What Is the Mean Procedure Time to Optimize Colonoscopy?

Open Access Colonoscopy is the most effective and popular method for the screening, prevention, and diagnosis of colorectal cancer worldwide. However, there have been concerns on the ability of colonoscopy to detect adenoma. Colonoscopic examination is limited in this regard even if lesions are not missed because of variables such as the endoscopist' s skill, experience, and the degree of bowel preparation. Thus, it is crucial to maintain and optimize the quality of colonoscopy. Several quality indicators for colonoscopy are recommended: adenoma detection rate (ADR), the degree of bowel preparation , cecal intubation rate, and withdrawal time. Adequate procedure time is a prerequisite for adenoma detection. In 2006, Barclay et al. reported that a minimum withdrawal time of 6 minutes enabled adequate adenoma detection during screening or diagnostic colonoscopy. 1 This has become the principal guideline of diagnostic colonoscopy and most current guidelines now recommend this minimal time of 6 minutes to avoid missing adenoma during colonoscopy. In this issue of the journal, Jain et al. tried to define the pre-procedure factors affecting colonoscopy procedure time. 2 They retrospectively analyzed 1,239 patients undergoing screening colonoscopy using variables including age, sex, body mass index (BMI), previous abdominal surgery history, procedure timing, indication, and endoscopist experience. Total procedure time was significantly shorter in patients who underwent afternoon colonoscopy. Other factors including sex and history of surgery did not affect the procedure time. Using multiple regression analysis, the authors created a total procedure time prediction model. This model approaches the procedure time from the perspective of patient satisfaction or anxiety while awaiting colonoscopy. Jain et al. state that this prediction model might help to decrease the waiting time and improve the patient' s satisfaction with the colonoscopy. 2 However, the results of this study have raised some issues for readers to consider. First, the ADR is not shown. Adequate ADR is an indicator for high quality colonoscopy. After assessing and analyzing colonoscopy procedure time, the starting point and precondition status determined whether the enrolled patients underwent adequate colonoscopy. We could not evaluate the relationship between ADR and procedure time in this study. Second, it is not clear whether a prolonged or shortened procedure time is caused by delayed insertion or withdrawal time. Adequate colonoscopy procedure time is a prerequisite for optimized colonoscopy. Several factors affect colonoscopy procedure time. Patient factors include age, sex, BMI, constipation, the degree of bowel preparation status, history of …