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Ask Your GI Doctor: “What’s Your Withdrawal Time and Cecal Intubation Rate?”

Rachel Morrell

GI Doctor Checks for Colon Polyps During Colonoscopy

Choosing the best gastroenterologist for your colonoscopy begins with asking the right questions.

We’ve already talked about adenoma detection rate (ADR) as the primary indicator for the quality of a colonoscopy. ADR measures how adept a GI doctor is at detecting precancerous colon polyps called adenomas. You want to find a GI with an ADR of at least 30 percent for men and at least 20 percent for women, so your first question should be, “What is your ADR?”

Two other indicators for a quality colonoscopy are withdrawal time and cecal intubation rate.

“What is Your Average Withdrawal Time?”

Most colon cancers are preventable through routine colonoscopy. Your gastroenterologist uses a flexible, lit tube to inspect the lining of your colon for precancerous polyps, lesions and abnormalities. If polyps are detected during the exam, your GI can remove them so they do not develop into cancerous growths.

Withdrawal time refers to the amount of time it takes for your doctor to withdraw the colonoscope from the cecum (the farthest region of the colon) to the rectum (the end of the colon). It is expressed in minutes.

A careful examination of the entire colon takes time because some polyps are small or flat, which makes them easy to miss. You want your gastroenterologist to be exacting, methodical and precise in your colonoscopy, so you should seek a GI who has an average withdrawal time of at least six minutes. Longer withdrawal times are associated with higher ADRs, which means you are less likely to develop colon cancer.

Gastroenterologists should keep records of withdrawal times for their procedures, so do not hesitate to ask, “What is your average withdrawal time for colonoscopies?”

“What is Your Cecal Intubation Rate?”

We already know that the cecum is the farthest point in the colon, located above the appendix. The cecum marks the juncture of the last section of the small intestine called the ileum and beginning of the colon.

Cecal intubation rate refers to how successful a GI doctor is at advancing the colonoscope all the way to the cecum. This quality indicator is expressed as a percentage.

Being able to visualize cecum is vital because the cecum is one of the most common sites of missed polyps. There are two main reasons why adenomas go undetected in the cecum and neighboring ascending colon.

  1. Physician error. Some gastroenterologists may not be as thorough in their colonoscopy screening and may rush the procedure. They also may fail to fully advance the colonoscope to the ileocecal junction where the small and large intestine meet.
  2. Incomplete bowel preparation. The quality of your colonoscopy is directly affected by your bowel preparation before the exam. If you don’t follow the instructions included in your prep kit, you may not fully flush your bowel. If solid waste remains in the colon, your doctor may not be able to advance the scope into the cecum and this could result in undetected polyps.

When you are in the process of selecting a GI doctor for your colonoscopy, ask for his or her cecal intubation rate. The national benchmark is 90 percent, so choose a gastroenterologist with a cecal intubation rate of 90 percent or higher.

Keep in mind that, unlike ADR and withdrawal time, a GI has limited control over cecal intubation rate. Patient cooperation plays a significant role in determining cecal intubation rate.  

Colonoscopy is the gold standard for colon cancer screening because it is the only exam that can detect colon cancer and prevent it in the same procedure. Take special care when interviewing gastroenterologists for your colonoscopy. It is an important component of preventative health care, so commit to researching your provider options before making your informed decision.

Be confident in asking:

“What is your adenoma detection rate?”

“What is your average withdrawal time?”

“What is your cecal intubation rate?”

Remember, when you call each GI center, you will probably speak to a receptionist who may not know the answer to these questions. You will need to talk to a nurse, so be prepared to leave a message, send an email or wait for a call-back.

If you would like to find a board-certified gastroenterologist in your area, click here. The American Cancer Society recommends that men and women who are at average risk for colon cancer begin screening at age 45, so you may need a colonoscopy sooner than you think.

Related Articles:

Importance of a Thorough Bowel Prep
How to Choose a Quality Gastroenterologist
Find a Screening Center



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