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Lorenzo-Zúñiga García V, Sábado Martí F, Pantaleón Sánchez MÁ, Machlab Mashlab S, Carral Martínez D, Gómez Rodríguez BJ, López Cano A, Rodríguez Muñoz S, Pérez Arellano E, Turbi Disla C, Esteban López-Jamar JM. Effectiveness and safety of a 1L polyethylene glycol and ascorbic acid preparation for colonoscopy in routine clinical practice in Spain. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024; 116. [PMID: 39087668 DOI: 10.17235/reed.2024.10426/2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
BACKGROUND AND AIMS Large clinical trials and small real-world studies show that a 1L polyethylene glycol and ascorbic acid solution (1L PEG-ASC) is an effective and safe bowel preparation for colonoscopy. Here, the effectiveness and safety of 1L PEG-ASC was evaluated in a large cohort of patients in routine clinical practice in Spain. METHODS A sub-analysis was performed in an observational, multicenter, retrospective study assessing the effectiveness and safety of 1L PEG-ASC in adult patients undergoing a colonoscopy at 10 centers in Spain. Cleansing quality was assessed with the Boston Bowel Preparation Scale, scores ≥6 with all segmental scores ≥2 was considered adequate colon cleansing, high-quality was considered as cleansing ≥8 or =3 in the right colon. Polyp and adenoma detection rates, and adverse events were also assessed. RESULTS Data was collected from 7160 patients: 48.3% males; mean age 58.0, 33.6% ≥65 years old. Adequate overall bowel cleansing was achieved in 95.6% of patients (95% CI 95.1%-96.0%), high quality cleansing in 74.4% (95% CI 73.4%-75.4%) and high-quality right colon cleansing in 66.0% (95% CI 64.9-67.1). The adequate overall cleansing rate was 97.0% with a split-dose and 94.0% with same-day regimen (P<0.0001), and high-quality right colon cleansing was 69.0% and 62.5% (P<0.0001), respectively. Colonoscopy was completed in 97.2% of cases. A multivariate regression analysis revealed that an overnight split-dose regimen and age <65 years were independent predictors of adequate bowel cleansing of the overall colon, age <65 years and female gender were independent predictors of HQ cleansing of the overall colon, and the three covariates were independent predictors of HQ cleansing of the right colon. At least one adverse event was experienced by 3.3% of participants, with nausea (1.5%) and vomiting (1.2%) being the most frequent. CONCLUSION This sub-analysis confirmed 1L PEG-ASC to be an effective and safe bowel cleansing preparation in a real world setting in Spain.
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Scalvini D, Lenti MV, Maimaris S, Lusetti F, Alimenti E, Fazzino E, Mauro A, Mazza S, Agazzi S, Strada E, Rovedatti L, Bardone M, Pozzi L, Schiepatti A, Di Sabatino A, Biagi F, Anderloni A. Superior bowel preparation quality for colonoscopy with 1L-PEG compared to 2L-PEG and picosulphate: Data from a large real-world retrospective outpatient cohort. Dig Liver Dis 2024:S1590-8658(24)00726-6. [PMID: 38729902 DOI: 10.1016/j.dld.2024.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Several randomized clinical trials comparing different bowel preparations (BP) have shown similar efficacy; however, there is a lack of real-world studies on this topic. AIMS This study aims to identify the most effective BP regimen in a real-world setting and any predictors of inadequate BP. METHODS A retrospective single-center study was conducted over 14 months at an academic hospital including outpatient colonoscopies in which adult patients did not teach on how to perform BP before colonoscopy. Colonoscopies with 1L-PEG, 2L-PEG and picosulphate mixtures were considered. A multivariable analysis for factors associated to poor BP was fitted. RESULTS Overall, 1779 patients (51 %F, 60±14) years were included. The 1L-PEG regimen provided a higher rate of BP adequacy at multivariate analysis (adjusted OR 2.30, 95 %CI 1.67-3.16,p < 0.001) and was associated with higher median Boston Bowel Preparation Scale score (p < 0.001), higher rate of right-colon cleansing (p < 0.001) and exam completion (p = 0.04). Furthermore, we identified male sex, history of constipation, active smoking, previous pelvic surgery, concomitant psychiatric/neurological or chronic kidney diseases as predictors of inadequate BP. CONCLUSIONS This is the largest real-world study comparing 1L-PEG to other BP regimens. Our results suggest 1L-PEG provides better BP in a non-controlled setting, improving clinical practice quality and minimizing the need for repeated colonoscopies and saving healthcare resources.
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Affiliation(s)
- Davide Scalvini
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy; Gastroenterology and Digestive Endoscopy unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy; University of Pavia, PhD in Experimental Medicine, Pavia, Italy.
| | - Marco Vincenzo Lenti
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy; First Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Stiliano Maimaris
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy; Istituti Clinici Scientifici Maugeri, IRCCS, Gastroenterology Unit of Pavia Institute, Italy
| | - Francesca Lusetti
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy; Gastroenterology and Digestive Endoscopy unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Eleonora Alimenti
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy; Gastroenterology and Digestive Endoscopy unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Erica Fazzino
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy; Gastroenterology and Digestive Endoscopy unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Aurelio Mauro
- Gastroenterology and Digestive Endoscopy unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Stefano Mazza
- Gastroenterology and Digestive Endoscopy unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Simona Agazzi
- Gastroenterology and Digestive Endoscopy unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Elena Strada
- Gastroenterology and Digestive Endoscopy unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Laura Rovedatti
- Gastroenterology and Digestive Endoscopy unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Marco Bardone
- Gastroenterology and Digestive Endoscopy unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Lodovica Pozzi
- Gastroenterology and Digestive Endoscopy unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Annalisa Schiepatti
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy; Istituti Clinici Scientifici Maugeri, IRCCS, Gastroenterology Unit of Pavia Institute, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy; First Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Federico Biagi
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy; Istituti Clinici Scientifici Maugeri, IRCCS, Gastroenterology Unit of Pavia Institute, Italy
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
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Maida M, Ventimiglia M, Facciorusso A, Vitello A, Sinagra E, Marasco G. Effectiveness and safety of 1-L PEG-ASC versus other bowel preparations for colonoscopy: A meta-analysis of nine randomized clinical trials. Dig Liver Dis 2023; 55:1010-1018. [PMID: 36470722 DOI: 10.1016/j.dld.2022.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/30/2022] [Accepted: 11/08/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND AND AIMS A 1-L polyethylene glycol plus ascorbate (PEG-ASC) preparation has been recently developed to improve patients' experience in colonoscopy. This meta-analysis aimed to evaluate the effectiveness and safety of 1-L PEG-ASC compared with those of other bowel preparations for colonoscopy. METHODS MEDLINE, Embase, Scopus, and the Cochrane Library were systematically searched for randomized controlled trials comparing 1-L PEG-ASC with other bowel preparations published through July 2022. A random-effects model was applied for pooling the results; heterogeneity was expressed as I2. RESULTS Nine studies met the inclusion criteria and were included. The analysis showed significantly higher cleansing success (CS) (OR = 1.50; 95% CI = 1.25-1.81; p < 0.01, I2 = 0%) and right-colon high-quality cleansing (HQC) (OR = 1.67; 95% CI = 1.21-2.31; p < 0.01, I2 = 43%) with 1-L PEG-ASC compared to the other preparations. The pooled estimate of the adenoma detection rate (ADR) did not significantly differ between the two groups either in the overall (OR = 1.02; 95% CI = 0.87-1.20; p = 0.79, I2 = 0%) or split-dosing regimen subgroup analysis (OR = 0.99; 95% CI = 0.84-1.18; p = 0.94, I2 = 0%). A significantly higher pooled estimate of the number of patients with adverse events (AEs) (OR = 1.51; 95% CI = 1.23-1.84; p<0.01, I2 = 0%) and incidence of AEs (IRR=1.33; 95% CI = 1.11-1.58; p<0.01, I2 = 71%) was observed with 1-L PEG-ASC than with the other preparations. No serious AEs or deaths occurred. CONCLUSIONS Compared to other preparations, 1-L PEG-ASC yielded higher overall CS, higher right-colon HQC rates, and similar ADR. The number of patients with AEs and incidence of the total AEs were significantly higher with 1-L PEG-ASC in the absence of serious AEs.
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Affiliation(s)
- M Maida
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta, Italy.
| | - M Ventimiglia
- Directorate General of Medical Device and Pharmaceutical Service, Italian Ministry of Health, Rome, Italy
| | - A Facciorusso
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - A Vitello
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta, Italy
| | - E Sinagra
- Gastroenterology and Endoscopy Unit, Fondazione Instituto San Raffaele Giglio, Cefalù, Italy
| | - G Marasco
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Spadaccini M, Schilirò A, Sharma P, Repici A, Hassan C, Voza A. Adenoma detection rate in colonoscopy: how can it be improved? Expert Rev Gastroenterol Hepatol 2023; 17:1089-1099. [PMID: 37869781 DOI: 10.1080/17474124.2023.2273990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 10/18/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION The introduction of widespread colonoscopy screening programs has helped in decreasing the incidence of Colorectal Cancer (CRC). However, 'back-to-back' colonoscopies revealed relevant percentage of missed adenomas. Quality indicators were created to further homogenize detection performances and decrease the incidence of post-colonoscopy CRC. Among them, the Adenoma Detection Rate (ADR), defined as the percentage obtained by dividing the number of endoscopic procedures in which at least one adenoma was resected, by the total number of procedures, was found to be inversely associated with the risks of interval colorectal cancer, advanced-stage interval cancer, and fatal interval cancer. AREAS COVERED In this paper, we performed a comprehensive review of the literature focusing on promising new devices and technologies, which are meant to positively affect the endoscopist performance in detecting adenomas, therefore increasing ADR. EXPERT OPINION Considering the current knowledge, although several devices and technologies have been proposed with this intent, the recent implementation of AI ranked over all of the other strategies and it is likely to become the new standard within few years. However, the combination of different device/technologies need to be investigated in the future aiming at even further increasing of endoscopist detection performances.
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Affiliation(s)
- Marco Spadaccini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Humanitas Clinical and Research Center -IRCCS-, Endoscopy Unit, Rozzano, Italy
| | - Alessandro Schilirò
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | | | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Humanitas Clinical and Research Center -IRCCS-, Endoscopy Unit, Rozzano, Italy
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Humanitas Clinical and Research Center -IRCCS-, Endoscopy Unit, Rozzano, Italy
| | - Antonio Voza
- Humanitas Clinical and Research Center -IRCCS-, Emergency Department, Rozzano, Italy
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Song JH, Bae JH, Yim JY. Efficacy of oral sulfate tablets for bowel preparation and adenoma detection rate. J Gastroenterol Hepatol 2023; 38:410-415. [PMID: 36453642 DOI: 10.1111/jgh.16079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/25/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND AND AIM The adenoma detection rate (ADR), which is closely related to bowel preparation, is the most important factor for colonoscopy quality assessment. New oral sulfate tablets (OSTs) have been developed to improve bowel preparation compliance. This study evaluated the efficacy of OSTs in terms of the ADR and bowel preparation status. METHODS Medical records of subjects under the age of 65 who underwent colonoscopy from March 2019 to February 2021 were retrospectively reviewed. Polyethylene glycol with ascorbic acid (PEG-A) was used as a bowel preparation for the first half of the study period, and OSTs were used for the second half. In total, 16 971 subjects were included in the study: 9199 (54.2%) used PEG-A, and 7772 (45.8%) used OSTs. Bowel cleansing quality was assessed by the Boston Bowel Preparation Scale (BBPS). RESULTS The average age was 50 years. The rate of adequate bowel preparation was higher in the OST group than in the PEG-A group (97.2% vs 95.0%, P < 0.001). The mean BBPS was also higher in the OST group (8.02 vs 7.75, P < 0.001). The adenomas per colonoscopy (APC), the ADR and the sessile serrated polyp detection rate (SSPDR) were higher in the OST group than in the PEG-A group (APC 0.56 ± 1.01 vs 0.48 ± 0.91, P < 0.001; ADR 34.5% vs 30.7%, P < 0.001; SSPDR 5.2% vs 3.3%, P < 0.001). CONCLUSIONS Compared with PEG-A, OSTs yielded superior APC, ADRs, SSPDRs, and better bowel cleanliness. Therefore, OSTs are a good alternative for patients who have difficulty taking large-volume bowel preparation formulations.
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Affiliation(s)
- Ji Hyun Song
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea
| | - Jung Ho Bae
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea
| | - Jeong Yoon Yim
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea
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Comparison of optimal bowel cleansing effects of 1L polyethylene glycol with ascorbic acid versus sodium picosulfate with magnesium citrate: A randomized controlled study. PLoS One 2022; 17:e0279631. [PMID: 36584216 PMCID: PMC9803231 DOI: 10.1371/journal.pone.0279631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 12/07/2022] [Indexed: 12/31/2022] Open
Abstract
Various low-volume bowel cleansing formulations that improve compliance have been approved and are being used in clinical practice. This study aimed to compare the effectiveness of 1 L polyethylene glycol (PEG) with ascorbic acid with that of sodium picosulfate (PICO) with magnesium citrate. This was a multicenter, randomized controlled, non-inferiority study. Patients were randomized into a 1 L PEG with ascorbic acid group and a PICO with magnesium citrate group according to the bowel cleansing agent used. Colonoscopy was performed as a single-blind study wherein the endoscopist had no information about any bowel preparation agent. The efficacy of bowel cleansing was assessed using the Harefield Cleansing Scale (HCS), and adverse events, preferences, and satisfaction were evaluated using a patient-reported questionnaire before colonoscopy. A total of 254 participants were randomly assigned to two groups: 115 in the 1 L PEG with ascorbic acid group and 113 in the PICO with magnesium citrate group. Overall bowel cleansing success was not statistically different between the two groups (97.4 vs. 97.3%), confirming that 1 L PEG with ascorbic acid was not inferior to PICO with magnesium citrate (lower confidence limit, -4.15%; p = 1.00). High-quality bowel cleansing was achieved in 87% of the 1 L PEG with ascorbic acid group and 77% of the PICO with magnesium citrate group (Lower confidence limit, 1.29%, p = 0.05). In terms of patient satisfaction, PICO with magnesium citrate was better, but compliance and side effects were similar in both groups. The 1 L PEG with ascorbic acid showed similar efficacy and adverse events as PICO with magnesium citrate. Although 1 L PEG with ascorbic acid is very effective in bowel preparation despite its small volume, it is necessary to increase satisfaction such as taste and feeling.
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Low DJ, Hong Z, Jugnundan S, Mukherjee A, Grover SC. Automated Detection of Bowel Preparation Scoring and Adequacy With Deep Convolutional Neural Networks. J Can Assoc Gastroenterol 2022; 5:256-260. [PMID: 36467599 PMCID: PMC9713630 DOI: 10.1093/jcag/gwac013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION Adequate bowel preparation is integral to effective colonoscopy. Inadequate bowel preparation has been associated with reduced adenoma detection rate and increased post-colonoscopy colorectal cancer (PCCRC). As a result, the USMSTF recommends early interval reevaluation for colonoscopies with inadequate bowel preparation. However, bowel preparation documentation is highly variable with subjective interpretation. In this study, we developed deep convolutional neural networks (DCNN) to objectively ascertain bowel preparation. METHODS Bowel preparation scores were assigned using the Boston Bowel Preparation Scale (BBPS). Bowel preparation adequacy and inadequacy were defined as BBPS ≥2 and BBPS <2, respectively. A total of 38523 images were extracted from 28 colonoscopy videos and split into 26966 images for training, 7704 for validation, and 3853 for testing. Two DCNNs were created using a Densenet-169 backbone in PyTorch library evaluating BBPS score and bowel preparation adequacy. We used Adam optimiser with an initial learning rate of 3 × 10-4 and a scheduler to decay the learning rate of each parameter group by 0.1 every 7 epochs along with focal loss as our criterion for both classifiers. RESULTS The overall accuracy for BBPS subclassification and determination of adequacy was 91% and 98%, respectively. The accuracy for BBPS 0, BBPS 1, BBPS 2, and BBPS 3 was 84%, 91%, 85%, and 96%, respectively. CONCLUSION We developed DCCNs capable of assessing bowel preparation adequacy and scoring with a high degree of accuracy. However, this algorithm will require further research to assess its efficacy in real-time colonoscopy.
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Affiliation(s)
- Daniel J Low
- St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
| | - Zhuoqiao Hong
- Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | | | | | - Samir C Grover
- Correspondence: Samir Grover, MD, MEd, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada, e-mail:
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Maratt JK, Siegel CA, Barkun AN, Bouhnik Y, Bressler B, Calderwood AH, East JE, Fischer M, Grossmann J, Korzenik JR, Menees SB, Panes J, Rex DK, Sey MSL, Allio MK, Baker KA, Guizzetti L, Remillard J, Sedano R, Feagan BG, Ma C, Jairath V. An Expert Consensus to Standardize Assessment of Bowel Cleansing for Clinical Trials of Bowel Preparations for Crohn's Disease. Dig Dis Sci 2022; 68:1718-1727. [PMID: 36436154 DOI: 10.1007/s10620-022-07775-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/14/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite regular need for colonoscopy in patients with Crohn's disease (CD), the efficacy and tolerability of bowel preparation (BP) agents is rarely assessed in this population. Assessing BP quality with existing scales may be challenging in CD due to presence of inflammation, bowel resection, and strictures. AIMS To provide recommendations for assessing BP quality in clinical trials for CD using a modified Research and Development/University of California, Los Angeles appropriateness process. METHODS Based on systematic reviews and a literature search, 110 statements relating to BP quality assessment in CD were developed. A panel of 15 gastroenterologists rated the statements as appropriate, uncertain, or inappropriate using a 9-point Likert scale. RESULTS Panelists considered it appropriate that central readers, either alone or with local assessment, score BP quality in clinical trials. Central readers should be trained on scoring BP quality and local endoscopists on performing high-quality video recording. Both endoscope insertion and withdrawal phases should be reviewed to score BP quality in each colonic segment and segments should align with endoscopic disease activity indices. The Harefield Cleansing Scale and the Boston Bowel Preparation Scale were considered appropriate. The final score should be calculated as the average of all visualized segments. Both total and worst segment scores should also be assessed. CONCLUSIONS We developed a framework for assessing BP quality in patients with CD based on expert feedback. This framework could support the development or refinement of BP quality scales and the integration of BP quality assessment in future CD studies.
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Affiliation(s)
- Jennifer K Maratt
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 340 W 10Th St, Indianapolis, IN, 46202, USA.,Richard L. Roudebush Veterans Affairs Medical Center, 1481 W 10Th St, Indianapolis, IN, 46202, USA.,Regenstrief Institute, Inc, 1101 W 10Th St, Indianapolis, IN, 46202, USA
| | - Corey A Siegel
- Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH, 03766, USA
| | - Alan N Barkun
- Division of Gastroenterology, McGill University and McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Yoram Bouhnik
- Gastroenterology and Nutrition Support Department, Department of Gastroenterology, Beaujon Hospital, 100 Bd du Général Leclerc, 92110, Clichy, France
| | - Brian Bressler
- Division of Gastroenterology, Department of Medicine, St Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Audrey H Calderwood
- Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH, 03766, USA.,The Geisel School of Medicine at Dartmouth, 1 Rope Ferry Rd, Hanover, NH, 03755, USA.,Dartmouth Institute of Health Policy and Clinical Practice, 1 Medical Center Dr, Lebanon, NH, 03766, USA
| | - James E East
- Translational Gastroenterology Unit, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK.,Division of Gastroenterology and Hepatology, Mayo Clinic Healthcare London, 15 Portland Pl, London, W1B 1PT, UK
| | - Monika Fischer
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 340 W 10Th St, Indianapolis, IN, 46202, USA
| | - Johannes Grossmann
- Department of Internal Medicine I, Bethesda Hospital, Glindersweg 80, 21029, Hamburg, Germany.,Johanniter GmbH, Ludwig-Weber-Straße 15, 41061, Mönchengladbach, Germany
| | - Joshua R Korzenik
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.,Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Stacy B Menees
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, 500 S State St, Ann Arbor, MI, 48109, USA.,Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Rd, Ann Arbor, MI, 48105, USA
| | - Julian Panes
- Inflammatory Bowel Disease Unit, Department of Gastroenterology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigaciones Biomédicas en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic de Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Douglas K Rex
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 340 W 10Th St, Indianapolis, IN, 46202, USA
| | - Michael S L Sey
- Division of Gastroenterology, Department of Medicine, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Michael K Allio
- ColonaryConcepts LLC, 103 San Marco Dr, Palm Beach Gardens, FL, 33418, USA
| | - K Adam Baker
- Alimentiv Inc, 100 Dundas St Suite 200, London, ON, N6A 5B6, Canada
| | | | - Julie Remillard
- Alimentiv Inc, 100 Dundas St Suite 200, London, ON, N6A 5B6, Canada
| | - Rocio Sedano
- Division of Gastroenterology, Department of Medicine, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada.,Alimentiv Inc, 100 Dundas St Suite 200, London, ON, N6A 5B6, Canada
| | - Brian G Feagan
- Division of Gastroenterology, Department of Medicine, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada.,Alimentiv Inc, 100 Dundas St Suite 200, London, ON, N6A 5B6, Canada.,Department of Epidemiology and Biostatistics, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Christopher Ma
- Alimentiv Inc, 100 Dundas St Suite 200, London, ON, N6A 5B6, Canada.,Division of Gastroenterology and Hepatology, Departments of Medicine and Community Health Sciences, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Vipul Jairath
- Division of Gastroenterology, Department of Medicine, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada. .,Alimentiv Inc, 100 Dundas St Suite 200, London, ON, N6A 5B6, Canada. .,Department of Epidemiology and Biostatistics, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada. .,Department of Medicine, Western University, 399 Windermere Road, London, ON, N6A 5A5, Canada.
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9
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Maida M, Facciorusso A, Sinagra E, Morreale G, Sferrazza S, Scalisi G, Pallio S, Camilleri S. Predictive Factors of Adequate Bowel Cleansing for Colonoscopy in the Elderly: A Retrospective Analysis of a Prospective Cohort. Diagnostics (Basel) 2022; 12:diagnostics12112867. [PMID: 36428927 PMCID: PMC9689943 DOI: 10.3390/diagnostics12112867] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/13/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022] Open
Abstract
Factors affecting the quality of bowel preparation for colonoscopy in the elderly are not fully known, and current guidelines provide no specific recommendations. This study aimed to assess the difference in bowel cleansing in young and elderly patients and evaluate predictors of bowel cleansing in the elderly. We retrospectively reviewed a prospective cohort of 1289 patients performing colonoscopy after a 1-, 2-, or 4-L PEG-based preparation. All 1289 were included in the analysis. Overall, 44.6% of patients were aged ≥65 years. Cleansing success (CS) was achieved in 77.3% and 70.3% of patients aged <65 years and ≥65 years, respectively. At multivariable analysis, split regimen (OR = 2.43, 95% CI = 1.34−4.38; p = 0.003), adequate cleansing at previous colonoscopy (OR = 2.29, 95% CI = 1.14−4.73; p = 0.02), tolerability score (OR = 1.29, 95% CI = 1.16−1.44; p < 0.001), a low-fiber diet for at least 3 days (OR = 2.45, 95% CI = 1.42−4.24; p = 0.001), and colonoscopy within 5 h after the end of preparation (OR = 2.67, 95% CI = 1.28−5.56; p = 0.008) were independently associated with CS in the elderly. Combining a low-fiber diet for at least 3 days, split preparation, and colonoscopy within 5 h allowed a CS rate above 90% and should always be encouraged. A 1-L PEG-ASC preparation was also associated with greater high-quality cleansing of the right colon and may be preferred.
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Affiliation(s)
- Marcello Maida
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, 93100 Caltanissetta, Italy
- Correspondence: ; Tel.: +39-0934512247; Fax: +39-0934512323
| | - Antonio Facciorusso
- Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy
| | - Emanuele Sinagra
- Gastroenterology and Endoscopy Unit, Fondazione Istituto San Raffaele Giglio, 90015 Cefalù, Italy
| | - Gaetano Morreale
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, 93100 Caltanissetta, Italy
| | - Sandro Sferrazza
- Gastroenterology and Endoscopy Unit, Santa Chiara Hospital, 38100 Trento, Italy
| | | | - Socrate Pallio
- Digestive Diseases Endoscopy Unit, Policlinico G. Martino Hospital, University of Messina, 98100 Messina, Italy
| | - Salvatore Camilleri
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, 93100 Caltanissetta, Italy
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A Novel Convolutional Neural Network Model as an Alternative Approach to Bowel Preparation Evaluation Before Colonoscopy in the COVID-19 Era: A Multicenter, Single-Blinded, Randomized Study. Am J Gastroenterol 2022; 117:1437-1443. [PMID: 35973166 DOI: 10.14309/ajg.0000000000001900] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/28/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Adequate bowel preparation is key to a successful colonoscopy, which is necessary for detecting adenomas and preventing colorectal cancer. We developed an artificial intelligence (AI) platform using a convolutional neural network (CNN) model (AI-CNN model) to evaluate the quality of bowel preparation before colonoscopy. METHODS This was a colonoscopist-blinded, randomized study. Enrolled patients were randomized into an experimental group, in which our AI-CNN model was used to evaluate the quality of bowel preparation (AI-CNN group), or a control group, which performed self-evaluation per routine practice (control group). The primary outcome was the consistency (homogeneity) between the results of the 2 methods. The secondary outcomes included the quality of bowel preparation according to the Boston Bowel Preparation Scale (BBPS), polyp detection rate, and adenoma detection rate. RESULTS A total of 1,434 patients were enrolled (AI-CNN, n = 730; control, n = 704). No significant difference was observed between the evaluation results ("pass" or "not pass") of the groups in the adequacy of bowel preparation as represented by BBPS scores. The mean BBPS scores, polyp detection rate, and adenoma detection rate were similar between the groups. These results indicated that the AI-CNN model and routine practice were generally consistent in the evaluation of bowel preparation quality. However, the mean BBPS score of patients with "pass" results were significantly higher in the AI-CNN group than in the control group, indicating that the AI-CNN model may further improve the quality of bowel preparation in patients exhibiting adequate bowel preparation. DISCUSSION The novel AI-CNN model, which demonstrated comparable outcomes to the routine practice, may serve as an alternative approach for evaluating bowel preparation quality before colonoscopy.
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11
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Establishment and evaluation of a nomogram predicting risks of missed diagnoses of colorectal polyps. BMC Gastroenterol 2022; 22:338. [PMID: 35820825 PMCID: PMC9277885 DOI: 10.1186/s12876-022-02415-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/04/2022] [Indexed: 12/09/2022] Open
Abstract
Background A missed diagnosis of colorectal polyps during colonoscopy may be associated with the occurrence of interval colorectal cancer. The risk factors for a missed diagnosis or a method to predict the risk of a missed diagnosis of colorectal polyps during colonoscopy remain unidentified. Methods The clinical data of patients who underwent two colonoscopies within three months at the Affiliated Hospital of North Sichuan Medical College between February 2017 and August 2019 were retrospectively reviewed. Independent risk factors for missed diagnoses were identified, and a nomogram was established to predict the risk of missed diagnoses. The prediction performance of the nomogram was evaluated using C-index and calibration curves, and its clinical application value was assessed using the Youden index and decision curve analysis. Results Independent influencing factors for missed diagnoses included age, endoscopist experience, bowel preparation, retroflected view, withdrawal time, number of polyps in the right colon, and number of polyps ≥ 6 mm. The C-index of the nomogram in the training and validation cohorts was 0.763 (95% confidence interval [CI]: 0.724 − 0.807) and 0.726 (95%CI: 0.657 − 0.794), respectively. The optimal cut-off value of the nomogram calculated using the Youden index was 152.2 points. Under the cut-off value, the sensitivity, specificity, positive predictive value, and negative predictive value were 67.1%, 75.7%, 45.8%, and 88.2%, respectively, in the training cohort, and 57.1%, 79.9%, 53.3%, and 82.3%, respectively, in the validation cohort. Conclusions The nomogram provides a reference value for clinicians to analyse the risk of a missed diagnosis of colorectal polyps in individuals, identify high-risk groups, and formulate appropriate follow-up strategies.
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Bednarska O, Nyhlin N, Schmidt PT, Johansson GW, Toth E, Lindfors P. The Effectiveness and Tolerability of a Very Low-Volume Bowel Preparation for Colonoscopy Compared to Low and High-Volume Polyethylene Glycol-Solutions in the Real-Life Setting. Diagnostics (Basel) 2022; 12:diagnostics12051155. [PMID: 35626310 PMCID: PMC9140572 DOI: 10.3390/diagnostics12051155] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/30/2022] [Accepted: 04/30/2022] [Indexed: 02/04/2023] Open
Abstract
Adequate bowel cleansing is essential for high-quality colonoscopy. Recently, a new very low-volume 1 litre (1L) polyethylene glycol (PEG) plus ascorbate solution (ASC) has been introduced. Our aims were to assess the effectiveness and tolerability of this product compared to low-volume 2L PEG-ASC and high-volume 4L PEG solutions, in a real-life setting. In six endoscopy units in Sweden, outpatients undergoing colonoscopy were either prescribed solutions according to local routines, or the very low-volume solution in split dose regimen. Bowel cleansing effectiveness and patient experience was assessed using the Boston Bowel preparation scale (BBPS) and a patient questionnaire. A total of 1098 patients (mean age 58 years, 52% women) were included. All subsegment and the total BBPS scores were significantly greater for 1L PEG-ASC in comparison to other solutions (p < 0.05 for 1L PEG-ASC and 4L PEG for transverse and left colon, otherwise p < 0.001). Nausea was more frequent with 1L PEG-ASC compared to 2L PEG-ASC (p < 0.001) and vomiting were more often reported compared to both other solutions (p < 0.01 and p < 0.05 for 2L PEG-ASC and 4L PEG, respectively). Smell, taste, and total experience was better for 1L PEG-ASC compared to 4L PEG (p < 0.001), and similar compared to the 2L PEG-ASC. In conclusion, 1L PEG-ASC leads to better bowel cleansing compared to 2L PEG-ASC or 4L PEG products, with similar or greater patient satisfaction.
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Affiliation(s)
- Olga Bednarska
- Department of Gastroenterology, Linköping University Hospital, S-581 85 Linköping, Sweden
- Correspondence: (O.B.); (N.N.); Tel.: +46-19-6022361 (N.N.)
| | - Nils Nyhlin
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, S-701 85 Örebro, Sweden
- Correspondence: (O.B.); (N.N.); Tel.: +46-19-6022361 (N.N.)
| | - Peter Thelin Schmidt
- Department of Medicine, Ersta Hospital, S-116 91 Stockholm, Sweden; or
- Department of Medicine, Karolinska Institutet, S-171 77 Solna, Sweden
| | - Gabriele Wurm Johansson
- Department of Gastroenterology, Skåne University Hospital, Lund University, S-205 02 Malmö, Sweden; (G.W.J.); (E.T.)
| | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Lund University, S-205 02 Malmö, Sweden; (G.W.J.); (E.T.)
| | - Perjohan Lindfors
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, S-171 77 Solna, Sweden; or
- Aleris Gastromottagningen City, S-111 37 Stockholm, Sweden
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de Sousa Magalhães R, Chálim Rebelo C, Sousa-Pinto B, Pereira J, Boal Carvalho P, Rosa B, Moreira MJ, Duarte MA, Cotter J. CC-CLEAR (Colon Capsule Cleansing Assessment and Report): the novel scale to evaluate the clinical impact of bowel preparation in capsule colonoscopy - a multicentric validation study. Scand J Gastroenterol 2022; 57:625-632. [PMID: 35068293 DOI: 10.1080/00365521.2022.2026463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Colon Capsule Cleansing Assessment and Report (CC-CLEAR) is a novel quantitative bowel preparation scale for colon capsule. AIM The aim of this study is to validate the association between CC-CLEAR's classification and major CC outcomes: lesion detection rate, surveillance recommendations and post-CC endoscopic treatment. METHODS Multicentric cohort of consecutive CCs. An expert's panel decided post-CC recommendations. Data included CC-CLEAR and Leighton-REX scales. Major CC outcomes were associated with the different cleansing grades. RESULTS From 168 CC's included, findings were reported in 123 (73.2%), 67 (54.4%) of those being colorectal polyps. CC-CLEAR influenced CC's lesion detection (OR 1.25 95% IC [1.07-1.46], p-value .004) and polyp detection rate (OR 1.22 95% IC [1.04-1.43], p-value.014). Thirty-two (19%) post-CC colonoscopies were recommended, including 22 (68.75%) with at least one polypectomy. CC-CLEAR was associated with post-CC colonoscopy treatment (OR 1.40 95% IC [1.07-1.84], p-value .015). Regarding surveillance, CC-CLEAR influenced the decision for immediate CC repetition (OR 0.21 95% IC [0.12-0.36], p-value < .001) and the recommendation for CC in 3-5 years' time (OR 1.47 95% IC [1.50-1.86], p-value < .002). The Leighton-Rex scale was not correlated with major CC outcomes. CONCLUSION CC-CLEAR impacts major CC outcomes: lesion detection, surveillance recommendations and post-CC endoscopic treatment.
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Affiliation(s)
- Rui de Sousa Magalhães
- Department of Gastroenterology, Hospital Senhora da Oliveira, Guimarães, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Carolina Chálim Rebelo
- Department of Gastroenterology, Hospital do Divino Espírito Santo de Ponta Delgada, EPER, Ponta Delgada, Portugal
| | - Bernardo Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Centre for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - José Pereira
- Department of Gastroenterology, Hospital do Divino Espírito Santo de Ponta Delgada, EPER, Ponta Delgada, Portugal
| | - Pedro Boal Carvalho
- Department of Gastroenterology, Hospital Senhora da Oliveira, Guimarães, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Bruno Rosa
- Department of Gastroenterology, Hospital Senhora da Oliveira, Guimarães, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Maria J Moreira
- Department of Gastroenterology, Hospital Senhora da Oliveira, Guimarães, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Maria A Duarte
- Department of Gastroenterology, Hospital do Divino Espírito Santo de Ponta Delgada, EPER, Ponta Delgada, Portugal
| | - José Cotter
- Department of Gastroenterology, Hospital Senhora da Oliveira, Guimarães, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
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Comparison of Procedural Sequences in Sedated Same-Day Bidirectional Endoscopy with Water-Exchange Colonoscopy: A Randomized Controlled Trial. J Clin Med 2022; 11:jcm11051365. [PMID: 35268456 PMCID: PMC8911281 DOI: 10.3390/jcm11051365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/21/2022] [Accepted: 02/28/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Previous studies have favored esophagogastroduodenoscopy (EGD) followed by colonoscopy as the optimal sequence in bidirectional endoscopy (BDE) with air insufflation. However, the optimal sequence in same-day BDE with WE colonoscopy is unclear. Methods: A total of 200 patients undergoing BDE with propofol sedation from May 2018 to January 2021 were randomized to either the EGD-first group (n = 100) or the colonoscopy-first group (n = 100). Results: The EGD-first group required a longer cecal-intubation time (median 16.0 min vs. 13.7 min, p < 0.001) and a lower Boston Bowel Preparation Scale score (8.5 vs. 9, p = 0.030) compared with the colonoscopy-first group. However, the EGD-first group needed a significantly lower dose of propofol (200 mg vs. 250 mg, p < 0.001) and a shorter recovery time (7 min vs. 13.5 min, p < 0.001), resulting in a shorter turnover time of the endoscopy room (39.5 min vs. 42.6 min, p = 0.004). There were no differences in the sedation-related adverse events, patients’ satisfaction scores, adenoma-detection rates, or the outcomes of EGD between the two groups. Conclusions: During propofol-sedated BDE, EGD followed by WE colonoscopy was more efficient with a shorter turnover time despite a longer cecal-intubation time (NCT03638713).
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Manning J, Halonen J, Cheriyamkunnel SJ, Álvarez-González MA. 1L NER1006 can improve rates of adequate and high-quality bowel cleansing in the right colon: a post hoc analysis of two randomised clinical trials. BMC Gastroenterol 2022; 22:35. [PMID: 35078404 PMCID: PMC8787873 DOI: 10.1186/s12876-022-02106-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 01/05/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The right colon is difficult to cleanse compared with other colon segments. This post hoc analysis of two randomised clinical trials (MORA and NOCT) examined whether 1L polyethylene glycol (PEG) NER1006 and two mid-volume alternatives could improve adequate and high-quality cleansing in the right colon among patients with complete cleansing assessments. METHODS Patients received NER1006 (N2D), 2L PEG plus ascorbate (2LPEG) or oral sulphate solution (OSS) as a 2-day evening/morning split-dosing regimen or NER1006 as a same-day morning-only dosing regimen (N1D). Patients had full segmental scoring assigned by treatment-blinded central readers using the Harefield Cleansing Scale. The right colon adequate (score ≥ 2) and high-quality (score ≥ 3) cleansing success of NER1006 (N2D and N1D) versus 2LPEG and OSS was analysed individually and as pooled groups (N2D vs. 2LPEG/OSS). We assessed the comparative right colon cleansing rates of the N2D versus 2LPEG/OSS in overweight males. We also performed a multivariable regression analysis to examine factors affecting cleansing in the right colon. RESULTS A total of 1307 patients were included. Pooled N2D showed significantly improved rates of adequate-level cleansing in the right colon compared with 2LPEG (97.5% [504/517] vs. 94.6% [246/260]; p = 0.020) and OSS (97.5% [504/517] vs. 93.8% [244/260]; p = 0.006). In MORA, the rate of adequate right colon cleansing did not significantly differ between N1D and 2LPEG (95.2% [257/270] vs. 94.6% [246/260]; p = 0.383). The rate of right colon high-quality cleansing was significantly improved with N2D or N1D vs. 2LPEG (p < 0.001 for both), and was numerically higher with N2D versus OSS (p = 0.11). In overweight males, NER1006 delivered numerically higher adequate (p = 0.398) and superior high-quality (p = 0.024) cleansing rates versus 2LPEG/OSS. Multivariable regression analysis showed NER1006 was associated with adequate and high-quality cleansing (p = 0.031 and p < 0.001), while time between preparation and colonoscopy was negatively associated (p = 0.034 and p = 0.006). CONCLUSIONS NER1006 delivered improved rates of adequate and high-quality right colon cleansing compared with 2LPEG and OSS. The increased rate of high-quality cleansing with NER1006 versus its comparators was also seen in overweight males.
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Affiliation(s)
- Jonathan Manning
- Borders General Hospital, NHS Borders, Melrose, Berwickshire, UK
| | - Juha Halonen
- Norgine Ltd, Medical Affairs, Widewater Place Moorhall Road, Harefield, Uxbridge, UB9 6NS, UK.
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de Sousa Magalhães R, Boal Carvalho P, Rosa B, Moreira MJ, Cotter J. The Prediction of Inadequate Colon Capsule Cleansing: A Cohort Selection Guided by CC-CLEAR. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2021; 29:311-321. [PMID: 36159193 PMCID: PMC9485925 DOI: 10.1159/000518588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/09/2021] [Indexed: 11/19/2022]
Abstract
Introduction In order to optimize the rate of adequate cleansing in colon capsule, it may be important to identify risk factors that can predict a suboptimal colon preparation. Aim To define predictive factors for inadequate bowel preparation in colon capsule, according to CC-CLEAR (Colon Capsule CLEansing Assessment and Report). Methods Retrospective, single center, cohort study. Patients' demographics, data, and quality of bowel preparation, according to CC-CLEAR, were collected retrospectively. A univariate analysis tested the association between covariables and the outcome, inadequate cleansing. The statistically significant variables were included in multivariable logistic binary regression, and a receiver operating characteristic curve (ROC) assessment was performed. Results We included 167 consecutive colon capsules. Sixty-eight percent (n = 114) of patients were female, with a mean age of 64 years. The main indication for colon capsule was previous incomplete colonoscopy, in 158 patients (94.6%). The colon capsules cleansing was graded as good or excellent in 96 patients (57.5%) and as inadequate in 71 (42.5%), according to CC-CLEAR. The variables inadequate previous colon cleansing (OR adjusted 41.72 [95% CI 12.57–138.57], p value < 0.001); chronic laxative (OR adjusted 4.86 [95% CI 1.08–21.79], p value = 0.039); antidepressant (OR adjusted 5.00 [95% CI 1.65–15.16], p value = 0.004), and impaired mobility (OR adjusted 5.54 [95% CI 1.17–26.31], p value = 0.031) were independently associated with the outcome inadequate cleansing, after adjusting for confoundment. The model presented an excellent discriminative power towards the outcome variable (AUC ROC 0.937 [CI 95% 0.899–0.975], p value < 0.001). Conclusion A previous inadequate colon cleansing, the use of chronic laxative and antidepressant, or impaired mobility are predictors of inadequate colon capsule cleansing, as assessed by the CC-CLEAR. These 4 predictors come together as a model enabling an accurate categorization of the patients at major risk of inadequate bowel preparation for capsule colonoscopy, with an excellent discriminative power and performance, which seems useful for the selection of patients for tailored optimization of the colon cleansing protocol.
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Affiliation(s)
- Rui de Sousa Magalhães
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
- * Rui de Sousa Magalhães,
| | - Pedro Boal Carvalho
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Bruno Rosa
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Maria João Moreira
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - José Cotter
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
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Epstein M, Halonen J, Sharma P. Bowel preparation with 1L polyethylene glycol and ascorbate NER1006 doubles the chance to detect three or more adenomas in overweight or obese males. Endosc Int Open 2021; 9:E1324-E1334. [PMID: 34466355 PMCID: PMC8367431 DOI: 10.1055/a-1499-6681] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/12/2021] [Indexed: 12/28/2022] Open
Abstract
Background and study aims Men have more colon cleansing failures, colorectal adenomas, and colorectal cancers than women. We analyzed whether 1-liter (1 L) polyethylene glycol (PEG) NER1006 improves high-quality (HQ) colon cleansing and adenoma detection in males versus two mid-volume alternatives. Patients and methods The analysis of 1028 adult patients in two randomized clinical trials was performed. Adenoma detection and HQ cleansing were compared for overnight split dosing regimens with NER1006 (n = 513) versus combined oral sulfate solution or 2 L PEG + ascorbate (OSS/2 L PEG) (n = 515). Analyses included males versus females, overweight or obese (OO) males versus lean males, and NER1006 versus OSS/2 L PEG. In male patients, the adenoma detection rate of at least 3 (ADR3 +) was predicted with multiple logistic regression and statistical comparisons used the two-sided t-test. Results ADR3 + was greater in males versus females (10.7 % [56/524] versus 5.8 % [29/504]; P = 0.004) despite comparable adequate cleansing success rates (93.2 % [479/514] versus 93.0 % [466/501]; P = 0.912) and more HQ-scores in females (41.6 % [1069/2570] versus 45.3 % [1134/2505]; P = 0.008). ADR was almost twice as high in OO versus lean males (43.4 % [184/424] versus 23.1 % [21/91]; P < 0.001). Multivariate logistic regression predicted ADR3 + detection to be twice as likely in OO males using NER1006 versus OSS/2 L PEG (odds ratio (95 % confidence interval [CI]) = 2.049 (1.082-3.973); P = 0.030) and 90 % more likely in all males (1.902 (1.045-3.526); P = 0.037). In males, including OO males, NER1006 attained more HQ-scores per trial than OSS or 2 L PEG (P ≤ 0.017 for all comparisons). Conclusions NER1006 predicted the detection of more males for frequent surveillance than OSS/2 L PEG.
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Affiliation(s)
- Michael Epstein
- Investigative Clinical Research, Annapolis, Maryland, United States
| | - Juha Halonen
- Medical Affairs, Norgine Ltd., Harefield, United Kingdom
| | - Prateek Sharma
- Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri, United States,Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, United States
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Baile-Maxia S, Amlani B, Martínez RJ. Bowel-cleansing efficacy of the 1L polyethylene glycol-based bowel preparation NER1006 (PLENVU) in patient subgroups in two phase III trials. Therap Adv Gastroenterol 2021; 14:17562848211020286. [PMID: 34249144 PMCID: PMC8237221 DOI: 10.1177/17562848211020286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/06/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Adequate bowel preparation prior to colonoscopy is essential for visualization of the colonic mucosa to maximize adenoma and polyp detection. The risk of inadequate bowel cleansing is heightened if the patient is older, male, overweight, and has comorbidities, such as diabetes. This post hoc analysis of the combined MORA and NOCT clinical trials explores the efficacy of evening/morning split-dose regimens of NER1006 (PLENVU®, Norgine Ltd), a 1-liter polyethylene glycol (PEG) bowel preparation, to evaluate its bowel-cleansing efficacy in patients at risk for inadequate cleansing. METHODS Patients requiring colonoscopy were randomized to receive evening/morning split-dosing of either NER1006, 2-liter (2L) PEG and ascorbate, or oral sulfate solution (OSS). Bowel-cleansing efficacy was assessed by treatment-blinded central readers using the validated Harefield Cleansing Scale (HCS). RESULTS Split-dose NER1006 was associated with high levels of cleansing, ranging between 87.0% and 94.0% across all patient subtypes (n = 551), including patients with obesity or diabetes. However, patients aged >65 years and <45 years showed significantly greater rates of successful cleansing than patients aged 45-65 years (94.0% versus 94.2% versus 87.0%, p = 0.002). The high-risk patient subgroup, which included obese males aged ⩾60 years, had significantly improved overall and high-quality bowel-cleansing success rates of 100% (33/33) and 72.7% (27/33) on the HCS with NER1006, compared with 86.7% (26/30) and 50% (15/30) with the comparator solutions (p = 0.015 and p = 0.033, respectively). In this high-risk subgroup, adenoma detection was greater per patient receiving NER1006 versus the comparator group (1.82 versus 0.93, p = 0.041). NER1006 was the only treatment that enabled the detection of patients with ⩾5 adenomas [9.1% (3/33) versus 0/30, p = 0.047]. CONCLUSION NER1006 effectively cleansed a broad range of patients and offered superior bowel cleansing versus 2LPEG/OSS in patients at increased risk of colorectal cancer. Future research should establish whether more effective cleansing also enables improved adenoma detection. PLAIN LANGUAGE SUMMARY A low-volume bowel preparation solution to better detect lesions associated with colorectal cancer during colonoscopyColorectal cancer (CRC) is the fourth most commonly diagnosed cancer in the world. Obese men over the age of 65 years are at particularly increased risk of developing CRC. If the changes in their large intestine (colon) could be seen more clearly during a colonoscopy (where a small camera is inserted via the anus to examine the bowels from the inside), patients who need treatment would be diagnosed earlier, thus improving their chances of survival. In this paper we discuss the use of a bowel preparation solution that is more convenient for patients (less to drink) but also cleans bowels more effectively, meaning more lesions are detected than when other solutions are used. This improved cleansing, and thus better visualization, occurred in a range of patients, including those at higher risk of CRC, such as older, overweight men.
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Affiliation(s)
- Sandra Baile-Maxia
- Gastroenterology Department, Hospital General
Universitario de Alicante, Instituto de Investigación Biomédica ISABIAL,
Alicante, Spain
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