BHUBANESWAR: High quality withdrawal technique during colonoscopy could improve adenoma detection rate (ADR) and bring down the risk of interval colorectal cancer (CRC), a new study has suggested.
The study, ‘Implementing key quality performance metrics improves colorectal adenoma detection: Evidence from India’, published in the Indian Journal of Gastroenterology, stated that implementation of quality improvement measures and standardised withdrawal techniques play a crucial role in improved adenoma detection in an Indian clinical practice setting.
Dr Sonmoon Mohapatra and Dr Ashutosh Mohapatra from Sai Institute of Gastroenterology and Liver Sciences (SIGLS), Bhubaneswar, who conducted the research, said India is seeing a steady rise in CRC cases, especially in urban and semi-urban populations.
“Yet, unlike many high-income countries, it still does not have a structured national screening programme for advance detection of adenoma to reduce the risk of CRC. Improving the quality of the colonoscopies could be one of the most practical ways to prevent colorectal cancer,” they said.
The researchers said adenoma, a type of polyp or small growth in the lining of the colon, has the potential to develop into cancer over time if left untreated. Colonoscopy continues to remains the gold standard for detection of these colorectal polyps. In their recent study, the researchers found that a systematic and high quality withdrawal technique improves polyp detection by more than 30 per cent.
Among 2,260 colonoscopies performed with quality measures such as a more systematic and high quality withdrawal colonoscopy technique, the intervention arm showed a higher polyp detection rate of 32.7 per cent against the control arm rate of about 11 per cent. The ADR was also significantly higher at 20.5 per cent compared to the previous 6.3 per cent.
Dr Sonmoon said their data also showed a clear age gradient wherein ADR was 11.1 pc in individuals younger than 45 years, 27.9 pc in those aged 45 years and above, 30.3 pc in those older than 50 years and 36.2 pc in those above 60 years of age.
She said withdrawal phase of colonoscopy is where most clinically relevant lesions are identified. Yet, in routine practice, this step is often rushed or insufficiently standardised. “A high quality withdrawal is not about sophisticated technology; it is about discipline and attention to detail. It includes adequate inspection time, meticulous cleaning of residual stool and fluid, careful evaluation behind mucosal folds and systematic examination of all colonic segments,” Dr Sonmoon explained.
Dr Ashutosh said, “When inspection is more methodical with adequate withdrawal time, mucosal cleaning, fold examination and optimal distension, more lesions are found.”
Dr Nitin Jagtap, Dr Krushna Chandra Pani, Dr Gurunath Bhange, Dr Vivek Kaul, Dr Nageshwar Reddy and Dr Mahesh K Goenka also participated in the study.