Increase your adenoma detection rate without using fancy adjunct tools

The correlation between a low adenoma detection rate (ADR) and interval cancers (ICs) has made ADR one of the most important quality indicators for colonoscopy. Data from nation-wide colorectal cancer (CRC) screening programs showed that there is room for improvement in ADR in order to reduce ICs in...

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Autores principales: Hsieh, Yu-Hsi, Leung, Felix W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6047331/
https://www.ncbi.nlm.nih.gov/pubmed/30069119
http://dx.doi.org/10.4103/tcmj.tcmj_86_18
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author Hsieh, Yu-Hsi
Leung, Felix W.
author_facet Hsieh, Yu-Hsi
Leung, Felix W.
author_sort Hsieh, Yu-Hsi
collection PubMed
description The correlation between a low adenoma detection rate (ADR) and interval cancers (ICs) has made ADR one of the most important quality indicators for colonoscopy. Data from nation-wide colorectal cancer (CRC) screening programs showed that there is room for improvement in ADR in order to reduce ICs in Taiwan. Measures with and without adjunct tools have been shown to have the potential to increase ADR, with the latter being more convenient to apply without additional cost. Optimal withdrawal techniques coupled with sufficient withdrawal time, training endoscopists with emphasis on recognition of subtle characteristics of flat lesions, dynamic position changes during the withdrawal phase, removing small polyps found during insertion, and retroflexion in the right colon have all been associated with increased ADR. In particular, water exchange (WE), which is characterized using water in lieu of air and suction removal of infused water during insertion, appears to meet the needs of colonoscopy patients in Taiwan. Analyses of both primary and secondary outcome variables of recently published studies have consistently shown that WE yields higher ADR than traditional air insufflation, even in propofol-sedated patients. Colonoscopists participating in the nationwide CRC screening program in Taiwan should consider applying one or more of the above measures to improve ADR and hopefully reduce ICs.
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spelling pubmed-60473312018-08-01 Increase your adenoma detection rate without using fancy adjunct tools Hsieh, Yu-Hsi Leung, Felix W. Tzu Chi Med J Review Article The correlation between a low adenoma detection rate (ADR) and interval cancers (ICs) has made ADR one of the most important quality indicators for colonoscopy. Data from nation-wide colorectal cancer (CRC) screening programs showed that there is room for improvement in ADR in order to reduce ICs in Taiwan. Measures with and without adjunct tools have been shown to have the potential to increase ADR, with the latter being more convenient to apply without additional cost. Optimal withdrawal techniques coupled with sufficient withdrawal time, training endoscopists with emphasis on recognition of subtle characteristics of flat lesions, dynamic position changes during the withdrawal phase, removing small polyps found during insertion, and retroflexion in the right colon have all been associated with increased ADR. In particular, water exchange (WE), which is characterized using water in lieu of air and suction removal of infused water during insertion, appears to meet the needs of colonoscopy patients in Taiwan. Analyses of both primary and secondary outcome variables of recently published studies have consistently shown that WE yields higher ADR than traditional air insufflation, even in propofol-sedated patients. Colonoscopists participating in the nationwide CRC screening program in Taiwan should consider applying one or more of the above measures to improve ADR and hopefully reduce ICs. Medknow Publications & Media Pvt Ltd 2018 /pmc/articles/PMC6047331/ /pubmed/30069119 http://dx.doi.org/10.4103/tcmj.tcmj_86_18 Text en Copyright: © 2018 Tzu Chi Medical Journal http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Review Article
Hsieh, Yu-Hsi
Leung, Felix W.
Increase your adenoma detection rate without using fancy adjunct tools
title Increase your adenoma detection rate without using fancy adjunct tools
title_full Increase your adenoma detection rate without using fancy adjunct tools
title_fullStr Increase your adenoma detection rate without using fancy adjunct tools
title_full_unstemmed Increase your adenoma detection rate without using fancy adjunct tools
title_short Increase your adenoma detection rate without using fancy adjunct tools
title_sort increase your adenoma detection rate without using fancy adjunct tools
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6047331/
https://www.ncbi.nlm.nih.gov/pubmed/30069119
http://dx.doi.org/10.4103/tcmj.tcmj_86_18
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