Impact of Cecal Intubation Rate on Adenoma Detection Rate: Analysis of Average Risk Screening Colonoscopy Examinations

Background and Aims: Several add-on devices have been developed to increase rates of colon adenoma detection. We aimed to compare the endocuff-assisted colonoscopy with cap-assisted colonoscopy through a pairwise meta-analysis of randomized trials. Methods: We searched the PubMed/Medline and Embase database through March 2020 and identified 6 randomized controlled trials (comprising 2,027 patients). The primary outcome was adenoma detection rate; secondary outcomes included sessile serrated adenoma detection rate, mean adenoma per colonoscopy, cecal intubation rate and time to reach cecum. Safety data were also analyzed. We performed pairwise meta-analysis through a random effects model and expressed data as risk ratio and 95% confidence interval. Results: Overall, pooled adenoma detection rate was 48.1% (39.3-56.8%) with endocuff and 40.5% (30.4- 50.6%; risk ratio 1.14, 0.96-1.35) with cap. Proximal adenoma detection rate was 45.7% (36.8-54.7%) and 24% (17-45.1%) with endocuff and cap, respectively (risk ratio 2.04, 0.93-4.49), whereas endocuff outperformed cap-assisted colonoscopy in detecting diminutive (≤ 5 mm) adenomas (risk ratio 2.74, 1.53-4.90) and in terms of mean adenoma per colonoscopy (mean difference 0.31, 0.05 -0.57; p=0.02). Sessile serrated adenoma detection rate (risk ratio 1.36, 0.72-2.59), cecal intubation rate (risk ratio 0.99, 0.98-1.00), and time to reach cecum (6.87 min versus 6.87 min) were similar between the two groups. No serious adverse event was observed. Conclusion: Endocuff-assisted colonoscopy seems to provide a higher adenoma detection rate as compared to cap-assisted colonoscopy, in particular concerning smaller diminutive polyps.

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Ileal intubation is not associated with higher detection rate of right-sided conventional adenomas and serrated polyps compared to cecal intubation after adjustment for overall adenoma detection rate

BMC Gastroenterology ◽

10.1186/s12876-019-1111-0 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Martin Buerger ◽

Philipp Kasper ◽

Gabriel Allo ◽

Johannes Gillessen ◽

Christoph Schramm

Keyword(s):

Detection Rate ◽

Adenoma Detection Rate ◽

Screening Colonoscopy ◽

Average Risk ◽

Cecal Intubation ◽

Serrated Polyps ◽

Polyp Detection Rate ◽

Adenoma Detection ◽

Increased Risk ◽

Ileal Intubation

Abstract Background High cecal intubation rate (CIR) is associated with significant improved adenoma detection rate (ADR), however, self-reported CIR may be overestimated and inadequate documentation of cecal intubation is associated with a lower polyp detection rate compared to clear documentation. We aimed to investigate if ileal intubation may be associated with higher detection rates (DR) for right-sided conventional adenomas (cAD) and serrated polyps (SP) compared to cecal intubation in a large screening colonoscopy cohort. Material and methods Retrospective analysis of individuals ≥50 years with average risk for colorectal cancer (CRC) who underwent screening colonoscopy between 01/01/2012 and 14/12/2016 at a tertiary academic hospital and six community-based private practices. Exclusion criteria were conditions with increased risk for CRC (e.g. inflammatory bowel disease, history of CRC, hereditary cancer syndromes), previous colonoscopy at the same institution, and incomplete procedures. Right-sided colon was defined as caecum and ascending colon. Results 4.138 individuals were analysed (mean age 62 years, 52.1% female). DR for right-sided cADs and SPs were significantly higher after ileal compared to cecal intubation in univariate (12.5% vs. 6.8%, p < 0.001, and 6.3% vs. 3.3%, p < 0.001), but not in multivariate analysis (OR 1.025, 95%-CI 0.639–1.646, p = 0.918, and OR 0.937, 95%-CI 0.671–1.309, p = 0.704). DRs did not differ between ileal and cecal intubation for endoscopists with ADR ≥25 and < 25%, respectively. ADR ≥25% was significantly associated with ileal intubation (OR 21.862, 95%-CI 18.049–26.481, p < 0.001). Conclusion Ileal intubation may not provide any benefit over cecal intubation concerning the detection of cADs and SPs in the right-sided colon.

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Colonoscopy for colorectal cancer screening - is it effective in the hands of a general surgery resident?

Polish Journal of Surgery ◽

10.5604/01.3001.0012.0755 ◽

2018 ◽

Vol 90 (4) ◽

pp. 11-15

Author(s):

Maciej Matyja ◽

Artur Pasternak ◽

Michał Wysocki ◽

Michał Pędziwiatr ◽

Mirosław Szura ◽

...

Keyword(s):

Colorectal Cancer ◽

General Surgery ◽

Detection Rate ◽

Screening Colonoscopy ◽

Intubation Rate ◽

Cecal Intubation ◽

Group I ◽

Adenoma Detection ◽

Patient Tolerance ◽

Cecal Intubation Rate

INTRODUCTION: Colonoscopy is considered to be a gold standard for colorectal cancer (CRC) screening. Endoscopy training is an essential component of general surgery training program. Patients should receive care at the highest level possible, nevertheless residents need to gain experience. The aim of our study was to evaluate the effectiveness of colonoscopy performed by general surgery residents by comparing quality indicators between surgical trainees and consultants MATERIALS AND METHODS: The analysis included 6384 patients aged 40-65 who underwent screening colonoscopy between October 2014 and February 2018. The patients were divided into two groups: group I - patients examined by residents, group II - patients examined by board certified general surgeons. Quality indicators such as cecal intubation rate, adenoma detection rate and patient tolerance scale were compared between the two groups. RESULTS: Group I comprised 2268 (35.53%) and group II 4116 (64.47%) patients. The overall cecal intubation rate (CIR) was 95.99%, equal for the both groups (p=0.994). There was no statistically significant difference in adenoma detection rate: 29.30% in residents group and 27.66% among consultants (p=0.203). Patient tolerance for exam was very good (4-point scale) in consultants group in 78.98% of cases and in 75.18% cases among residents (p<0.001). CONCLUSION: . Within a proper learning environment general surgery residents are able to perform high quality and effective screening colonoscopy. However, residents need to continue the progress in their technique to improve patient tolerance in order to reach the proficiency of the consultant.

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538 The Association of Cecal Withdrawal Time With Adenoma Detection Rate (ADR) and Sessile Serrated Adenoma/Polyp Detection Rate (SDR) in Average Risk Screening Colonoscopies

The American Journal of Gastroenterology ◽

10.14309/01.ajg.0000591684.52570.e8 ◽

2019 ◽

Vol 114 (1) ◽

pp. S310-S311

Author(s):

Seemeen Hassan ◽

Zaheer Ahmed ◽

Rajiv Chhabra ◽

Mouhanna Abu Ghanimeh ◽

Esmat Sadeddin ◽

...

Keyword(s):

Detection Rate ◽

Adenoma Detection Rate ◽

Average Risk ◽

Polyp Detection ◽

Sessile Serrated Adenoma ◽

Serrated Adenoma ◽

Withdrawal Time ◽

Risk Screening ◽

Polyp Detection Rate ◽

Adenoma Detection

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Diagnostic application of water exchange colonoscopy: A meta-analysis of randomized controlled trials

Journal of International Medical Research ◽

10.1177/0300060518819626 ◽

2019 ◽

Vol 47 (2) ◽

pp. 515-527

Author(s):

Xiufang Xu ◽

Dongqiong Ni ◽

Yuping Lu ◽

Xuan Huang

Keyword(s):

Patient Satisfaction ◽

Detection Rate ◽

Water Exchange ◽

Meta Analysis ◽

Controlled Trials ◽

Intubation Rate ◽

Cecal Intubation ◽

Randomized Controlled ◽

Adenoma Detection ◽

Cecal Intubation Rate

Background Few well-designed studies have investigated water exchange colonoscopy (WE). We performed a meta-analysis to comprehensively evaluate the clinical utility of WE based on high-quality randomized controlled trials (RCTs) and to compare the impacts of WE, water immersion colonoscopy (WI), and gas-insufflation colonoscopy. Methods We searched the Cochrane Library, MEDLINE, Embase, PubMed, Elsevier, CNKI, VIP, and Wan Fang Data for RCTs on WE. We analyzed the results using fixed- or random-effect models according to the presence of heterogeneity. Publication bias was assessed by funnel plots. Results Thirteen studies were eligible for this meta-analysis. The colonoscopic techniques included WE as the study group, and WI and air- or CO2-insufflation colonoscopy as control groups. WE was significantly superior to the control procedures in terms of adenoma detection rate, proportion of painless unsedated colonoscopy procedures, and cecal intubation rate according to odds ratios. WE was also significantly better in terms of maximal pain score and patient satisfaction score according to mean difference. Conclusions WE can remarkably improve the adenoma detection rate, proportion of painless unsedated colonoscopy procedures, patient satisfaction, and cecal intubation rate, as well as reducing the maximal pain score in patients undergoing colonoscopy.

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