PTH-045 A missed opportunity ? colonoscopy withdrawal times in a large DGH

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Abstract

Introduction

Colonoscopy is the gold standard investigation for identification of colorectal pathology. Published evidence has confirmed that a higher adenoma detection rate (ADR) is associated with lower rates of post colonoscopy cancer detection. The ADR increases when withdrawal times from the caecum to the rectum are ≥6 min. Even the most experienced endoscopists (defined as performing >1000 colonoscopies) will miss adenomas if their withdrawal times are <6 min.

Aim

This audit was designed to evaluate compliance with current guidelines on colonoscopy withdrawal times across three East Kent Hospitals.

Guidelines

National guidelines recommend a mean colonoscopy withdrawal time of ≥6 min from caecum to rectum as per the Bowel Cancer Screening colonoscopy quality indicators.

Methods

Over a period of two weeks in 2017, endoscopy nurses across the three Hospitals recorded withdrawal times from the caecum to the rectum for all colonoscopy procedures. The endoscopists were unaware that withdrawal times were being recorded.

Results

138 colonoscopies were performed. 29 were less than 6 min (21%) (table 1).

Conclusion

In 138 colonoscopy procedures performed in a large Trust, 21% did not adhere to the minimal withdrawal time of 6 min as recommended in the best practice guidelines. If this finding were replicated across the UK, a significant amount of pathology may be missed, increasing risks to our patients.

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