with these factors. Adenoma detection did not differ between sedated and unsedated colonoscopy (P = 0.143). CONCLUSION: This study demonstrated important associations between colonoscopy practice and adenoma detection. Use of intravenous antispasmodic was associated with increased adenoma detection. The effect of the start time of colonoscopy suggests that endoscopist fatigue may have a deleterious impact on adenoma detection.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1055/s-0033-1358831

Cites

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The number of endoscopies performed in a day by an endoscopist negatively impacts performance.

    “It was found that the number of endoscopies performed in a day by an endoscopist negatively impacted performance [86][87][88] , but the use of CADe eliminates this adverse effect [85] .”

    From Enhancing human-AI collaboration: The case of colonoscopy (2024) · cites this paper as [88]

    The Patient and procedure characteristics section (p. 206) reports lower adenoma detection for procedures starting in the second half of a session. The discussion suggests fatigue as a possible explanation, but the paper does not establish that the number of endoscopies performed in a day causes poorer performance. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

No references could be resolved yet.

Research works printed but not linked: 37

  1. Morson B. President's address: the polyp-cancer sequence in the large bowel. Proc R Soc Med 1974; 67: 451 -457
  2. Rex DK, Petrini JL, Baron TH et al. Quality indicators in colonoscopy. Gastrointest Endosc 2006; 63: 16 -28
  3. Kaminski MF, Regula J, Krasewska E et al. Quality indicators for colonos- copy and the risk of interval cancer. N Engl J Med 2010; 362: 1795 - 1803
  4. Lieberman DA, Prindiville S, Weiss DG et al. Risk factors for advanced co- lonic neoplasia and hyperplastic polyps in asymptomatic individuals. JAMA 2003; 290: 2959 -2967
  5. Anderson JC, Attam R, Alpern Z et al. Prevalence of colorectal neoplasia in smokers. Am J Gastroenterol 2003; 98: 2777 -2783
  6. Reid ME, Marshall JR, Roe D et al. Smoking exposure as a risk factor for prevalent and recurrent colorectal adenomas. Cancer Epidemiol Bio- markers Prev 2003; 12: 1006 -1011
  7. Anderson JC, Alpern Z, Sethi G et al. Prevalence and risk of colorectal neoplasia in consumers of alcohol in a screening population. Am J Gas- troenterol 2005; 100: 2049 -2055
  8. Martinez ME, McPherson RS, Annegers JF et al. Cigarette smoking and alcohol consumption as risk factors for colorectal adenomatous polyps. J Natl Cancer Inst 1995; 87: 274 -279
  9. Chen SC, Rex DK. Endoscopist can be more powerful than age and male gender in predicting adenoma detection at colonoscopy. Am J Gastro- enterol 2007; 102: 856 -861
  10. Barclay RL, Vicari JJ, Doughty AS et al. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med 2006; 355: 2533 -2541
  11. Simmons DT, Harewood GC, Baron TH et al. Impact of endoscopist with- drawal speed on polyp yield: implications for optimal colonoscopy withdrawal time. Aliment Pharmacol Ther 2006; 24: 965 -971
  12. Lee TJW, Blanks RG, Rees CJ et al. Longer mean colonoscopy withdrawal time is associated with increased adenoma detection: evidence from the Bowel Cancer Screening Programme in England. Endoscopy 2013; 45: 20 -26
  13. Harewood GC, Sharma VK, de Garmo P. Impact of colonic preparation quality on detection of suspected colonic neoplasms. Gastrointest En- dosc 2003; 58: 76 -79 15
  14. Froelich F, Wietlisbach V, Gonvers JJ et al. Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Ap- propriateness of Gastrointestinal Endoscopy European Multicentre Study. Gastrointest Endosc 2005; 61: 378 -384
  15. Belsey J, Epstein O, Heresbach D. Systematic review: oral bowel prepa- ration for colonoscopy. Aliment Pharmacol Ther 2007; 25: 373 -384
  16. de Brouwer EJ, Arbouw ME, van der Zwet WC et al. Hyoscine N-butyl- bromide does not improve polyp detection during colonoscopy: a dou- ble-blind, randomized, placebo-controlled, clinical trial. Gastrointest Endosc 2012; 75: 835 -840
  17. Mui L, Enders KWN, Kang-chung C et al. Randomized, double-blinded, placebo-controlled trial of intravenously administered hyoscine n-bu- tyl bromide in patients undergoing colonoscopy with patient con- trolled sedation. Gastrointest Endosc 2004; 59: 22 -27
  18. Lee JM, Cheon JH, Park JJ et al. Effects of hyoscine n-butyl bromide on the detection of polyps during colonoscopy. Hepatogastroenterology 2010; 57: 90 -94
  19. Corte C, Dahlenburg L, Selby S et al. Hyoscine butylbromide adminis- tered at the cecum increases polyp detection: a randomized double- blind placebo-controlled trial. Endoscopy 2012; 44: 917 -922
  20. Hanson JM, Atkin WS, Cunliffe WJ et al. Rectal retroflexion: an essential part of lower gastrointestinal endoscopic examination. Dis Colon Rec- tum 2002; 45: 1120 -1121
  21. Saad A, Rex DK. Routine rectal retroflexion during colonoscopy has a low yield for neoplasia. World J Gastroenterol 2008; 14: 6503 -6505
  22. Chan MY, Cohen H, Spiegel BMR. Fewer polyps detected by colonoscopy as the day progresses at a veteran's administration teaching hospital. Clin Gastroenterol Hepatol 2009; 7: 1217 -1223
  23. Long MD, Martin C, Sandler RS et al. Reduced polyp detection as endos- copy shift progresses: experience with screening colonoscopy at a ter- tiary-care hospital. J Clin Gastroenterol 2011; 45: 253 -258
  24. Radaelli F, Meucci G, Sgroi G et al. Technical performance of colonosco- py: the key role of sedation/analgesia and other quality indicators. Am J Gastroenterol 2008; 103: 1122 -1130
  25. Wang A, Hoda KM, Holub JL et al. Does level of sedation impact detec- tion of advanced neoplasia. Dig Dis Sci 2010; 55: 2337 -2343
  26. Logan RF, Patnick J, Nickerson C et al. Outcomes of the Bowel Cancer Screening Programme (BCSP) in England after the first 1 million tests. Gut 2012; 61: 1439 -1446
  27. Lee TJW, Rutter MD, Blanks RG et al. Colonoscopy quality measures: ex- perience from the NHS Bowel Cancer Screening Programme. Gut 2012; 61: 1050 -1057
  28. Lee TJW, Clifford GM, Rajasekhar P et al. High yield of colorectal neopla- sia detected by colonoscopy following a positive faecal occult blood test in the NHS Bowel Cancer Screening Programme. J Med Screen 2011; 18: 82 -86
  29. Chokshi RV, Hovis CE, Hollander T et al. Prevalence of missed adenomas in patients with inadequate bowel preparation on screening colonos- copy. Gastrointest Endosc 2012; 75: 1197 -1203 33
  30. Saunders BP, Williams CB. Premedication with intravenous antispas- modic speeds colonoscope insertion. Gastrointest Endosc 1996; 43: 209 -211
  31. Atkin W, Rogers P, Cardwell C et al. Wide variation in adenoma detec- tion rates at screening flexible sigmoidoscopy. Gastroenterology 2004; 126: 1247 -1256 35
  32. Segnan N, Patnick J, von Karsa L et al. European guidelines for quality assurance in colorectal cancer screening and diagnosis-first edition. Luxemburg: Publications Office of the European Union; 2011
  33. Jover R, Zapater P, Polania E et al. Modifiable endoscopic factors that in- fluence the adenoma detection rate in colorectal cancer screening co- lonoscopies. Gastrointest Endosc 2013; 77: 381 -389
  34. Adler A, Wegscheider K, Lieberman D et al. Factors determining the quality of screening colonoscopy: a prospective study on adenoma de- tection rates from 12 134 examination (Berlin colonoscopy project 3, BECOP-3). Gut 2013; 52: 236 -241
  35. Liang J, Kalady MF, Church J et al. Serrated polyp detection rate during colonsocpy. Colorectal Dis 2012; 14: 1323 -1327
  36. De Wijkerslooth TR, Stoop EM, Bossuyt PM et al. Differences in proximal serrated polyp detection among endoscopists are associated with variability in withdrawal time. Gastrointest Endosc 2013; 77: 617 - 623
  37. Rex DK. Colonoscopic withdrawal technique is associated with adeno- ma miss rates. Gastrointest Endosc 2000; 51: 33 -36

Cited by

Sorted by citations

Authors
Lee, T., Rees, C., Blanks, R., Moss, S., Nickerson, C., Wright, K., James, P., McNally, R., Patnick, J., & Rutter, M.
Affiliations
  • University Hospital of North Tees (GB)
  • Durham University (GB)
  • University of Oxford (GB)
  • University of London (GB)
  • NHS Cancer Screening Programmes, Sheffield, UK
  • Newcastle University (GB)
Corresponding author
Lee, Thomas
ORCID
Venue
Endoscopy
Publisher
Georg Thieme Verlag KG
Published
2014-01-28
Volume
46
Issue
03
Pages
203-211
ISSN
  • 0013-726X (ISSN-L)
  • 1438-8812
DOI
10.1055/s-0033-1358831
OpenAlex
W2139935751
Cited by
111
References
0
Citations by year
2026: 5 · 2025: 7 · 2024: 2 · 2023: 9 · 2022: 8 · 2021: 11 · 2020: 8 · 2019: 7 · 2018: 9 · 2017: 8 · 2016: 17 · 2015: 8 · 2014: 12
FWCI
6.78
Type
journal article
Language
en
Open access
Locations
  • Endoscopy (publishedVersion)
  • PubMed (publishedVersion)
  • Newcastle University ePrints (Newcastle Univesity) (cc-by-nc-nd)
Funders
Cancer Research UK (16491)
Topics
  • Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
  • Health Sciences › Medicine › Oncology › Colorectal Cancer Surgical Treatments
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
Keywords
adenoma detection, colonoscopy, colorectal cancer screening, bowel preparation quality, cecal intubation, withdrawal time, sedation, advanced adenoma, fecal occult blood test
MeSH terms
Adenoma, Aged, Cecum, Clinical Competence, Colonoscopy, England, Female, Humans, Intubation, Gastrointestinal, Male, Middle Aged, Parasympatholytics, Time Factors, Colorectal Neoplasms, Colon, Ascending, Deep Sedation, Early Detection of Cancer

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review