Comparing Right-sided Colon Adenoma and Serrated Polyp Miss Rates with Water Exchange and CO2 Insufflation: A Randomized Controlled Trial.

Autor:	Cheng CL; Division of Gastroenterology, Evergreen General Hospital, Taoyuan, Taiwan., Tang JH; Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.; Division of Gastroenterology and Hepatology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan., Hsieh YH; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.; Tzu Chi University, Hualien, Taiwan., Kuo YL; Division of Gastroenterology, Evergreen General Hospital, Taoyuan, Taiwan., Fang KC; Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan., Tseng CW; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.; Tzu Chi University, Hualien, Taiwan., Su IC; Division of Gastroenterology, Evergreen General Hospital, Taoyuan, Taiwan.; Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan., Chang CC; Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan., Tsui YN; Division of Gastroenterology, Evergreen General Hospital, Taoyuan, Taiwan., Lee BP; Division of Gastroenterology, Evergreen General Hospital, Taoyuan, Taiwan., Zou KY; Department of Biotechnology, School of Health Technology, Ming Chuan University, Taoyuan, Taiwan., Lee YS; Department of Biotechnology, School of Health Technology, Ming Chuan University, Taoyuan, Taiwan., Leung FW; Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hills, California, United States of America.; David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America.
Jazyk:	angličtina
Zdroj:	The American journal of gastroenterology [Am J Gastroenterol] 2024 Oct 30. Date of Electronic Publication: 2024 Oct 30.
DOI:	10.14309/ajg.0000000000003168
Abstrakt:	Introduction: Postcolonoscopy colorectal cancers primarily occur in the right-sided colon because of missed adenomas and serrated polyps (SPs). Water exchange (WE) improves cleanliness and visibility of the right-sided colon. We hypothesized that WE could reduce the right-sided colon adenoma (rAMR) and SP miss rate (rSPMR) compared to standard colonoscopy. Methods: We randomly assigned 386 colonoscopy patients to insertion with either WE or CO2 insufflation. During the first withdrawal, polypectomies were performed up to the hepatic flexure. A second endoscopist, blinded to the insertion technique, reexamined the right-sided colon. The miss rate was determined by dividing the number of additional adenomas or SPs by the total number detected in both examinations. The primary outcome was the combined rAMR and rSPMR. Results: WE significantly decreased the combined rAMR and rSPMR (22.2% vs 32.2%, P < 0.001) and rSPMR alone (22.5% vs 37.1%, P = 0.002) compared to CO2 insufflation, but not rAMR (21.8% vs 29.8%, P = 0.079). Additionally, WE significantly increased the detection of SP per colonoscopy (SPPC) in the right-sided colon (0.95 ± 1.56 vs 0.50 ± 0.79, P < 0.001). Multivariate logistic regression analysis showed that ≥2 SPs in the right-sided colon was an independent predictor of rSPMR (odds ratio [OR], 3.47; 95% confidence interval [CI], 1.89─6.38), along with a higher right-sided colon Boston Bowel Preparation Scale score (OR, 0.55; 95% CI, 0.32─0.94). Conclusions: The significant reduction in rSPMR and increase in right-sided colon SPPC suggest that colonoscopy insertion using WE is a valid alternative to CO2 insufflation (Clinical trial registration number: NCT04124393). (Copyright © 2024 by The American College of Gastroenterology.)
Databáze:	MEDLINE
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