The impact of video recording colonoscopy on adenoma detection rates

Background: The adenoma detection rate (ADR) is a quality benchmark for colonoscopy, influenced by several factors including bowel preparation, withdrawal time, and withdrawal technique.

Objective: To assess the impact of video recording of all colonoscopies on the ADR.

Design: Comparison of two cohorts of patients undergoing colonoscopy before and after implementation of video recording.

Setting: Academic outpatient endoscopy facility.

Patients: This study involved asymptomatic, average-risk adults undergoing screening colonoscopy.

Intervention: Video recording of all colonoscopy procedures. Polyp findings and withdrawal times were recorded for 208 consecutive screening colonoscopies. A policy of video recording all colonoscopies was implemented and announced to the staff. Data on another 213 screening colonoscopies were subsequently collected.

Main outcome measurements: Adenoma detection rate, withdrawal time, advanced polyp detection rate, hyperplastic polyp detection rate.

Results: At least one adenoma was found in 38.5% of patients after video recording versus 33.7% before video recording (P = .31). There was a significant increase in the hyperplastic polyp detection rate (44.1% vs 34.6%; P = .046). Most endoscopists had a numerical increase in their ADRs, but only one was significant (57.7% vs 22.6%; P < .01). There were trends toward higher detection of adenomas of <5 mm (59.1% vs 52%; P = .23) and right-sided adenomas (40.2% vs 30.4%; P = .11) in the video recorded group.

Limitations: No randomization, confounding of intervention effects, and sample size limitations.

Conclusion: Video recording of colonoscopies is associated with a nonsignificant increase in the ADR and a significant increase in the hyperplastic polyp detection rate. There may be a benefit of video recording for endoscopists with low ADRs.