A prospective RCT comparing combined chromoendoscopy with water exchange (CWE) vs water exchange (WE) vs air insufflation (AI) in adenoma detection in screening colonoscopy

Autor: Jia H, Feller C, Wilson, Andrew W. Yen, Felix W. Leung, Leung Jw, Andrey Melnik, Opada C, Atkins J
Rok vydání: 2019
Předmět:
Male
Colonoscopy
Water exchange
Screening colonoscopy
Gastroenterology
Chromoendoscopy
law.invention
0302 clinical medicine
Randomized controlled trial
law
Mass Screening
Prospective Studies
Intestinal Mucosa
Coloring Agents
Early Detection of Cancer
chromoendoscopy
Cancer
medicine.diagnostic_test
Air
Middle Aged
Colo-Rectal Cancer
United States Department of Veterans Affairs
Oncology
030220 oncology & carcinogenesis
030211 gastroenterology & hepatology
Female
Air insufflation
Colorectal Neoplasms
Adenoma
medicine.medical_specialty
Colon
Adenoma detection
screening colonoscopy
Indigo Carmine
03 medical and health sciences
Internal medicine
medicine
Humans
Proximal colon
sessile serrated lesions
Aged
business.industry
Prevention
Water
Insufflation
Original Articles
medicine.disease
United States
water exchange
business
Digestive Diseases
Zdroj: United European gastroenterology journal, vol 7, iss 4
Popis: 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).
Databáze: OpenAIRE
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