Tu1158 THE IMPACT OF WATER BASED TECHNIQUES COMPARED TO AIR/CO2 INSUFFLATION ON PROXIMAL ADENOMA DETECTION RATE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Background and study aims Choice of sedation (propofol vs opioid/benzodiazepine) has been studied in the literature and has shown variable outcomes. The majority of recent studies have evaluated propofol sedation (PS) versus opioids, benzodiazepines, or a combination of both. We performed a systematic review and meta-analysis of studies comparing PS to other sedation methods to assess the impact on colonoscopy outcomes. Methods Multiple databases were searched and studies of interest were extracted. Primary outcome of the study was adenoma detection rate (ADR) and secondary outcomes included polyp detection rate (PDR), advanced adenoma detection rate (AADR), and cecal intubation rate (CIR). Results A total of 11 studies met the inclusion criteria with a total of 177,016 patients (148,753 and 28,263 in the opioids/benzodiazepine group and PS group, respectively). Overall, ADR (RR: 1.07, 95 % CI 0.99–1.15), PDR (RR: 1.01, 95 % CI 0.93–1.10), and AADR (RR: 1.17, 95 % CI 0.92–1.48) did not improve with the use of PS. The CIR was slightly higher for propofol sedation group (RR 1.02, 95 % CI 1.00–1.03). Conclusion Based on our analysis, PS and opioid/benzodiazepine sedation seem to have comparable ADR. Our results do not favor use of a particular sedation method and the choice of sedation should be individualized based on patient preference, risk factors and resource availability.

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ENDOCUFF-ASSISTED COLONOSCOPY INCREASES ADENOMA DETECTION RATE: A SYSTEMATIC REVIEW AND META-ANALYSIS

10.1055/s-0039-1681469 ◽

2019 ◽

Author(s):

P Gkolfakis ◽

G Tziatzios ◽

K Triantafyllou

Keyword(s):

Systematic Review ◽

Detection Rate ◽

Meta Analysis ◽

Adenoma Detection Rate ◽

Adenoma Detection

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Effect of dynamic position changes on adenoma detection rate during colonoscope withdrawal: systematic review and meta-analysis

Endoscopy International Open ◽

10.1055/a-1265-6634 ◽

2020 ◽

Vol 08 (12) ◽

pp. E1842-E1849

Author(s):

Venkat Nutalapati ◽

Madhav Desai ◽

Vivek Sandeep Thoguluva-Chandrasekar ◽

Mojtaba Olyaee ◽

Amit Rastogi

Keyword(s):

Systematic Review ◽

Detection Rate ◽

Meta Analysis ◽

Lateral Position ◽

Adenoma Detection Rate ◽

Position Change ◽

Withdrawal Time ◽

Left Lateral Position ◽

Adenoma Detection ◽

Withdrawal Phase

Abstract Background and study aims The adenoma detection rate (ADR) is an important quality metric of colonoscopy. Higher ADR correlates with lower incidence of interval colorectal cancer. ADR is variable between endoscopists and depends upon the withdrawal technique amongst other factors. Dynamic position change (lateral rotation of patients with a view to keep the portion of the colon being inspected at a higher level) helps with luminal distension during the withdrawal phase. However, impact of this on ADR is not known in a pooled sample. We performed a systematic review and meta-analysis to study the impact of dynamic position changes during withdrawal phase of colonoscopy on ADR Methods A comprehensive search of MEDLINE, EMBASE, Google Scholar, and the Cochrane Database was conducted from each database’s inception to search for studies comparing dynamic position changes during colonoscope withdrawal with static left lateral position (control). The primary outcome of interest was ADR. Other studied outcomes were polyp detection rate (PDR) and withdrawal time. Outcomes were reported as pooled odds ratio (OR) with 95 % confidence intervals (CI) with statistical significance (P < 0.05). RevMan 5.3 software was used for statistical analysis. Results Six studies were included in our analysis with 2860 patients. Of these, dynamic position change was implemented in 1177 patients while 1183 patients served as the controls. ADR was significantly higher in the dynamic position change group with pooled OR 1.36 (95 % CI, 1.15–1.61; P < 0.01). There was low heterogeneity in inclusion studies (I2 = 0 %). PDR was numerically higher in position change group (53.4 % vs 49.6 %) but not statistically significant (P = 0.16). Mean withdrawal time did not significantly change with dynamic position change (12.43 min vs 11.46 min, P = 0.27). Conclusion Position change during the withdrawal phase of colonoscopy can increase the ADR compared to static left lateral position. This is an easy and practical technique that can be implemented to improve ADR.

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