Withdrawal time as a quality indicator for colonoscopy - a nationwide analysis.

BACKGROUND AND STUDY AIMS: A withdrawal time of at least 6 min has been recommended as a quality indicator for colonoscopy. One drawback of many of the studies that have investigated withdrawal time and produced conflicting results has been their single-center design involving few endoscopists. Therefore, the validity of withdrawal time as a quality measure remains unclear. This study explores the value of individual withdrawal time in a nationwide analysis. PATIENTS AND METHODS: This prospective cohort study comprised data from outpatient colonoscopies performed at 19 Norwegian centers from January to September 2009 and registered in the Norwegian Gastronet Quality Assurance (QA) program. The participating endoscopists were characterized by their median withdrawal time for visual colonoscopies (diagnostic colonoscopies without biopsy or therapy) and categorized into two visual withdrawal time (VWT) groups (< 6 min or ≥ 6 min) to analyze the predictive value of VWT for detection of one or more polyps ≥ 5 mm in diameter using multiple logistic regression models. RESULTS: The study included 4429 consecutive colonoscopies performed by 67 endoscopists. The adjusted odds ratio for the detection of polyps ≥ 5 mm was 1.21 (95 %CI 0.94 - 1.56, P = 0.14) for endoscopists with a median VWT ≥ 6 min compared with endoscopists with a median VWT < 6 min. CONCLUSION: Withdrawal time using 6 min as the threshold is not a strong predictor of the likelihood of finding a polyp during colonoscopy and should not be used as a quality indicator.

PALIREL, a computer program for analyzing particle-to-membrane relations, with emphasis on electron micrographs of immunocytochemical preparations and gold labeled molecules.

Many vital substances, such as receptors, transporters, and ion channels, in cells occur associated with membranes. To an increasing extent their precise localization is demonstrated by immunocytochemical methods including labeling with gold particles followed by electron microscopy. PALIREL has primarily been developed to facilitate such research, enabling rapid analysis of topographic relations of particles (gold or others) to neighboring linear interfaces (membranes). After digitization of membranes and particles, the program particularly allows computation of (1) the particle number and number per unit length of membrane, in individual bins (membrane lengths) interactively defined along the membrane; (2) the distance of each particle from the membrane; (3) the particle number, and the density (number per micron2), in zones defined along (over and under) the membrane; and (4) the particle number and density in "zonebins" resulting from zones and bins being defined simultaneously. If there occurs, somewhere in the membrane, a segment of different nature, such as a synapse, the quantitative data may be had separately for that and the adjoining parts of the membrane. PALIREL allows interactive redefinition of bins, zones, or objects (particle-line files) while other definitions are retained. The results can be presented on the screen as tables and histograms and be printed on request. A dedicated graphic routine permits inspection on screen of lines, particles, zones, and bins. PALIREL is equally applicable to biological investigations of other kinds, in which the topographic relations of points (structures represented as points) to lines (boundaries) are to be examined. PALIREL is available from the authors on a noncommercial basis.