Compared with air insufflation (AI), water-exchange (WE) colonoscopy increases adenoma detection rate (ADR) in the right colon. The impact of insertion methodological differences on withdrawal examination has not been studied.
To develop and validate a novel method for analyzing distractions from mucosal inspection, bowel preparation scores and yield of quality outcome in prerecorded videos.
Edited videos of the withdrawal phase of screening colonoscopies meeting inclusion criteria.
Two reviewers blinded to colonoscope insertion technique evaluated edited recordings using agreed upon criteria. Distractions from mucosal inspection were defined as colonic spasms, water infusion or suctioning to clean the mucosa. The total number and duration of each distraction were analyzed in the cecum, ascending, transverse, descending and rectosigmoid colon. Total withdrawal time, bowel preparation scores and withdrawal techniques were assessed. Yield (biopsy or polypectomy) was considered a quality outcome.
Fourteen videos were evaluated by both reviewers. Inter-rater reliability was assessed by the Shrout-Fleiss reliability index. Nine of the 13 outcome measures received substantial to perfect inter-rater reliability, with the remaining variables achieving fair reliability and one with slight agreement between reviewers.
Retrospective study with small numbers.
The data suggest that the devised criteria, based on review of the literature, set up to evaluate video recordings of the withdrawal phase of colonoscopy can be applied by independent reviewers, regardless of actual experience in colonoscopy. The instrument is appropriate for assessing the hypothesis that reduced distraction during withdrawal inspection results in significantly higher yield, e.g. increased adenoma detection.