797 Comparison of Adenoma Detection by Inspection During Both Insertion and Withdrawal Phases Versus Only Withdrawal Phase of Colonoscopy: A Randomized Controlled Trial

797 Comparison of Adenoma Detection by Inspection During Both Insertion and Withdrawal Phases Versus Only Withdrawal Phase of Colonoscopy: A Randomized Controlled Trial Madhusudhan R. Sanaka*, Mansour A. Parsi, Carol A. Burke, James M. Church, David S. Barnes, Maged K. Rizk, Nizar N. Zein, Rajesh Joseph, Prashanthi N. Thota, Rocio Lopez, Pokala R. Kiran Gastroenterology, Cleveland Clinic, Cleveland, OH Background: Standard method of colonoscopy is to insert the colonoscope rapidly to reach the cecum, with careful inspection and polyp removal during the withdrawal phase (WP). However, some polyps seen during insertion phase (IP) are difficult to find during withdrawal phase. Also, colon is in different conformation during insertion and withdrawal phases. Hence we hypothesized that careful inspection and removal of polyps during insertion also may improve adenoma detection rate (ADR). Aim: To determine whether careful inspection and removal of polyps during both insertion and withdrawal phases of colonoscopy would increase ADR. Methods: Patients undergoing screening or surveillance colonoscopy at a single center were randomized to undergo colonoscopy with inspection and removal of polyps performed during instrument withdrawal (control arm) or colonoscopy with inspection and removal of polyps performed during both instrument insertion and withdrawal (study arm. Exclusion criteria were previous colorectal resection, inflammatory bowel disease and polyposis syndromes. Colonoscopy procedures were performed using high definition colonoscopes under conscious sedation. Patients with inadequate bowel preparation and incomplete procedures were excluded from analysis. The primary outcome measure was ADR in the two groups. ADR was defined as proportion of colonoscopies with at least one adenoma detected. Polyp detection rate (PDR) was defined similarly. Secondary outcomes were differences in Insertion time, Withdrawal time, total procedure time, polyp detection rates, number of adenomas per patient, patients discomfort during procedure and ease of procedure. Group comparisons were performed using Wilcoxon rank sum or chi-square tests as appropriate. (Figure 1). Results: A total of 768 patients were randomized. After 151 exclusions, 617 were included in analysis (328 in study arm and 289 in control arm). Patient demographics and colonoscopy-related variables were similar in both arms (table1). ADR (36% vs 36.3%, P 0.93) and PDR (57.3% and 55.7%, P 0.69) were similar in study and control arms (figure1). Mean number of adenomas per patient was also similar in both arms, 0.78 1.4 in study arm and 0.77 1.5 in control arm, P 0.92. Mean insertion time was significantly higher in the study group (10.3 5.8 min vs. 9.3 5.6 min, p 0.038). There were no significant differences in other secondary outcomes. Conclusions: Inspection and removal of polyps during BOTH colonoscope insertion and withdrawal offered no additional benefit on ADR compared to inspection and removal of polyps performed entirely during withdrawal. These results do not support a role for routine inspection during colonoscope insertion.