Withdrawal time as a quality indicator for colonoscopy – a nationwide analysis

V. Moritz; M. Bretthauer; H. K. Ruud; T. Glomsaker; T. de Lange; P. Sandvei; G. Huppertz-Hauss; Ø. Kjellevold; G. Hoff

doi:10.1055/s-0032-1306898

Endoscopy, Table of Contents

Endoscopy 2012; 44(05): 476-481
DOI: 10.1055/s-0032-1306898

Original article

Withdrawal time as a quality indicator for colonoscopy – a nationwide analysis

V. Moritz

¹Department of Medicine, Telemark Hospital, Skien, Norway

²Gastronet Quality Assurance Program, Norway

,

M. Bretthauer

²Gastronet Quality Assurance Program, Norway

³Cancer Registry, Oslo, Norway

⁴Department of Gastroenterology, Oslo University Hospital Rikshospitalet, Oslo, Norway

,

H. K. Ruud

⁵Research Centre, University of Oslo and South-East Regional Health Board, Oslo, Norway

,

T. Glomsaker

⁶Department of Surgery, Stavanger University Hospital, Stavanger, Norway

,

T. de Lange

⁷Department of Medicine, Vestre Viken Hospital, Bærum, Norway

,

P. Sandvei

⁸Department of Medicine, Østfold Hospital, Frederikstad and Sarpsborg, Norway

,

G. Huppertz-Hauss

¹Department of Medicine, Telemark Hospital, Skien, Norway

,

Ø. Kjellevold

⁹Department of Medicine, Telemark Hospital, Kragerø

,

G. Hoff

¹Department of Medicine, Telemark Hospital, Skien, Norway

²Gastronet Quality Assurance Program, Norway

³Cancer Registry, Oslo, Norway

› Author Affiliations

Abstract

Background and study aims: A withdrawal time of at least 6 min has been recommended as a quality indicator for colonoscopy. One drawback of many of the studies that have investigated withdrawal time and produced conflicting results has been their single-center design involving few endoscopists. Therefore, the validity of withdrawal time as a quality measure remains unclear. This study explores the value of individual withdrawal time in a nationwide analysis.

Patients and methods: This prospective cohort study comprised data from outpatient colonoscopies performed at 19 Norwegian centers from January to September 2009 and registered in the Norwegian Gastronet Quality Assurance (QA) program. The participating endoscopists were characterized by their median withdrawal time for visual colonoscopies (diagnostic colonoscopies without biopsy or therapy) and categorized into two visual withdrawal time (VWT) groups (< 6 min or ≥ 6 min) to analyze the predictive value of VWT for detection of one or more polyps ≥ 5 mm in diameter using multiple logistic regression models.

Results: The study included 4429 consecutive colonoscopies performed by 67 endoscopists. The adjusted odds ratio for the detection of polyps ≥ 5 mm was 1.21 (95 %CI 0.94 – 1.56, P = 0.14) for endoscopists with a median VWT ≥ 6 min compared with endoscopists with a median VWT < 6 min.

Conclusion: Withdrawal time using 6 min as the threshold is not a strong predictor of the likelihood of finding a polyp during colonoscopy and should not be used as a quality indicator.

Full Text

References

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