P3841 - Decreasing the Missing Rate of Polyps While Enhancing Patient's Experience With the Addition of a Simple Step in Our Colonoscopies

Fernando Contreras, MD¹, Diego Abreu, MD², Marcos A. Martinez, MD³, Isabella Mella, MD³, Cesar Ortiz, MD², Dolly Ruiz, MD³, Carlota Cabrer, MD⁴, Cynthia Contreras, MD^5
1Centro de Gastroenterologia Avanzada, Santo Domingo, Distrito Nacional, Dominican Republic; ²CGA, Santo Domingo, Distrito Nacional, Dominican Republic; ³cga, Santo Domingo, Distrito Nacional, Dominican Republic; ⁴CEDIMAT, Santo Domingo, Distrito Nacional, Dominican Republic; ⁵University of Kansas Medical Center, Kansas City, KS

Introduction: Using CO2 has improved patient experience during colonoscopy. We adopted this strategy in
addition to a quick reinsertion of the colonoscope to the cecum, followed by rapid withdrawal
to remove as much air as possible to decrease distention. Studies suggest that up to 25% of
polyps are missed during conventional colonoscopy. To address this, we removed as much
colonic gas as possible and registered the polyps found during the reinsertion.

Methods: A retrospective descriptive observational case series study was conducted, employing a non-
experimental and non-probabilistic design. A total of 959 colonoscopies were performed
from April 2023 to March 2024. The procedures intercalated illumination between LCI and
WL, with data analyzed at a 95% confidence interval.
Data extraction from electronic medical records was organized in Google Sheets and
transferred to CSV formats for statistical analysis using JASP.

Results: Among the 826 colonoscopies performed utilizing the reinsertion strategy, 451 (54.6%)
initially detected polyps. All had good or excellent BPPS scores. Upon reinsertion, an
additional 7% (58) of cases revealed previously missed polyps, of which 3.4% (2) were high-
risk adenomas. Among these patients, 6.9% (4) were negative for polyps during the initial
colonoscopy. Although the reinsertion and subsequent quick withdrawal time was not
measured, it is estimated to be less than 1-2 minutes. The average age of our subjects was
55.7 years. White light was used in 36.2% of the missed polyp detections, whereas 65.5%
were found using Linked-Color Imaging (LCI) illumination. A z-test revealed statistically
significant results (p < 0.001), indicating a strong association between the reinsertion of the
colonoscope and an increased likelihood of detecting polyps.

Discussion: The Adenoma Detection Rate (ADR) achieved in our clinic is 51% in screening
colonoscopies, which is significantly higher than the rate established by the ASGE/ACG.
Regardless, some polyps were still missed and subsequently detected upon reinsertion,
highlighting the importance of performing meticulous examinations even for highly trained
endoscopists. The integration of endoscopic techniques, such as the use of AI, enhanced
illumination, and the simple step of reinserting the colonoscope, can improve diagnostic
accuracy and patient outcomes. These advancements highlight the need for further research
on their impact on patient care.


Disclosures:


Fernando Contreras, MD¹, Diego Abreu, MD², Marcos A. Martinez, MD³, Isabella Mella, MD³, Cesar Ortiz, MD², Dolly Ruiz, MD³, Carlota Cabrer, MD⁴, Cynthia Contreras, MD⁵. P3841 - Decreasing the Missing Rate of Polyps While Enhancing Patient's Experience With the Addition of a Simple Step in Our Colonoscopies, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.