Reduced Adenoma Miss Rate With 9-Minute vs 6-Minute Withdrawal Times for Screening Colonoscopy: A Multicenter Randomized Tandem Trial

Shengbing Zhao, Yihang Song, Shuling Wang, Rong Wang, Zhijie Feng, Aixia Gong, Xia Yang, Peng Pan, Dongmei Yao, Jingwen Zhang, Yaqin Zhu, Tao Li, Junhua Bi, Xu Ren, Xiufen Tang, Qiang Li, Dan Yu, Jinghua Zheng, Bo Song, Ping Wang, Weigang Chen, Guochen Shang, Yanqiu Xu, Ping Xu, Yuexing Lai, Huanhai Xu, Xiaomin Yang, Jianqiu Sheng, Yurong Tao, Xinghua Li, Yangbei Zhu, Xiaofeng Zhang, Hongzhang Shen, Yingcai Ma, Fangyu Wang, Lin Wu, Xianfei Wang, Zhaoshen Li, Yu Bai, Shengbing Zhao, Yihang Song, Shuling Wang, Rong Wang, Zhijie Feng, Aixia Gong, Xia Yang, Peng Pan, Dongmei Yao, Jingwen Zhang, Yaqin Zhu, Tao Li, Junhua Bi, Xu Ren, Xiufen Tang, Qiang Li, Dan Yu, Jinghua Zheng, Bo Song, Ping Wang, Weigang Chen, Guochen Shang, Yanqiu Xu, Ping Xu, Yuexing Lai, Huanhai Xu, Xiaomin Yang, Jianqiu Sheng, Yurong Tao, Xinghua Li, Yangbei Zhu, Xiaofeng Zhang, Hongzhang Shen, Yingcai Ma, Fangyu Wang, Lin Wu, Xianfei Wang, Zhaoshen Li, Yu Bai

Abstract

Introduction: Although the 9-minute mean withdrawal time (m-WT) is often reported to be associated with the optimal adenoma detection rate (ADR), no randomized trials of screening colonoscopy have confirmed the impact of a 9-minute m-WT on adenoma miss rate (AMR) and ADR.

Methods: A multicenter tandem trial was conducted in 11 centers. Seven hundred thirty-three asymptomatic participants were randomized to receive segmental tandem screening colonoscopy with a 9-minute withdrawal, followed by a 6-minute withdrawal (9-minute-first group, 9MF, n = 366) or vice versa (6-minute-first group, 6MF, n = 367). The primary outcome was the lesion-level AMR.

Results: The intention-to-treat analysis revealed that 9MF significantly reduced the lesion-level (14.5% vs 36.6%, P < 0.001) and participant-level AMR (10.9% vs 25.9%, P < 0.001), advanced adenoma miss rate (AAMR, 5.3% vs 46.9%, P = 0.002), multiple adenomas miss rate (20.7% vs 56.5%, P = 0.01), and high-risk adenomas miss rate (14.6% vs 39.5%, P = 0.01) of 6MF without compromising detection efficiency ( P = 0.79). In addition, a lower false-negative rate for adenomas ( P = 0.002) and high-risk adenomas ( P < 0.05), and a lower rate of shortening surveillance schedule ( P < 0.001) were also found in 9MF, accompanying with an improved ADR in the 9-minute vs 6-minute m-WT (42.3% vs 33.5%, P = 0.02). The independent inverse association between m-WT and AMR remained significant even after adjusting ADR, and meanwhile, 9-minute m-WT was identified as an independent protector for AMR and AAMR.

Discussion: In addition to increasing ADR, 9-minute m-WT also significantly reduces the AMR and AAMR of screening colonoscopy without compromising detection efficiency.

Trial registration: ClinicalTrials.gov NCT04797065.

Conflict of interest statement

Guarantor of the article: Zhaoshen Li, MD, PhD.

Specific author contributions: L.Z.S., B.Y., and Z.S.B.: study concept and design. Z.S.B., S.Y.H., W.S.L., P.P., W.R., F.Z.J., G.A.X., Y.X., Y.D.M., Z.J.W., B.J.H., L.T., R.X., T.X.F., L.Q., Y.D., Z.J.H., S.B., W.P., C.W.G., S.G.C., X.Y.Q., X.P., L.Y.X., X.H.H., Y.X.M., S.J.Q., T.Y.R., L.X.H., Z.Y.B., M.Y.C., S.H.Z., Z.X.F., W.F.Y., W.L., and W.X.F.: acquisition of data. B.Y., Z.S.B., S.Y.H., and W.S.L.: analysis and interpretation of data. Z.S.B. and S.Y.H.: drafting of the manuscript. Z.S.B., B.Y., L.Z.S., S.Y.H., and W.S.L.: critical revision of the manuscript. Z.S.B., S.Y.H., and W.S.L.: statistical analysis. B.Y. and L.Z.S.: administrative, technical, or material support. B.Y. and L.Z.S.: study supervision.

Financial support: This work was supported by the National Science and Technology Plan Project of the Ministry of Science and Technology of China (grant no. 2015BAI13B08). B.Y. is supported by the National Natural Science Foundation of China (No.82170567, 81873546), Program of Shanghai Academic/Technology Research Leader (No. 22XD1425000), the “Shu Guang” project of Shanghai Municipal Education Commission and Shanghai Education Development Foundation (No. 19SG30, China), and 234 Discipline Climbing Plan of Changhai Hospital, Naval Medical University (No. 2019YXK004, China).

Potential competing interests: There are no conflicts of interest for each author.

Data sharing: Data from deidentified individual patients can be shared with investigators who propose to use the data under the approval of an independent review committee. Data can only be used for the goals specified in the proposal. Data sharing will be implemented between 6 and 18 months after article publication with a data-sharing agreement signed. Zhaoshen Li can be contacted at the corresponding email.

Registration: This trial is registered at ClinicalTrials.gov as NCT04797065.

Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.

Figures

Graphical abstract
Graphical abstract
Figure 1.
Figure 1.
Flow diagram of participant enrollment and colonoscopy. BBPS, Boston Bowel Preparation Score; WT, withdrawal time.

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