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• W4249096139 abstract "On behalf of our co-authors, we would like to express our appreciation for the comments made by Jin et al1Jin Z. Zhang X. Inspection and polypectomy during insertion of colonoscopy: is this the better way to go?.Gastrointest Endosc. 2021; 93: 285-286Abstract Full Text Full Text PDF Scopus (1) Google Scholar about our recent study evaluating “Adenoma and polyp detection rates during insertion versus withdrawal phase of colonoscopy: a systematic review and meta-analysis of randomized controlled trials.”2Chandan S, Mohan BP, Khan SR et al. Adenoma and polyp detection rates during insertion versus withdrawal phase of colonoscopy: a systematic review and meta-analysis of randomized controlled trials. Gastrointest Endosc. Epub 2020 Jun 12.Google Scholar The authors raise several points about our inclusion criteria, methodology, and outcomes that we would like to take this opportunity to clarify. First, we acknowledge the possibility of overlap cohorts in our included studies. However, as part of validating the results of our meta-analysis, we performed a sensitivity analysis to assess whether any 1 study had a dominant effect on the pooled outcomes. By doing this, we excluded 1 study at a time and analyzed its effect on the main summary estimate. We found that no single study significantly affected the outcome or the heterogeneity. This means that exclusion of the study by Ji et al3Ji J.-S. Lee S.-W. Lee J. Comparison of adenoma detection by polypectomy during both insertion and withdrawal versus only withdrawal of colonoscopy: a randomized, controlled multicenter trial.Ann Oncol. 2016; 27: 69Google Scholar would not significantly alter the outcomes. Second, we clearly report the significant heterogeneity in the pooled outcomes in our article. This is often an inherent limitation of performing a meta-analysis. Furthermore, we agree and report that we were unable to characterize our results in terms of proximal adenoma detection rate (ADR) or advanced ADR, because those data were not consistently reported in all the included studies. The overall ADR was reported because this remains a quality indicator for colonoscopy as per the American Society for Gastrointestinal Endoscopy.4Rex D.K. Schoenfeld P.S. Cohen J. et al.Quality indicators for colonoscopy.Gastrointest Endosc. 2015; 81: 31-53Abstract Full Text Full Text PDF PubMed Scopus (485) Google Scholar In our analysis, we included studies that reported on outcomes for patients undergoing screening as well as surveillance colonoscopies. Thus, this was based on the inherent design of the randomized controlled trials (RCTs) that were included. Due to a paucity of data, we were unable to report overall ADR in screening and surveillance populations separately. In the study by Teramoto et al,5Teramoto A. Aoyama N. Ebisutani C. et al.Clinical importance of cold polypectomy during the insertion phase in the left side of the colon and rectum: a multicenter randomized controlled trial (PRESECT study).Gastrointest Endosc. 2020; 91: 917-924Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar although the time taken for polypectomy was not included in the total procedure time, this was applicable to both the study and control groups. The difference in the “duration of polypectomy” was not statistically significant between the 2 groups. In our pooled estimates of total procedure time, we did not include the study by Gweon et al6Gweon TG, Lee SW, Ji JS, et al. Comparison of adenoma detection by colonoscopy between polypectomy performed during both insertion and withdrawal versus during withdrawal only: a multicenter, randomized, controlled trial. Surg Endosc. Epub 2020 Jan 17.Google Scholar because this information was not reported by the authors. We found that although the withdrawal and total procedure times were shorter in the insertion/withdrawal cohort compared with the withdrawal only cohort, the difference between these was not statistically significant. We have summarized pooled results in Table 2 of our article. The study design of the RCTs included in the amalysis was such that the endoscopist was aware of the cohort to which patients were assigned. It is certainly plausible that the difference in withdrawal and total procedure time was due to operator-dependent variability and the single blinded design of the trials. Based on the current body of evidence, it appears that additional time spent during the insertion phase of colonoscopy does not influence the overall ADR or polyps detected per patient. Further RCTs including only patients undergoing screening colonoscopies will help to further clarify our study results. All authors disclosed no financial relationships. Inspection and polypectomy during insertion of colonoscopy: Is this the better way to go?Gastrointestinal EndoscopyVol. 93Issue 1PreviewWe read with interest the meta-analysis by Chandan et al1 investigating whether additional inspection and polypectomy during insertion of colonoscopy offer additional benefit. Debate about the colonoscopy examination strategies has become extremely active during recent years, and we also have a registered meta-analysis (PROSPERO: CRD42020172424) on this topic currently under review. We have some questions and comments regarding the review by Chandan et al.1 Full-Text PDF" @default.
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