scholarly journals Cap-assisted endoscopy: Do we have enough evidence?

2018 ◽  
Vol 06 (10) ◽  
pp. E1224-E1226 ◽  
Author(s):  
Thomas Frieling
Keyword(s):  
Clinical Practice ◽  
Detection Rate ◽  
Meta Analysis ◽  
Intubation Time ◽  
Polyp Detection ◽  
Cecal Intubation ◽  
Polyp Detection Rate ◽  
Adenoma Detection ◽  
Clinical Benefits ◽  
Transparent Cap

AbstractSo, is there enough evidence to incorporate CC in clinical practice? If we interpret the literature and the meta-analysis by Nutalapati et al., the answer for the clinically-focused endoscopist, with regard to adenoma detection rate (ADR), at present, may be “no”. Significant differences do not necessarily imply clinical benefits and translation into clinical practice. The answer for the improvement of cecal intubation frequency and intubation time by the cap depends on the focus of training commitment, because these effects of the cap may be beneficial, especially for unexperienced endoscopists. It is obvious that further studies are needed. In this line, it is interesting to know, that in a recent meta-analysis of prospective studies, the length of the transparent cap had opposite effects on investigation time and polyp detection rate. Whereas, the anal to cecal time was significantly shortened by a cap length of > 7 mm and a polyp detection rate was significantly improved by a cap length of < 4 mm.

Su1018 Higher Polyp Detection Rate and Shorter Cecal Intubation Time With Cap-Assisted Colonoscopy (CAC): A Systematic Review and Meta-Analysis

2012 ◽  
Vol 142 (5) ◽  
pp. S-401
Author(s):  
Sachin Wani ◽  
Srinivas Gaddam ◽  
Ajay Bansal ◽  
Matthew Hall ◽  
Prateek Sharma ◽  
...  
Keyword(s):  
Systematic Review ◽  
Detection Rate ◽  
Meta Analysis ◽  
Intubation Time ◽  
Polyp Detection ◽  
Cecal Intubation ◽  
Polyp Detection Rate ◽  
Cecal Intubation Time

New technologies improve adenoma detection rate, adenoma miss rate, and polyp detection rate: a systematic review and meta-analysis

2018 ◽  
Vol 88 (2) ◽  
pp. 209-222.e11 ◽  
Author(s):  
Daniel Castaneda ◽  
Violeta B. Popov ◽  
Elijah Verheyen ◽  
Praneet Wander ◽  
Seth A. Gross
Keyword(s):  
Systematic Review ◽  
Detection Rate ◽  
New Technologies ◽  
Meta Analysis ◽  
Adenoma Detection Rate ◽  
Polyp Detection ◽  
Polyp Detection Rate ◽  
Adenoma Detection

scholarly journals Efficacy of Macrogol 4000 Plus Electrolytes in Bowel Preparation for Colonoscopy in Patients with Chronic Constipation

2021 ◽  
Author(s):  
Ryoji Ichijima ◽  
Sho Suzuki ◽  
Mitsuru Esaki ◽  
Tomomi Sugita ◽  
Kanako Ogura ◽  
...  
Keyword(s):  
Adverse Events ◽  
Bowel Preparation ◽  
Chronic Constipation ◽  
Detection Rate ◽  
Observation Time ◽  
Insertion Time ◽  
Polyp Detection ◽  
Cecal Intubation ◽  
Polyp Detection Rate ◽  
Adenoma Detection

Abstract Background: Chronic constipation is a significant factor in poor bowel preparation for colonoscopy. Macrogol 4000 plus electrolytes (Movicol, EA Pharma, Tokyo, Japan), containing polyethylene glycol (PEG) and electrolytes, have been used recently to treat patients with constipation. However, prospective studies on the use of macrogol 4000 for bowel cleansing for colonoscopy are lacking. This study aimed to investigate the efficacy and safety of macrogol 4000 in addition to PEG administered in patients with chronic constipation.Methods: This single-center, single-arm prospective study enrolled patients with chronic constipation who were scheduled to undergo colonoscopy. The primary endpoint was the proportion of good bowel preparation assessed using the Boston Bowel Preparation Scale (BBPS) (6 or more points). The secondary endpoints were the time from when pPEG (MoviPrep, EA Pharma, Tokyo, Japan) was taken until colonoscopy could be started, amount of PEG taken, number of defecations, whether additional PEG doses were taken, and adverse events. Endoscopy-related endpoints included cecal intubation rate, insertion time, observation time, adenoma detection rate (ADR), and polyp detection rate (PDR). The tolerability of PEG and macrogol 4000 was assessed using a questionnaire.Results: Forty patients were included in the analysis. The median BBPS was 7 (range, (3–9)) and ³6 points in 37 cases (92.5%). The median time until colonoscopy can be started was 210 min (90–360 min), the median volume of PEG taken was 1500 mL (1000–2000 mL), and the median number of defecations was 7 (3-20). No adverse events were observed. Fourteen patients required an additional dose of PEG. Cecal intubation was achieved in all cases, the median insertion time was 6.0 min (range, 2.3–22 min), and the median observation time was 8.8 min (range, 4.0–16.0 min). The ADR and PDR were 60.0% and 75.0%, respectively. A greater proportion of patients rated the tolerability of macrogol 4000 as good compared with that of PEG (95.0% vs. 50.0%, p < 0.01).Conclusions: Intake of macrogol 4000 in addition to PEG is effective and safe for colonoscopy in patients with chronic constipation.

scholarly journals A120 NO EVIDENCE OF A FRIDAY EFFECT ON COLONOSCOPY QUALITY OUTCOMES

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 101-102
Author(s):  
Z Hindi ◽  
L Guizzetti ◽  
S cocco ◽  
M Brahmania ◽  
A Wilson ◽  
...  
Keyword(s):  
Detection Rate ◽  
Hospital Setting ◽  
Polyp Detection ◽  
Cecal Intubation ◽  
Detection Rates ◽  
Adjusted Risk ◽  
Polyp Detection Rate ◽  
Adenoma Detection ◽  
Significant Difference ◽  
Colonoscopy Quality

Abstract Background Colonoscopy quality may be influenced by operator fatigue. Prior studies have shown lower adenoma detection rates for procedures performed at the end of the day. However, it is unknown if colonoscopy quality is impaired at the end of the work week. Aims We investigated whether colonoscopy quality-related metrics differ at the end of the work week using the South West Ontario Colonoscopy Cohort. Methods Between April 2017 to February 2018, 45,510 consecutive colonoscopies from 20 academic and community hospitals in our health region were captured to form the cohort. In Canada, outpatient endoscopies are generally performed between Monday to Friday, taking Friday, or the last business day, as the last day of the work week compared to the rest of the work week. When a statutory holiday occurred on a Friday, Thursday was designated the last day of the work week. The primary outcome was adenoma detection rate (ADR), and secondary outcomes were sessile serrated polyp detection rate (ssPDR), polyp detection rate (PDR), and failed cecal intubation. Outcomes were presented as unadjusted and adjusted risk ratios derived from modified Poisson regression and adjusting for physician-level clustering, and characteristics of the patient (age, sex, severity), procedure (hospital setting, trainee presence, indication, sedation, bowel preparation quality) and physician (experience and specialty). Results During the observation period, 9,132 colonoscopies were performed on the last day of the work week compared to 36,378 procedures during the rest of the work week. No significant difference was observed for ADR (26.4% vs. 26.6%, p=0.75), ssPDR (4.5% vs. 5.0%, p=0.12), PDR (44.1% vs. 43.1%, p=0.081), or failed cecal intubation (2.8% vs. 2.9%, p=0.51) for colonoscopies performed on the last day of the work week compared to the rest of the week, respectively. After adjusting for potential confounders, there were no significant differences in the ADR (RR 1.01, 95% CI [0.88, 1.15], p=0.94), ssPDR (RR 0.90, 95% CI [0.70, 1.14], p=0.38), PDR (RR 1.00, 95% CI [0.92, 1.09], p=0.94), or failed cecal intubation (RR 0.92, 95% CI [0.72, 1.18], p=0.51) for colonoscopies performed on the last day of the work week compared to the rest of week, respectively. Conclusions Colonoscopy quality metrics, including ADR, ssPDR, PDR, and failed cecal intubation are not significantly different at the end of the week. Funding Agencies None

Routine ileal intubation in colonoscopy does not increase the polyp detection rate: a retrospective study

2020 ◽  
Vol 58 (10) ◽  
pp. 955-959
Author(s):  
Weiyi Wang ◽  
Ke Chen ◽  
Ying Xu ◽  
Yufen Zhou ◽  
Ping Chen
Keyword(s):  
Retrospective Study ◽  
Detection Rate ◽  
Multivariable Analysis ◽  
Polyp Detection ◽  
Cecal Intubation ◽  
Abdominal Symptoms ◽  
Polyp Detection Rate ◽  
Clinical Benefits ◽  
The Mean ◽  
Mean Time

AbstractColonoscopy is effective in the prevention and screening of colorectal cancer. Whether terminal ileal (TI) intubation is required during conventional colonoscopy and whether it offers clinical benefits with respect to polyp detection rate (PDR) remain unclear. This retrospective study included patients who underwent colonoscopy at our hospital between July 1, 2018 and April 20, 2019. The positive findings and time for TI intubation were recorded. Univariate and multivariate analyses were performed to identify factors associated with PDR. There were 1675 patients with cecal intubation colonoscopy, including 994 (59 %) with TI intubation and 8 (1 %) with intestinal disease. The mean time for TI intubation was 40 seconds (3–338), and the mean time from cecal intubation to arrival at the deep part of TI mucosa was 24 seconds (2–118). The overall PDR was 27 %. On multivariable analysis, age > 50 years [95 % confidence interval (CI) 2.837–4.590], male sex (95 %CI, 0.406–0.649), presence of symptoms (abdominal symptoms vs. asymptomatic, 95 % CI, 1.146–2.468; stool changes vs. asymptomatic, 95 % CI, 1.070–1.834), and non-TI intubation (95 % CI, 1.040–1.648) were independent predictors of higher PDR. Trend analysis indicated decreasing trend of PDR among non-TI intubation group, 0–5 cm TI intubation group, and > 5 cm TI intubation group (30 % vs. 27 % vs. 24 %, respectively; p < 0.05). TI intubation is necessary to identify small bowel disease among a designated population, but it was not suggested to be routinely performed as part of colonoscopy, owing to limited positive intestinal findings, extra time requirement, and possible PDR worsening.

Cuff-assisted versus cap-assisted colonoscopy for adenoma detection: results of a randomized study

Endoscopy ◽  
2019 ◽  
Vol 51 (08) ◽  
pp. 742-749 ◽  
Author(s):  
Javier Sola-Vera ◽  
Lourdes Catalá ◽  
Francisco Uceda ◽  
María Dolores Picó ◽  
Estefanía Pérez Rabasco ◽  
...  
Keyword(s):  
Detection Rate ◽  
Removal Rate ◽  
Randomized Study ◽  
Intubation Rate ◽  
Device Removal ◽  
Polyp Detection ◽  
Cecal Intubation ◽  
Polyp Detection Rate ◽  
Adenoma Detection ◽  
Cecal Intubation Rate

Abstract Background The adenoma detection rate (ADR) is the most important marker of colonoscopy quality. Devices to improve adenoma detection have been developed, such as the Endocuff and transparent cap. The aim of the current study was to examine whether there was a difference in ADR between Endocuff-assisted (EAC) and cap-assisted colonoscopy (CAC). Methods A randomized prospective trial was conducted. Eligible patients included adults ≥ 18 years referred because of symptoms, surveillance, or colonoscopies as part of the Bowel Cancer Screening Programme (BCSP). The primary outcome measure was ADR. Secondary outcomes included mean number of adenomas, mean number of polyps, polyp detection rate, cecal intubation rate, and time to cecal intubation. Procedural measures, device removal rate, and adverse events were also recorded. Results A total of 711 patients (51.1 % men; median age 63 years) were included, of whom 357 patients were randomized to EAC and 354 patients to CAC. In the intention-to-treat analysis, the ADR was similar in both groups: EAC 50.4 % (95 % confidence interval [CI] 45.1 – 55.7) vs. CAC 50.6 % (95 %CI 45.2 – 55.9). Similar results were obtained in the per-protocol analysis: EAC 51.6 % (95 %CI 46.2 – 57) vs. CAC 51.4 % (95 %CI 46 – 56.8). There were no differences between the two devices in ADR according to the mean number of adenomas and polyps per procedure, polyp detection rate, cecal intubation rate, and time to cecal intubation. Device removal rate and adverse events were also similar. Conclusion In this randomized study, no differences in ADR were found between Endocuff- and cap-assisted colonoscopy.

scholarly journals Efficacy of Endocuff Vision compared to first-generation Endocuff in adenoma detection rate and polyp detection rate in high-definition colonoscopy: a systematic review and network meta-analysis

2021 ◽  
Vol 09 (01) ◽  
pp. E41-E50
Author(s):  
Muhammad Aziz ◽  
Hossein Haghbin ◽  
Manesh Kumar Gangwani ◽  
Sachit Sharma ◽  
Yusuf Nawras ◽  
...  
Keyword(s):  
Systematic Review ◽  
Detection Rate ◽  
Meta Analysis ◽  
Final Analysis ◽  
Adenoma Detection Rate ◽  
Complication Rates ◽  
Polyp Detection ◽  
High Definition ◽  
Polyp Detection Rate ◽  
Adenoma Detection

Abstract Background and study aims Recently, the newer Endocuff Vision (ECV) has been evaluated for improving colonoscopy outcome metrics such as adenoma detection rate (ADR) and polyp detection rate (PDR). Due to lack of direct comparative studies between ECV and original Endocuff (ECU), we performed a systematic review and network meta-analysis to evaluate these outcomes. Methods The following databases were searched: PubMed, Embase, Cochrane, and Web of Sciences to include randomized controlled trials (RCTs) comparing ECV or ECU colonoscopy to high-definition (HD) colonoscopy. Direct as well as network meta-analyses comparing ADR and PDR were performed using a random effects model. Relative-risk (RR) with 95 % confidence interval (CI) was calculated. Results A total of 12 RCTs with 8638 patients were included in the final analysis. On direct meta-analysis, ECV did not demonstrate statistically improved ADR compared to HD colonoscopy (RR: 1.12, 95 % CI 0.99–1.27). A clinically and statistically improved PDR was noted for ECV compared to HD (RR: 1.15, 95 % CI 1.03–1.28) and ECU compared to HD (RR: 1.26, 95 % CI 1.09–1.46) as well as improved ADR (RR: 1.22, 95 % CI 1.05–1.43) was observed for ECU colonoscopy when compared to HD colonoscopy. These results were also consistent on network meta-analysis. Lower overall complication rates (RR: 0.14, 95 % CI 0.02–0.84) and particularly lacerations/erosions (RR: 0.11, 95 % CI 0.02–0.70) were noted with ECV compared to ECU colonoscopy. Conclusions Although safe, the newer ECV did not significantly improve ADR compared to ECU and HD colonoscopy. Further device modification is needed to increase the overall ADR and PDR.

scholarly journals Colonoscopy quality across Europe: a report of the European Colonoscopy Quality Investigation (ECQI) Group

2021 ◽  
Vol 09 (10) ◽  
pp. E1456-E1462
Author(s):  
Cristiano Spada ◽  
Anastasios Koulaouzidis ◽  
Cesare Hassan ◽  
Pedro Amaro ◽  
Anurag Agrawal ◽  
...  
Keyword(s):  
Bowel Preparation ◽  
Detection Rate ◽  
Gastrointestinal Endoscopy ◽  
Polyp Detection ◽  
Cecal Intubation ◽  
Withdrawal Time ◽  
Polyp Detection Rate ◽  
Adenoma Detection ◽  
Cecal Intubation Rate ◽  
Colonoscopy Quality

Abstract Background and study aims The European Colonoscopy Quality Investigation (ECQI) Group comprises expert colonoscopists and investigators with the aim of raising colonoscopy standards. We assessed the levels of monitoring and achievement of European Society of Gastrointestinal Endoscopy (ESGE) performance measures (PMs) across Europe using responses to the ECQI questionnaires. Methods The questionnaire comprises three forms: institution and practitioner questionnaires are completed once; a procedure questionnaire is completed on multiple occasions for individual total colonoscopies. ESGE PMs were approximated as closely as possible from the data collected via the procedure questionnaire. Procedure data could provide rate of adequate bowel preparation, cecal intubation rate (CIR), withdrawal time, polyp detection rate (PDR), and tattooing resection sites. Results We evaluated ECQI questionnaire data collected between June 2016 and April 2018, comprising 91 practitioner and 52 institution questionnaires. A total of 6445 completed procedure forms were received.Institution and practitioner responses indicate that routine recording of PMs is not widespread: adenoma detection rate (ADR) is routinely recorded in 29 % of institutions and by 34 % of practitioners; PDR by 42 % and 47 %, CIR by 62 % and 64 %, bowel preparation quality by 56 % and 76 %, respectively.Procedure data showed a rate of adequate bowel preparation of 84.2 %, CIR 73.4 %, PDR 40.5 %, mean withdrawal time 7.8 minutes and 12.2 % of procedures with possible removal of a non-pedunculated lesion ≥ 20 mm reporting tattooing. Conclusions Our findings clearly show areas in need of quality improvement and the importance of promoting quality monitoring throughout the colonoscopy procedure.

scholarly journals Enhanced Patient Education for Colonic Polyp and Adenoma Detection: Meta-Analysis of Randomized Controlled Trials (Preprint)

2019 ◽  
Author(s):  
Xu Tian ◽  
Ling-Li Xu ◽  
Xiao-Ling Liu ◽  
Wei-Qing Chen
Keyword(s):  
Detection Rate ◽  
Meta Analysis ◽  
Adenoma Detection Rate ◽  
Advanced Adenoma ◽  
Polyp Detection ◽  
Sessile Serrated Adenoma ◽  
Serrated Adenoma ◽  
Polyp Detection Rate ◽  
Adenoma Detection ◽  
Number Of Patients

BACKGROUND To improve patients’ comprehension of bowel preparation instructions before colonoscopy, enhanced patient education (EPE) such as cartoon pictures or other visual aids, phone calls, mobile apps, multimedia education and social media apps have been proposed. However, it is uncertain whether EPE can increase the detection rate of colonic polyps and adenomas. OBJECTIVE This meta-analysis aimed to evaluate the efficacy of EPE in detecting colonic polyps and adenomas. METHODS We searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trials from their inception to June 2019 for the identification of trials comparing the EPE with standard patient education for outpatients undergoing colonoscopy. We used a random effects model to calculate summary estimates of the polyp detection rate (defined as the number of patients with at least one polyp divided by the total number of patients undergoing selective colonoscopy), adenoma detection rate (defined as the number of patients with at least one adenoma divided by the total number of patients undergoing selective colonoscopy), advanced adenoma detection rate (defined as the number of patients with at least one advanced adenoma divided by the total number of patients undergoing selective colonoscopy), sessile serrated adenoma detection rate (defined as the number of patients with at least one sessile serrated adenoma divided by the total number of patients undergoing selective colonoscopy), cancer detection rate (defined as the number of patients with at least one cancer divided by the total number of patients undergoing selective colonoscopy), or adenoma detection rate - plus (defined as the number of additional adenomas found after the first adenoma per colonoscopy). Moreover, we conducted trial sequential analysis (TSA) to determine the robustness of summary estimates of all primary outcomes. RESULTS We included 10 randomized controlled trials enrolling 4560 participants for analysis. The meta-analysis suggested that EPE was associated with an increased polyp detection rate (9 trials; 3781 participants; risk ratio [RR] 1.19, 95% CI 1.05-1.35; <i>P</i>&lt;.05; I<sup>2</sup>=42%) and adenoma detection rate (5 trials; 2133 participants; RR 1.37, 95% CI 1.15-1.64; <i>P</i>&lt;.001; I2=0%), which were established by TSA. Pooled result from the inverse-variance model illustrated an increase in the sessile serrated adenoma detection rate (3 trials; 1248 participants; odds ratio 1.76, 95% CI 1.22-2.53; <i>P</i>&lt;.05; I<sup>2</sup>=0%). One trial suggested an increase in the adenoma detection rate - plus (RR 4.39, 95% CI 2.91-6.61; <i>P</i>&lt;.001). Pooled estimates from 3 (1649 participants) and 2 trials (1375 participants) generated no evidence of statistical difference for the advanced adenoma detection rate and cancer detection rate, respectively. CONCLUSIONS The current evidence indicates that EPE should be recommended to instruct bowel preparation in patients undergoing colonoscopy because it can increase the polyp detection rate, adenoma detection rate, and sessile serrated adenoma detection rate. However, further trials are warranted to determine the efficacy of EPE for advanced adenoma detection rate, adenoma detection rate - plus, and cancer detection rate because of limited data.

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