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Liu P, Wu J, He C, Wang W. ENDOANGEL versus water exchange for the detection of colorectal adenomas. Therap Adv Gastroenterol 2023; 16:17562848231218570. [PMID: 38116388 PMCID: PMC10729641 DOI: 10.1177/17562848231218570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 11/10/2023] [Indexed: 12/21/2023] Open
Abstract
Background Recently, the ENDOANGEL (EN) system, a computer-assisted detection technique, and water exchange (WE) assisted colonoscopy have both been shown to increase the colorectal adenoma detection rate (ADR). Objectives The aim of this study was to compare the ADR between EN- and WE-assisted colonoscopy. Design This was a retrospective study. Methods Data from patients who underwent either EN- or WE-assisted colonoscopy between October 2021 and August 2022 were analysed consecutively. The primary outcome measure was the ADR. Results The ADR was found to be similar between the EN and WE groups, with 80 out of 199 (40.2%) patients in the EN group compared to 78 out of 174 (44.8%) patients in the WE group [1.21; 95% confidence interval (CI), 0.80-1.83]. In the analysis using stabilized inverse probability treatment weighting after adjustment for confounding factors, both colonoscopy methods had similar performance in terms of ADR (1.41; 95% CI, 0.88-2.27). Conclusion EN was found to be comparable to WE in terms of ADR during colonoscopy, and both methods may be effectively used in clinical practice.
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Affiliation(s)
- Pengwei Liu
- Department of Gastroenterology, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Jie Wu
- Department of Gastroenterology, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Chiyi He
- Department of Gastroenterology, Yijishan Hospital of Wannan Medical College, No. 2 Zheshan West Road, Wuhu 241001, China
| | - Wei Wang
- Department of Gastroenterology, Yijishan Hospital of Wannan Medical College, No. 2 Zheshan West Road, Wuhu 241001, China
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Shao PP, Shao CR, Romero T, Leung FW. Sessile serrated adenoma/polyp detection rate of water exchange, Endocuff, and cap colonoscopy: A network meta-analysis. J Gastroenterol Hepatol 2021; 36:3268-3277. [PMID: 34622488 DOI: 10.1111/jgh.15702] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/15/2021] [Accepted: 09/28/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Sessile serrated adenoma/polyp (SSA/P) may contribute to interval cancer. In a recent meta-analysis, water exchange (WE) was shown to be superior to Endocuff and cap colonoscopy at adenoma and advanced adenoma detection. The strong positive correlation between adenoma detection rate (ADR), advanced adenoma detection rate (AADR), and sessile serrated adenoma/polyp detection rate (SSA/PDR) prompted us to hypothesize that WE could significantly improve SSA/PDR compared with Endocuff and cap colonoscopy. METHODS The literature was searched for all randomized controlled trials (RCTs) that reported SSA/PDR as an outcome and included the keywords colonoscopy, and water exchange, Endocuff, or cap. We performed traditional network meta-analyses with random effect models comparing SSA/PDR of each method using air insufflation as the control and reported the odds ratios (ORs) with 95% confidence interval (CI). Performances were ranked based on P-score. RESULTS A total of 531 articles resulted from initial keywords search. Eleven RCTs were included in the analysis. A total of 7856 patients underwent air insufflation, WE, Endocuff, or cap colonoscopy. WE significantly increased SSA/PDR (OR 2.04; 95% CI 1.33-3.13). Endocuff (OR 1.15; 95% CI 0.94-1.41) and cap (OR 1.08; 95% CI 0.42-2.74) did not significantly impact SSA/P detection. P-scores for WE (0.96), Endocuff (0.49), cap (0.37), and air insufflation (0.17) suggested that WE had the highest SSA/PDR. The results did not change after adjusting for mean withdrawal time and indication for colonoscopy. CONCLUSION Water exchange significantly increases SSA/PDR and is superior to Endocuff and cap colonoscopy at detecting SSA/P.
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Affiliation(s)
- Paul P Shao
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,VA Sepulveda Ambulatory Care Center, North Hills, California, USA.,David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | | | - Tahmineh Romero
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Felix W Leung
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,VA Sepulveda Ambulatory Care Center, North Hills, California, USA.,David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Leung JW, Yen AW, Jia H, Opada C, Melnik A, Atkins J, Feller C, Wilson MD, Leung FW. A prospective RCT comparing combined chromoendoscopy with water exchange (CWE) vs water exchange (WE) vs air insufflation (AI) in adenoma detection in screening colonoscopy. United European Gastroenterol J 2019; 7:477-487. [PMID: 31065365 DOI: 10.1177/2050640619832196] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 01/22/2019] [Indexed: 12/15/2022] Open
Abstract
Background A low adenoma detection rate (ADR) increases risks of interval cancers (ICs). Proximal colon flat polyps, e.g. serrated lesions (SLs), are difficult to find. Missed proximal colon flat lesions likely contribute to IC. Aims We compared chromoendoscopy with water exchange (CWE), water exchange (WE) and air insufflation (AI) in detecting adenomas in screening colonoscopy. Methods After split-dose preparation, 480 veterans were randomized to AI, WE and CWE. Results Primary outcome of proximal ADR (55.6% vs 53.4% vs 52.2%, respectively) were similar in all groups. Adenoma per colonoscopy (APC) and adenoma per positive colonoscopy (APPC) were comparable. Detection rate of proximal colon SLs was significantly higher for CWE and WE than AI (26.3%, 23.6% and 11.3%, respectively, p = 0.002). Limitations: single operator; SLs only surrogate markers of but not IC. Conclusions When an endoscopist achieves high-quality AI examinations with overall ADR twice (61.6%) the recommended standard (30%), use of WE and CWE does not produce further improvement in proximal or overall ADR. Comparable APC and APPC confirm equivalent withdrawal inspection techniques. WE alone is sufficient to significantly improve detection of proximal SLs. The impact of increased detection of proximal SLs by WE on prevention of IC deserves to be studied. This study is registered at ClinicalTrial.gov (NCT#01607255).
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Affiliation(s)
- J W Leung
- Section of Gastroenterology, Sacramento Veteran Affairs Medical Center, Veteran Affairs Northern California Health Care System (VANCHCS), Mather, CA, USA.,Division of Gastroenterology and Hepatology, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - A W Yen
- Section of Gastroenterology, Sacramento Veteran Affairs Medical Center, Veteran Affairs Northern California Health Care System (VANCHCS), Mather, CA, USA
| | - H Jia
- Department of Gastroenterology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - C Opada
- Section of Gastroenterology, Sacramento Veteran Affairs Medical Center, Veteran Affairs Northern California Health Care System (VANCHCS), Mather, CA, USA
| | - A Melnik
- Section of Gastroenterology, Sacramento Veteran Affairs Medical Center, Veteran Affairs Northern California Health Care System (VANCHCS), Mather, CA, USA
| | - J Atkins
- Section of Gastroenterology, Sacramento Veteran Affairs Medical Center, Veteran Affairs Northern California Health Care System (VANCHCS), Mather, CA, USA
| | - C Feller
- Section of Gastroenterology, Sacramento Veteran Affairs Medical Center, Veteran Affairs Northern California Health Care System (VANCHCS), Mather, CA, USA
| | - M D Wilson
- Clinical and Translational Science Center, Department of Public Health Sciences, Division of Biostatistics, University of California, Davis, Sacramento, CA, USA
| | - F W Leung
- Sepulveda Ambulatory Care Center, Veteran Affairs Greater Los Angeles Healthcare System (VAGLAHS) and David Geffen School of Medicine at UCLA, North Hills, CA, USA
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4
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Fan C, Younis A, Bookhout CE, Crockett SD. Management of Serrated Polyps of the Colon. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2018; 16:182-202. [PMID: 29445907 PMCID: PMC6284520 DOI: 10.1007/s11938-018-0176-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the management of serrated colorectal polyps (SPs), with a particular focus on the most common premalignant SP, sessile serrated adenoma or polyp (SSA/P). These lesions present a challenge for endoscopists with respect to detection and resection, and are also susceptible to pathologic misdiagnosis. RECENT FINDINGS Patients with SSA/Ps are at an increased risk of future colorectal neoplasia, including advanced polyps and cancer. Reasonable benchmarks for SP detection rates are 5-7% for SSA/Ps and 10-12% for proximal SPs. Certain endoscopic techniques such as chromoendoscopy, narrow band imaging, water immersion, and wide-angle viewing may improve SSA/P detection. Emerging endoscopic techniques such as underwater polypectomy, suction pseudopolyp technique, and piecemeal cold snare polypectomy are helpful tools for the endoscopist's armamentarium for removing SSA/Ps. Proper orientation of SSA/P specimens can improve the accuracy of pathology readings. Patients with confirmed SSA/Ps and proximal HPs should undergo surveillance at intervals similar to what is recommended for patients with conventional adenomas. Patients with SSA/Ps may also be able to lower their risk of future polyps by targeting modifiable risk factors including tobacco and alcohol use and high-fat diets. NSAIDs and aspirin appear to be protective agents. SPs and SSA/Ps in particular are important colorectal cancer precursors that merit special attention to ensure adequate detection, resection, and surveillance.
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Affiliation(s)
- Claire Fan
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Adam Younis
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Christine E Bookhout
- Department of Pathology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Seth D Crockett
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, CB#7080, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA.
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East JE, Atkin WS, Bateman AC, Clark SK, Dolwani S, Ket SN, Leedham SJ, Phull PS, Rutter MD, Shepherd NA, Tomlinson I, Rees CJ. British Society of Gastroenterology position statement on serrated polyps in the colon and rectum. Gut 2017; 66:1181-1196. [PMID: 28450390 PMCID: PMC5530473 DOI: 10.1136/gutjnl-2017-314005] [Citation(s) in RCA: 183] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 03/31/2017] [Accepted: 04/03/2017] [Indexed: 02/07/2023]
Abstract
Serrated polyps have been recognised in the last decade as important premalignant lesions accounting for between 15% and 30% of colorectal cancers. There is therefore a clinical need for guidance on how to manage these lesions; however, the evidence base is limited. A working group was commission by the British Society of Gastroenterology (BSG) Endoscopy section to review the available evidence and develop a position statement to provide clinical guidance until the evidence becomes available to support a formal guideline. The scope of the position statement was wide-ranging and included: evidence that serrated lesions have premalignant potential; detection and resection of serrated lesions; surveillance strategies after detection of serrated lesions; special situations-serrated polyposis syndrome (including surgery) and serrated lesions in colitis; education, audit and benchmarks and research questions. Statements on these issues were proposed where the evidence was deemed sufficient, and re-evaluated modified via a Delphi process until >80% agreement was reached. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool was used to assess the strength of evidence and strength of recommendation for finalised statements. Key recommendation: we suggest that until further evidence on the efficacy or otherwise of surveillance are published, patients with sessile serrated lesions (SSLs) that appear associated with a higher risk of future neoplasia or colorectal cancer (SSLs ≥10 mm or serrated lesions harbouring dysplasia including traditional serrated adenomas) should be offered a one-off colonoscopic surveillance examination at 3 years (weak recommendation, low quality evidence, 90% agreement).
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Affiliation(s)
- James E East
- Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Wendy S Atkin
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Adrian C Bateman
- Department of Cellular Pathology, Southampton General Hospital, Southampton, UK
| | - Susan K Clark
- The Polyposis Registry, St. Mark's Hospital, London, UK
| | - Sunil Dolwani
- Cancer Screening, Prevention and Early Diagnosis Group, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Shara N Ket
- Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Simon J Leedham
- Gastrointestinal Stem-cell Biology Laboratory, Oxford Centre for Cancer Gene Research, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Perminder S Phull
- Department of Digestive Disorders, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Matt D Rutter
- Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, Cleveland, UK
- School of Medicine, Durham University, Durham, UK
| | - Neil A Shepherd
- Gloucestershire Cellular Pathology Laboratory, Cheltenham General Hospital, Cheltenham, UK
| | - Ian Tomlinson
- Oxford Centre for Cancer Gene Research, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Colin J Rees
- School of Medicine, Durham University, Durham, UK
- Department of Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, UK
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Cadoni S, Falt P, Sanna S, Argiolas M, Fanari V, Gallittu P, Liggi M, Mura D, Porcedda ML, Smajstrla V, Erriu M, Leung FW. Insertion water exchange increases right colon adenoma and hyperplastic polyp detection rates during withdrawal. Dig Liver Dis 2016; 48:638-43. [PMID: 27017108 DOI: 10.1016/j.dld.2016.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 02/09/2016] [Accepted: 03/04/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Single site studies in male Veterans in the U.S. reported increased detection of presumptive cancer precursors (adenomas, hyperplastic polyps) in the proximal colon (cecum-splenic flexure) by water exchange. AIMS Assess the reproducibility of the observation. METHODS Analysis of secondary outcomes collected prospectively in 3 similarly designed randomized controlled trials using water exchange, water immersion and insufflation (air or carbon dioxide). MAIN OUTCOME detection rates of adenomas and hyperplastic polyps in proximal, transverse and right colon (cecum-ascending). RESULTS 704 males (173 screening) were evaluated. In the proximal colon, WE showed increased detection of small adenomas (p=0.009) and adenomas plus hyperplastic polyps (p=0.015) (vs insufflation); increased detection of adenomas plus hyperplastic polyps of any size (p=0.045) and of small size (p=0.04) (vs water immersion). In the right colon water exchange increased detection of small adenomas (19% vs 12.1%, p=0.04) (vs insufflation); small adenomas (19% vs 12%, p=0.038), adenomas plus hyperplastic polyps of any size (25% vs 16.7%, p=0.028) and of small size (23.7% vs 14.6%, p=0.012) (vs water immersion). Water exchange significantly improved bowel cleanliness. Sedation had no impact on lesion detection. CONCLUSIONS Water exchange is a superior insertion technique for detection of adenomas and hyperplastic polyps primarily in the right colon, especially those of small size.
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Affiliation(s)
- Sergio Cadoni
- Digestive Endoscopy Unit, St. Barbara Hospital, Iglesias, CI, Italy.
| | - Přemysl Falt
- Digestive Diseases Center, Vìtkovice Hospital, Ostrava, Czech Republic
| | - Stefano Sanna
- Digestive Endoscopy Unit, N. S. di Bonaria Hospital, San Gavino Monreale, VS, Italy
| | - Mariangela Argiolas
- Digestive Endoscopy Unit, N. S. di Bonaria Hospital, San Gavino Monreale, VS, Italy
| | - Viviana Fanari
- Digestive Endoscopy Unit, N. S. di Bonaria Hospital, San Gavino Monreale, VS, Italy
| | - Paolo Gallittu
- Digestive Endoscopy Unit, St. Barbara Hospital, Iglesias, CI, Italy
| | - Mauro Liggi
- Digestive Endoscopy Unit, St. Barbara Hospital, Iglesias, CI, Italy
| | - Donatella Mura
- Digestive Endoscopy Unit, St. Barbara Hospital, Iglesias, CI, Italy
| | - Maria L Porcedda
- Digestive Endoscopy Unit, N. S. di Bonaria Hospital, San Gavino Monreale, VS, Italy
| | - Vit Smajstrla
- Digestive Diseases Center, Vìtkovice Hospital, Ostrava, Czech Republic
| | - Matteo Erriu
- Department of Surgical Sciences, University of Cagliari, Cagliari, CA, Italy
| | - Felix W Leung
- Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hills, CA, USA; David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA, USA
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7
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Rodríguez-García JL, Carmona-Sánchez R, Rosas-Vitorino C. Usefulness of oil lubrication during colonoscopy: A comparative study with the conventional technique. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2016; 81:28-34. [PMID: 26780984 DOI: 10.1016/j.rgmx.2015.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 12/02/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The different forms of lubrication are among the most simple, accessible, and economic techniques that have been implemented for improving the diagnostic performance of colonoscopy. AIM To determine whether the use of oil improved the number of complete colonoscopies, facilitated the procedure, reduced pain, or improved the study's diagnostic performance, compared with the conventional lubrication technique. PATIENTS AND METHODS One hundred and seventy-five patients referred for colonoscopy were alternately allocated to receive treatment with the standard lubrication method with chlorhexidine gel (group 1) or lubrication with corn oil administered through the working channel (group II). The number of complete colonoscopies, the length of time needed to reach the cecum, the degree of difficulty estimated by the endoscopist and the assistant, the level of pain at the end of the study estimated by the patient, and the endoscopic findings were all determined. RESULTS Eighty-eight patients made up group I and 87 made up group II. No statistically significant differences were found between the two groups in relation to general characteristics, the number of complete colonoscopies (93 vs. 97%, respectively), the time needed to reach the cecum (8:00 vs. 8:41min, respectively), the level of pain at the end of the study, or the detection of polyps. The degree of difficulty was slightly lower in group II, but with no statistical significance. CONCLUSIONS Lubrication with oil during colonoscopy did not improve the number of complete colonoscopies, did not facilitate the study, nor did it reduce pain or increase the diagnostic performance of the study, when compared with the conventional technique.
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Affiliation(s)
| | | | - C Rosas-Vitorino
- Departamento de Enfermería, Hospital Ángeles-CMP, San Luis Potosí, México
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8
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Rodríguez-García J, Carmona-Sánchez R, Rosas-Vitorino C. Usefulness of oil lubrication during colonoscopy: A comparative study with the conventional technique. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2016. [DOI: 10.1016/j.rgmxen.2015.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
Water-aided methods for colonoscopy include the established water immersion and the recent novel modification of water exchange. Water immersion entails the use of water as an adjunct to air insufflations to facilitate insertion. Water exchange evolved from water immersion to facilitate completion of colonoscopy without discomfort in unsedated patients. Infused water is removed predominantly during insertion rather than withdrawal. A higher adenoma detection rate has been reported with water exchange. Aggregate data of randomized controlled trials suggest that water exchange may be superior to water immersion in attenuating colonoscopy discomfort and optimizing adenoma detection, particularly in the proximal colon.
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Affiliation(s)
- Felix W Leung
- Division of Gastroenterology, Department of Medicine, Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, 111G, 16111 Plummer Street, North Hill, CA 91343, USA.
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10
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Falt P, Šmajstrla V, Fojtík P, Liberda M, Kliment M, Tvrdík J, Urban O. Cap-assisted water immersion for minimal sedation colonoscopy: prospective, randomized, single-center trial. Dig Endosc 2013; 25:434-9. [PMID: 23808948 DOI: 10.1111/j.1443-1661.2012.01402.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 09/19/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Water immersion insertion is able to reduce discomfort and need for sedation during colonoscopy. A cap attached to the colonoscope tip may improve insertion during air insufflation colonoscopy. According to several reports, both techniques alone may result in higher detection of neoplastic lesions. Our study was designed to evaluate the efficacy of cap-assisted water immersion compared to water immersion colonoscopy in minimally sedated patients. METHODS A total of 208 consecutive outpatients were randomized to either cap-assisted water immersion (Cap Water) or water immersion colonoscopy (Water). The primary endpoint was cecal intubation time. RESULTS Cecal intubation time was 6.9 ± 2.9 min in Cap Water and 7.4 ± 4.2 min in the Water arm (P = 0.73). Success rate of minimal sedation colonoscopy was equal in both groups (92.9%, P = 1.00). From the endoscopist's point of view, there were non-significant trends towards lower discomfort (P = 0.06), less need for abdominal compression (P = 0.06) and lower difficulty score (P = 0.05) during Cap Water colonoscopy. Adenoma detection rate was similar in both arms (44% in Cap Water vs 45% in the Water group, P = 0.88). There were no complications recorded in the present study. CONCLUSIONS In comparison with water immersion without cap, cap-assisted water immersion colonoscopy was not able to shorten the cecal intubation time. However, it has the possibility of reducing patient discomfort and difficulty of colonoscope insertion. Potential impact on improved detection of neoplastic lesions has to be evaluated by further studies.
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Affiliation(s)
- Přemysl Falt
- Digestive Diseases Center, Vítkovice Hospital, Ostrava, Czech Republic.
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11
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Abstract
OBJECTIVES Little is known about the correlation between the polyp detection rate (PDR) and the adenoma detection rate (ADR) in individual colonic segments. The adenoma-to-polyp detection rate quotient (APDRQ) has been utilized in retrospective study as a constant to estimate ADR from PDR. It has been previously stated that diminutive polyps in the rectum are more likely to be non-adenomatous, compared with more proximal segments, yet the APDRQ uses data from the entire colon. We sought to characterize and compare ADR and PDR in each colonic segment, estimate ADR using the conversion factor, APDRQ, and assess the correlation between estimated and actual ADR for each colonic segment. METHODS As part of a quality improvement program, a retrospective chart review was conducted of all outpatient colonoscopies performed by 20 gastroenterologists between 1 October 2010 and 31 March 2011 at a single academic tertiary-care referral center. PDR, ADR, and the APDRQ were calculated for each gastroenterologist, using data from the entire colon and then for each colonic segment separately. Actual ADR was compared with estimated ADR based on the measured APDRQ. RESULTS During 1,921 colonoscopies, 2,285 polyps were removed; 1,122 (49%) were adenomas. The mean (s.d.) PDR for the group was 49% (12.4%) (range, 16-64%). The mean (s.d.) ADR was 31% (7.4%) (range, 13-42%). PDR and ADR correlated well in segments proximal to the splenic flexure, but diverged in distal segments. ADR was significantly higher in the right colon (17.1%) than in the left (13.5%) (P=0.001). The correlation between estimated and actual ADR using the APDRQ was significantly higher in the right colon (r=0.95 (95% confidence interval (CI), 0.87-0.98)) than in the left (r=0.59 (95% CI, 0.17-0.83)) (P<0.05). CONCLUSIONS Although PDR and ADR correlate well in segments proximal to the splenic flexure, they do not correlate well in the left colon. Caution should be exercised when using PDR as a surrogate for ADR if data from the rectum and sigmoid are included.
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Aswakul P, Prachayakul V, Lohsiriwat V, Bunyaarunnate T, Kachintorn U. Screening colonoscopy from a large single center of Thailand - something needs to be changed? Asian Pac J Cancer Prev 2013; 13:1361-4. [PMID: 22799332 DOI: 10.7314/apjcp.2012.13.4.1361] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Results of screening colonoscopy from Western countries reported adenoma detection rates (ADRs) of 30-40% while those from Asia had ADR as low as 10%. There have been limited data regarding screening colonoscopy in Thailand. The objectives of this study were therefore to determine polyp and adenoma detection rates in Thai people, to evaluate the incidence of colorectal cancer detected during screening colonoscopy and to determine the endoscopic findings of the polyps which might have some impact on endoscopists to perform polypectomy. MATERIALS AND METHODS This study was a retrospective electronic chart review of asymptomatic Thai adults who underwent screening colonoscopy in our endoscopic center from June 2007 to October 2010. RESULTS A total of 1,594 cases were reviewed. The patients had an average age of 58.3 ± 10.5 years (range 27-82) and 55.5% were female. Most of the cases (83.8%) were handled by staff who were endoscopists. A total of 488 patients (30.6%) were reported to have colonic polyps. Left-sided colon was the most common site (45.1%), followed by right-sided colon (36.5%) and the rectum (18%). Those polyps were removed in 97.5% of cases and 88.5 % of the polyps were sent for histopathology (data lost 11.5%). Two hundred and sixty three cases had adenomatous polyps, accounting for 16.5 % ADR. Advanced adenomas were detected in 43 cases (2.6%). Hyperplastic polyps were mainly located distal to the splenic flexure of the colon whereas adenomas were found throughout the large intestine. Ten cases (0.6%) were found to have colorectal cancer. Four advanced adenomas and two malignant polyps were reported in lesions ≤ 5 mm. CONCLUSION The polyp detection rate, adenoma detection rate, advanced adenoma detection rate and colorectal cancer detection rate in the screening colonoscopy of Thai adults were 30.9%, 16.5%, 2.6% and 0.6% respectively. Malignant transformation was detected regardless of the size and location of the polyps. Therefore, new technology would play an important role indistinguishing polyps.
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Affiliation(s)
- Pitulak Aswakul
- Department of Medicine, Siriraj GI Endoscopy Center, Siriraj Hospital, Bangkok, Thailand
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13
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Abstract
Gastrointestinal endoscopy has undergone a remarkable expansion in its capabilities as a result of sophisticated technological advances in recent years. New imaging technologies, novel ablation and resection techniques, cutting-edge endoscope development and creative extraluminal applications have taken gastrointestinal endoscopy to an exciting new level. An update on some of these advances is presented for the physician audience.
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Affiliation(s)
- V Kwan
- Department of Gastroenterology, Westmead Hospital, Sydney, New South Wales, Australia.
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Cohen B, Tang RS, Groessl E, Herrin A, Ho SB. Effectiveness of a simplified "patient friendly" split dose polyethylene glycol colonoscopy prep in Veterans Health Administration patients. JOURNAL OF INTERVENTIONAL GASTROENTEROLOGY 2012; 2:177-182. [PMID: 23687605 DOI: 10.4161/jig.23748] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 12/12/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Adequate colon cleansing is an important factor in performing quality colonoscopy. Split dose Polyethylene Glycol (PEG) solutions have been shown to improve colon cleansing, but the effectiveness in a large clinical practice of elderly co-morbid patients has not been demonstrated. The aim of this study was to assess the efficacy of a simplified split PEG bowel prep in Veterans Health Administration (VHA) patients. METHODS Prospective pre-post study design of VHA patients undergoing routine colonoscopy. Bowel prep quality was assessed using a standardized semi-quantitative 5-point scale. "Standard" 4L PEG prep was consumed once the evening before the procedure. "Split" prep was consumed half in the early evening and half in the late evening or early morning depending on procedure time. RESULTS Right colon preps were Excellent/Good in 81.4% of split preps (n=199) vs. 63% of standard preps (n=447, p<0.001). Left colon preps were Excellent/Good in 85.9% of split preps vs. 71.6% of standard preps (p<0.001). Diabetics (n=133) had significantly more right colon preps rated fair or worse compared to non-diabetics irrespective of prep (39.9% vs. 29.0%, p=0.02). Split prep in diabetics resulted in fewer right colon preps rated fair or worse compared to diabetics using standard prep (28.3% vs. 45.9%, p=0.049). Average adenomas detected per colonoscopy were 1.04 for split prep vs. 0.85 for standard prep (p=NS). Patient satisfaction was higher for split preps. CONCLUSION System-wide implementation of a split PEG prep resulted in significantly improved bowel cleansing in VHA patients, particularly in the right colon. Improved bowel cleansing with split preps was associated with higher patient satisfaction.
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Affiliation(s)
- Benjamin Cohen
- Division of Medicine, VA San Diego Healthcare System and University of California, San Diego, San Diego, CA, USA
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Leung FW, Amato A, Ell C, Friedland S, Harker JO, Hsieh YH, Leung JW, Mann SK, Paggi S, Pohl J, Radaelli F, Ramirez FC, Siao-Salera R, Terruzzi V. Water-aided colonoscopy: a systematic review. Gastrointest Endosc 2012; 76:657-66. [PMID: 22898423 DOI: 10.1016/j.gie.2012.04.467] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 04/25/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND Water-aided methods for colonoscopy are distinguished by the timing of removal of infused water, predominantly during withdrawal (water immersion) or during insertion (water exchange). OBJECTIVE To discuss the impact of these approaches on colonoscopy pain and adenoma detection rate (ADR). DESIGN Systematic review. SETTING Randomized, controlled trial (RCT) that compared water-aided methods and air insufflation during colonoscope insertion. PATIENTS Patients undergoing colonoscopy. INTERVENTION Medline, PubMed, and Google searches (January 2008-December 2011) and personal communications of manuscripts in press were considered to identify appropriate RCTs. MAIN OUTCOME MEASUREMENTS Pain during colonoscopy and ADR. RCTs were grouped according to whether water immersion or water exchange was used. Reported pain scores and ADR were tabulated based on group assignment. RESULTS Pain during colonoscopy is significantly reduced by both water immersion and water exchange compared with traditional air insufflation. The reduction in pain scores was qualitatively greater with water exchange as compared with water immersion. A mixed pattern of increases and decreases in ADR was observed with water immersion. A higher ADR, especially proximal to the splenic flexure, was obtained when water exchange was implemented. LIMITATIONS Differences in the reports limit application of meta-analysis. The inability to blind the colonoscopists exposed the observations to uncertain bias. CONCLUSION Compared with air insufflation, both water immersion and water exchange significantly reduce colonoscopy pain. Water exchange may be superior to water immersion in minimizing colonoscopy discomfort and in increasing ADR. A head-to-head comparison of these 3 approaches is required.
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Affiliation(s)
- Felix W Leung
- Research and Medical Services, Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hills, Los Angeles, California 91343, USA
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Leung FW. Benchmarking and quality-screening colonoscopy. JOURNAL OF INTERVENTIONAL GASTROENTEROLOGY 2012; 2:100-102. [PMID: 23805385 DOI: 10.4161/jig.23726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 05/07/2012] [Accepted: 05/08/2012] [Indexed: 12/17/2022]
Affiliation(s)
- Felix W Leung
- Gastroenterology, Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hill ; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Hsieh YH, Tseng KC, Hsieh JJ, Tseng CW, Hung TH, Leung FW. Feasibility of colonoscopy with water infusion in minimally sedated patients in an Asian Community Setting. JOURNAL OF INTERVENTIONAL GASTROENTEROLOGY 2011; 1:185-190. [PMID: 22586535 DOI: 10.4161/jig.1.4.19961] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Revised: 11/01/2011] [Accepted: 11/05/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND: Investigators in the US described large volume water infusion with marked benefits but acknowledged the limitation of male veteran predominance in the study subjects. The aim of this study was to assess the feasibility of large volume water infusion in Asian patients undergoing minimal sedation diagnostic colonoscopy in a community setting. METHODS: Consecutive patients who underwent colonoscopy were randomized to receive large volume (entire colon) (Group A, n=51), limited volume (rectum and sigmoid colon) (Group B, n=51) water infusion, or air insufflation (Group C, n=51). Pain during insertion, completion rate, cecal intubation and total procedure times, and patient satisfaction were evaluated. Pain and satisfaction were assessed with a 0-10 visual analog scale. RESULTS: The mean pain scores during insertion were lower in the Group A and Group B than in Group C, 3.3±2.4, 3.0±2.2 and 4.4±2.6, respectively (p=0.028 and p=0.004). The completion rates and cecal intubation times were similar among the three groups. The procedure time was significantly longer in Group A than in group C (15.3±5.9 min vs. 13.1±5.4 min, p=0.049). Overall satisfaction with the procedure was greater in Group B than in Group C only (9.7±0.5 vs. 9.4±0.8, p=0.044). CONCLUSIONS: Diagnostic colonoscopy with large volume water infusion without air insufflation appears to be feasible in minimally sedated Asian patients in a community setting. Measures to improve the outcome further are discussed.
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Affiliation(s)
- Yu-Hsi Hsieh
- Division of Gastroenterology, Department of Medicine, Buddhist Dalin Tzu Chi General Hospital, Chia-Yi, Taiwan
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Leung F, Harker J, Leung J, Siao-Salera R, Mann S, Ramirez F, Friedland S, Amato A, Radaelli F, Paggi S, Terruzzi V, Hsieh Y. Removal of infused water predominantly during insertion (water exchange) is consistently associated with an increase in adenoma detection rate - review of data in randomized controlled trials (RCTs) of water-related methods. JOURNAL OF INTERVENTIONAL GASTROENTEROLOGY 2011; 1:121-126. [PMID: 22163082 DOI: 10.4161/jig.1.3.18517] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 06/18/2011] [Accepted: 06/20/2011] [Indexed: 02/06/2023]
Abstract
INTRODUCTION: Variation in outcomes in RcTs comparing water-related methods and air insufflation raises challenging questions regarding the new approach. This report reviews impact of water exchange - simultaneous infusion and removal of infused water during insertion on adenoma detection rate (ADR) defined as proportion of patients with a least one adenoma of any size. METHODS: Medline (2008-2011) searches, abstract of 2011 Digestive Disease Week (DDW) meeting and personal communications were considered to identify RcTs that compared water-related methods and air insufflation to aid insertion of colonoscope. RESULTS: Since 2008, eleven reports of RcTs (6 published, 1 submitted and 4 abstracts, n=1728) described ADR in patients randomized to be examined by air and water-related methods. The water-related methods differed in timing of removal of the infused water -predominantly during insertion (water exchange) (n=825) or predominantly during withdrawal (water immersion) (n=903). Water immersion was associated with both increases and decreases in ADR compared to respective air method patients and the net overall change (-7%) was significant. On the other hand water exchange was associated with increases in ADR consistently and the net changes (overall, 8%; proximal overall, 11%; and proximal <10 mm, 12%) were all significant. CONCLUSION: Comparative data generated the hypothesis that significantly larger increases in overall and proximal colon ADRs were associated with water exchange than water immersion or air insufflation during insertion. The hypothesis should be evaluated by RCTs to elucidate the mechanism of water exchange on adenoma detection.
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Affiliation(s)
- Fw Leung
- Sepulveda ACC, VAGLAHS, North Hill, CA, USA
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Leung F, Harker J, Leung J, Siao-Salera R, Mann S, Ramirez F, Friedland S, Amato A, Radaelli F, Paggi S, Terruzzi V, Hsieh Y. Removal of infused water predominantly during insertion (water exchange) is consistently associated with a greater reduction of pain score - review of randomized controlled trials (RCTs) of water method colonoscopy. JOURNAL OF INTERVENTIONAL GASTROENTEROLOGY 2011; 1:114-120. [PMID: 22163081 DOI: 10.4161/jig.1.3.18510] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 05/29/2011] [Accepted: 06/03/2011] [Indexed: 02/06/2023]
Abstract
INTRODUCTION: Variation in the outcomes in RcTs comparing water-related methods and air insufflation during the insertion phase of colonoscopy raises challenging questions regarding the approach. This report reviews the impact of water exchange on the variation in attenuation of pain during colonoscopy by water-related methods. METHODS: Medline (2008 to 2011) searches, abstracts of the 2011 Digestive Disease Week (DDW) and personal communications were considered to identify RcTs that compared water-related methods and air insufflation to aid insertion of the colonoscope. Results: Since 2008 nine published and one submitted RcTs and five abstracts of RcTs presented at the 2011 DDW have been identified. Thirteen RcTs (nine published, one submitted and one abstract, n=1850) described reduction of pain score during or after colonoscopy (eleven reported statistical significance); the remaining reports described lower doses of medication used, or lower proportion of patients experiencing severe pain in colonoscopy performed with water-related methods compared with air insufflation (Tables 1 and 2). The water-related methods notably differ in the timing of removal of the infused water - predominantly during insertion (water exchange) versus predominantly during withdrawal (water immersion). Use of water exchange was consistently associated with a greater attenuation of pain score in patients who did not receive full sedation (Table 3). CONCLUSION: The comparative data reveal that a greater attenuation of pain was associated with water exchange than water immersion during insertion. The intriguing results should be subjected to further evaluation by additional RcTs to elucidate the mechanism of the pain-alleviating impact of the water method.
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Affiliation(s)
- Fw Leung
- Sepulveda ACC, VAGLAHS, North Hill, CA; USA
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Leung FW, Leung JW, Mann SK, Friedland S, Ramirez FC, Olafsson S. DDW 2011 cutting edge colonoscopy techniques - state of the art lecture master class - warm water infusion/CO(2) insufflation for colonoscopy. JOURNAL OF INTERVENTIONAL GASTROENTEROLOGY 2011; 1:78-82. [PMID: 21776430 DOI: 10.4161/jig.1.2.16830] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 05/23/2011] [Accepted: 05/25/2011] [Indexed: 12/17/2022]
Abstract
Pain limits the success of cecal intubation in unsedated patient. Carbon dioxide infusion instead of air insufflation and water infusion as an adjunction to air insufflation have both been investigated as modalities to minimize pain associated with colonoscopy. Multiple RCT support an effect of carbon dioxide in reducing pain after colonoscopy. A modern method of water infusion as the sole modality for aiding colonoscope insertion has been shown to reduce pain during and after colonoscopy. Favorable effects in reducing discomfort have been documented in both sedated and unsedated patients. Because of the need to perform water exchange in the patients with suboptimal bowel perparation, a serendipitous consequence of salvage cleansing is evident with application of the water method. The associated increase in adenoma detection especially in the proximal colon is most intriguing. The hypothesis that the water method during insertion combined with carbon dioxide insufflation during withdrawal will optimally decrease colonoscopy pain should be evaluated. The implications of increased adenoma detection by the water method also deserve to be studied.
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Affiliation(s)
- Felix W Leung
- The Research and Medical Services, Sepulveda Ambulatory Care Center, VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA, Los Angeles, CA
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