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Cheng TF, Cheng KS. A randomized prospective study comparing single-balloon-assisted colonoscopy and cap-assisted colonoscopy in patients with previous incomplete conventional colonoscopy. J Gastroenterol Hepatol 2023; 38:225-232. [PMID: 36398729 DOI: 10.1111/jgh.16062] [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: 10/03/2022] [Revised: 11/01/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cecal intubation may be unsuccessful by conventional colonoscopy in some patients. Single-balloon-assisted colonoscopy (SBC) and cap-assisted colonoscopy (CAC) were studied to solve this problem. There was no head-to-head comparison between them. METHODS We conducted a randomized study from 2018 to 2021 to compare cecal intubation rate of SBC and CAC in patients with previous incomplete conventional colonoscopy. We recruited patients with incomplete conventional colonoscopy in two hospitals in Hong Kong. Patients were randomized into SBC group and CAC group in 1:1 ratio. In the case of failure in cecal intubation by allocated method, alternative modality would be performed as rescue. RESULTS Forty-four patients were recruited. Cecal intubation rate was superior in SBC group (22/22, 100%) than CAC group (16/22, 72.7%) (P = 0.02). No difference in cecal intubation time, polyp detection rate, and diagnostic gain in area not examined previously. SBC induced less discomfort (modified Gloucester comfort score 2.14 vs 2.63, P = 0.03) with use of comparable amount of midazolam and fentanyl as CAC. For patients failed cecal intubation by CAC, all (n = 6) were rescued successfully by SBC. Body weight, body mass index (BMI), and waist circumference were greater in rescue subgroup. More patients were obese (BMI ≥ 25 kg/m) in rescue subgroup (67% vs 19%). None in rescue subgroup had history of successful cecal intubation by conventional colonoscopy (0% vs 56%, P = 0.046). However, we failed to demonstrate significant association in multivariate analysis owing to small sample size. No adverse event was noted. CONCLUSION SBC is superior to CAC in cecal intubation in patients with previous incomplete conventional colonoscopy.
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Affiliation(s)
- Tsz Fai Cheng
- Department of Medicine and Geriatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Ka Shing Cheng
- Department of Medicine and Geriatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong
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Tan X, Yang W, Wichmann D, Huang C, Mothes B, Grund KE, Chen Z, Chen Z. Magnetic endoscopic imaging as a rational investment for specific colonoscopies: a systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol 2021; 15:447-458. [PMID: 33267703 DOI: 10.1080/17474124.2021.1842192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Magnetic endoscopic imaging (MEI) was regarded as an adjuvant device to improve procedural efficacy and patients' comfort during colonoscopy. METHODS Several electronic databases were searched to identify eligible studies. Based on the heterogeneity of included studies, random-effects or fixed-effects models were used to calculate pooled risk ratios (RR), risk difference (RD) or mean difference (MD) along with 95% confidence intervals (CIs). RESULTS Twenty-one randomized controlled trials (RCTs) were selected for meta-analysis, with a total of 7,060 patients. Although there is a slightly lower risk of cecal intubation failure with the adjuvant of MEI (RD 3%; P < 0.00001) compared to the control group, the updated studies show no significant benefits. Similarly, the cecal intubation time, pain scores, and loop formation with the adjuvant of MEI did not show any advantages. However, considerable significant benefits were found in the subgroup of technically difficult colonoscopy and inexperienced colonoscopists. Moreover, MEI was associated with lower loop intubation time, lower abdominal compression times, and better lesion localization. CONCLUSION The clinical benefits of MEI could be exaggerated. However, MEI has considerable advantages in technically difficult colonoscopies, the assistance for inexperienced colonoscopists, loop resolving, and lesion localization.
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Affiliation(s)
- Xiangzhou Tan
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, Hunan Province, China.,Hunan Key Laboratory of Precise Diagnosis and Treatment of Gastrointestinal Tumor, Xiangya Hospital Central South University, Changsha, Hunan Province, China.,Department of General, Visceral and Transplant Surgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Weimin Yang
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, Hunan Province, China.,Hunan Key Laboratory of Precise Diagnosis and Treatment of Gastrointestinal Tumor, Xiangya Hospital Central South University, Changsha, Hunan Province, China.,Department of General Surgery, Huaihua Hospital Affiliated to University of South China, Huaihua, Hunan Province, China
| | - Doerte Wichmann
- Department of General, Visceral and Transplant Surgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Changhao Huang
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, Hunan Province, China.,Hunan Key Laboratory of Precise Diagnosis and Treatment of Gastrointestinal Tumor, Xiangya Hospital Central South University, Changsha, Hunan Province, China
| | - Benedikt Mothes
- Department of General, Visceral and Transplant Surgery, University Hospital Tuebingen, Tuebingen, Germany
| | - K E Grund
- Department of General, Visceral and Transplant Surgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Zhikang Chen
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, Hunan Province, China.,Hunan Key Laboratory of Precise Diagnosis and Treatment of Gastrointestinal Tumor, Xiangya Hospital Central South University, Changsha, Hunan Province, China
| | - Zihua Chen
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, Hunan Province, China.,Hunan Key Laboratory of Precise Diagnosis and Treatment of Gastrointestinal Tumor, Xiangya Hospital Central South University, Changsha, Hunan Province, China
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