One or two operator technique and quality performance of colonoscopy: a randomised controlled trial.
BACKGROUND
The two-operator technique for colonoscopy, with the endoscopy assistant actively advancing and withdrawing the scope, is still commonly practiced in Europe. As uncontrolled data has suggested that the one-operator technique is associated with a higher adenoma detection rate, we tested the hypothesis that the two-operator-technique can achieve comparable performances in terms of adenoma detection.


METHODS
Non-inferiority trial in which consecutive adult outpatients were randomised to undergo colonoscopy by one (one-operator) or by four endoscopists. Each performed half the procedures by one-operator and half by two-operator technique independently of routine clinical practice. Main outcome measure was adenoma detection rate.


RESULTS
352 subjects (49% males, mean age 60 ± 12.1 years) were randomised to one (n=176) or to two-operator technique (n=176) colonoscopy. No significant differences were found in adenoma detection (33% vs. 30.7%, p=0.65), or cecal intubation rate, procedure times, and patient tolerability. No differences were found in the subgroup analysis according to routinely adopted colonoscopy technique.


CONCLUSIONS
This study does not confirm a higher adenoma detection rate for one-operator technique colonoscopy. Changing current practice to improve adenoma detection rate for endoscopists routinely using two-operator technique is not warranted.
['Paggi|Silvia|S|', 'Rondonotti|Emanuele|E|', 'Amato|Arnaldo|A|', 'Baccarin|Alessandra|A|', 'Spinzi|Giancarlo|G|', 'Radaelli|Franco|F|']
D000236:Adenoma D002432:Cecum D003110:Colonic Neoplasms D003113:Colonoscopy D005260:Female D006801:Humans D007441:Intubation, Gastrointestinal D008297:Male D061212:Memory, Episodic D008875:Middle Aged D061646:Operative Time D011787:Quality of Health Care D016037:Single-Blind Method
Two operators Adenoma detection rate Colonoscopy technique One operator