Colonoscopy withdrawal time of 15 minutes boosts polypoid dysplasia detection in IBD
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CHICAGO — Colonoscopy withdrawal time was independently associated with polypoid dysplasia detection in patients with inflammatory bowel disease, with a cutoff time of at least 15 minutes linked to increased odds for detection.
“We know that colonoscopy withdrawal time is an important predictor of adenoma detection and a quality metric of colonoscopy within the general population,” Chandler McMillan, BA, a medical student at Yale School of Medicine, told attendees at Digestive Disease Week. “Society guidelines, including the ASGE and ACG, have recommended a minimum average withdrawal time of 6 minutes for the optimal detection of dysplastic and neoplastic lesions.”
She continued, “While several colonoscopy withdrawal time cutoffs have been proposed within the general population, the association between withdrawal time and the detection of polypoid dysplasia in patients with IBD has not been well-studied.”
In a single center, retrospective study, McMillan and colleagues sought to determine the optional colonoscopy withdrawal time associated with detection of polypoid dysplasia among 259 adults (mean age, 56 years; 51.3% women; 68% ulcerative colitis; 32% Crohn’s disease) with IBD in endoscopic healing. Participants underwent 330 high-definition, white light colonoscopies from January 2017 to September 2022.
Researchers noted 24.7% of patients had a history of polypoid dysplasia, 10% had a family history of colorectal cancer and 4.6% had a personal history of invisible dysplasia. Both IBD specialists (40.9%) and gastroenterology fellows (9.7%) performed the colonoscopies, and nontargeted biopsies were obtained in 97.3% of colonoscopies performed. The median withdrawal time was 22 minutes.
According to results, invisible dysplasia was detected in 2.1% of procedures, while polypoid dysplasia was noted in 17.3%. Patients with polypoid dysplasia were older (mean age, 62.9 years) and more likely to have a personal history of polypoid dysplasia and invisible dysplasia. Further, median withdrawal time was significantly higher at 26 minutes in patients with polypoid dysplasia compared with 21 minutes in patients without.
Multivariate regression analysis also showed increased age and withdrawal time, and personal history of polypoid dysplasia were all significantly associated with increased odds of polypoid dysplasia detection.
McMillian reported that a withdrawal time cutoff of at least 15 minutes (OR = 2.71; 95% CI, 1.11-6.6) or at least 20 minutes (OR = 3.02; 95% CI, 1.53-5.98) was significantly associated with odds of polypoid dysplasia detection. A 9-minute withdrawal time cutoff was not significantly associated with increased detection.
Further, each 1-minute increase in withdrawal time correlated with a 4.2% increase in polypoid dysplasia detection (OR = 1.042; 95% CI, 1.021-1.064).
“Our study found that colonoscopy withdrawal time was independently associated with polypoid dysplasia detection in patients with IBD,” McMillan concluded. “Specifically, a withdrawal time cutoff of at least 15 minutes was found to be significantly associated with polypoid dysplasia detection in this group.”
She added, “Moving forward, future perspective studies are needed to corroborate our findings.”
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McMillan C, et al. Abstract 113: Longer colonoscopy withdrawal time is associated with the detection of polypoid dysplasia in patients with inflammatory bowel disease. Presented at: Digestive Disease Week; May 5-9, 2023; Chicago (hybrid).
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