Background and Aims

Colonoscopy is the preferred modality for colorectal cancer screening because it has both diagnostic and therapeutic capabilities. Current consensus states that colonoscopy should be performed with initial rapid passage of the instrument to the cecum, followed by thorough evaluation for and removal of all polyps during a deliberate slow withdrawal. Reports have suggested that polyps that are seen but not removed during insertion are sometimes quite difficult to find during withdrawal.

Methods

We performed a comprehensive literature search of several major databases (from inception to March 2020) to identify randomized controlled trials comparing inspection and polypectomy during the insertion phase as opposed to the traditional practice of inspection and polypectomy performed entirely during the withdrawal phase. We examined differences in terms of adenoma detection rate (ADR), polyps detected per patient (PDPP), cecal intubation time (CIT), withdrawal time, and total procedure time.

Results

Seven randomized controlled trials, including 3834 patients, were included in our final analysis. The insertion/withdrawal cohort had 1951 patients and the withdrawal-only cohort 1883 patients. Pooled odds of adenoma detection in the insertion/withdrawal cohort was .99 (P = .8). ADR was 47.2% in the insertion/withdrawal cohort and 48.6% in the withdrawal-only cohort. Although total procedure and withdrawal times were shorter in the insertion/withdrawal cohort, PDPP in both cohorts were not statistically significant (1.4 vs 1.5, P = .7).

Conclusions

Additional inspection and polypectomy during the insertion and withdrawal phases of colonoscopy offer no additional benefit in terms of ADR or PDPP.

中文翻译：

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结肠镜检查在插入与撤回阶段的腺瘤和息肉检出率：随机对照试验的系统评价和荟萃分析。

背景和目标

结肠镜检查是大肠癌筛查的首选方式，因为它具有诊断和治疗功能。目前的共识是，结肠镜检查应在器械快速快速进入盲肠时进行，然后在有意缓慢撤除的过程中彻底评估并清除所有息肉。报告表明，有时在拔除时很难发现可见的息肉，但在插入时并未去除息肉。

方法

我们对几个主要数据库（从成立到2020年3月）进行了全面的文献检索，以发现比较在插入阶段检查和息肉切除术的常规对照和完全在撤回阶段进行息肉切除术的随机对照试验。我们检查了腺瘤检出率（ADR），每名患者检出的息肉（PDPP），盲肠插管时间（CIT），停药时间和总手术时间的差异。

结果

我们的最终分析包括7项随机对照试验，包括3834例患者。插入/退出队列有1951例患者，仅退出队列有1883例患者。在插入/退出队列中发现腺瘤的总机率是0.99（P  = 0.8）。插入/退出队列的ADR为47.2％，仅退出队列的ADR为48.6％。尽管在插入/退出队列中总程序和退出时间都较短，但两个队列中的PDPP均无统计学意义（1.4 vs 1.5，P  = 0.7）。

结论

在结肠镜检查的插入和撤回阶段进行额外的检查和息肉切除术，就ADR或PDPP而言没有其他好处。