Caecal Intubation Time Research Articles

Endocuff Vision-Assisted Colonoscopy Significantly Improves Adenoma Detection In A Shorter Withdrawal Time Compared With Standard Colonoscopy: A Randomized Controlled Trial.

Although several studies in Western countries have shown that Endocuff Vision-assisted colonoscopy (EC) can improve the colorectal adenoma detection rate (ADR), such evidence in Asia is still scarce. This study aimed to evaluate the performance of EC in detecting colorectal adenomas in Vietnamese patients. This was a randomized controlled trial conducted at a tertiary hospital in Vietnam. Subjects aged ≥ 18 years referred for colonoscopy for symptomatic investigation or screening were randomly assigned to the EC group or standard colonoscopy (SC) group. The primary outcome was the ADR. The secondary outcomes included the mean number of adenomas per procedure (MAP), caecal intubation time, and withdrawal time. There were 476 participants (241 in the EC group, 235 in the SC group) with a median age of 52 (interquartile range [IR]: 46, 58) years. There were no significant differences between the two groups regarding age, sex, smoking status, family history of colorectal cancer or indications for colonoscopy. Compared with the SC group, the EC group had significantly higher ADRs (35.7% vs. 22.6%, p = 0.002) and MAPs (0.68 vs. 0.39, p = 0.004). The intubation durations were comparable between the two groups. The withdrawal time in the EC group was shorter than that in the SC group (median [seconds]: 266 [IR: 224, 314] vs. 360 [IR: 310, 390], p < 0.001). Compared with SC, EC significantly increased both the ADR and MAP in a shorter inspection time and could be a better choice for colonoscopy screening.

Comparison between Split Dose and Single Dose Bowel Laxatives for Preparation of Colonoscopy in Patients with Bangladeshi Diets: A Randomized Clinical Trial

Introduction: Colonoscopy is an important diagnostic tool for colonic disease and its efficacy and safety have been correlated with adequate bowel preparation. This study compared the efficacy and tolerability of single-dose and split-dose sodium picosulfate lavage as a colon cleansing agent for colonoscopy preparation. Methods: This randomized clinical trial was conducted at the Department of Gastroenterology in Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh from June 2021 to May 2022.A total of 110 patients were selected by randomized sampling technique who underwent elective colonoscopy and were divided into split-dose (n=57) and single-dose (n=53) laxative groups. Bowel preparation was assessed by the Ottawa Bowel Preparation Scale (OBPS) and data were analyzed by SPSS 24.0. Result: The mean age of the patients was 47.4±17.7(SD) years in split-dose and 47.6±15.9 (SD) years in single-dose group. Both groups were statistically similar in terms of socio-demographic profile, medical history, clinical manifestation, and indication of colonoscopy (p&gt;0.05). The mean of total OBPS score (4.39±2.0 vs 5.56±2.2, p=0.004) and caecal intubation time (6.60±3 vs 7.74±2.5, p=0.035) was lower significantly in split-dose than the single-dose group. However, colonoscopy findings, adverse events, and patient compliance were similar between groups (p&gt;0.05). Conclusion: Split-dose is superior to single-dose bowel laxatives for colonoscopy preparation in terms of better mucosal cleanliness and lower caecal intubation time. However, further randomized controlled trial is recommended. J Bangladesh Coll Phys Surg 2024; 42: 329-335

Randomised trial of ‘hybrid’ water-assisted colonoscopy (modified water immersion) versus water exchange colonoscopy: WAVE study

Background and aimsColonoscopy practice has evolved with a trend towards water-assisted insertion. A recent national survey suggests a hybrid approach to colonic distension during insertion, with water used predominately to...

The impact of wearing an abdominal corset to achieve compression on colonoscopy outcomes: a randomised controlled trial

Aim: This study aimed to evaluate the effect of abdominal corset use on colonoscopy outcomes in patients undergoing colonoscopy. Methods: This randomised controlled trial was conducted between March 2019 and January 2020, with the participation of 60 patients who underwent colonoscopy in the endoscopy unit of a university hospital. Half (n=30) of these patients were included in the experimental group and wore an abdominal corset during colonoscopy. Findings: It was determined that there was no statistically significant difference between the groups according to variables, including caecal intubation time (p=0.371), the need for position change in the colonoscopy process (p=0.554), position change in caecum imaging (p=1.000) and manual abdominal compression during the procedure (p=0.091). Conclusions: The results of this study reveal that abdominal corset usage does not provide a significant extra benefit compared with conventional colonoscopy in improving colonoscopy outcomes.

Hydro-jet propelled colonoscopy: proof of concept in a phantom colon

BackgroundColonoscopy is a widely used and effective procedure, but it often causes patient discomfort and its execution requires considerable skill and training. We demonstrate an alternative approach to colonoscope propulsion with the potential to minimise patient discomfort by reducing the forces exerted on the colonic wall and mesentery, and to reduce the level of skill required for execution.MethodsA prototype colonoscopic device is described, consisting of a tethered capsule that is propelled and manoeuvred through a water-filled colon (hydro-colonoscopy) by an array of water jets. As an initial proof of concept, experiments were performed to assess the ability of the device to navigate through a simplified PVA cryogel human colon phantom arranged in various anatomical configurations.ResultsThe prototype was capable of successfully navigating through three out of four colon configurations: a simple layout, alpha loop and reverse alpha loop. It was unable to negotiate the fourth configuration involving an “N loop”, but this was attributed to problems with the colon phantom. In the successful test replicates, mean complete insertion (i.e. caecal intubation) time was 4.7 min. Measured pressures, temperatures and forces exerted on the colon appeared to be within a physiologically acceptable range. The results demonstrate the viability of propelling a colonoscope through a colon phantom using hydro-jets.ConclusionsResults indicate that this approach has the potential to enable rapid and safe caecal intubation. This suggests that further development towards clinical translation is worthwhile.

Effect of Body Mass Index and Fat Mass Measured Using a Tanita Body-fat Analyser on Caecal Intubation Time: A Prospective Clinical Study

Effect of Body Mass Index and Fat Mass Measured Using a Tanita Body-fat Analyser on Caecal Intubation Time: A Prospective Clinical Study

Colonoscopy is safe and not associated with higher pain scores in patients with hypermobility spectrum disorder: results from an exploratory prospective study.

Background:Patient perception of colonoscopy varies greatly. Young slender women and patients with irritable bowel syndrome (IBS) appear to be at risk for periprocedural pain. Recent evidence suggests a high prevalence of joint hypermobility related connective tissue disorders in this population. Therefore, we aimed to investigate whether hypermobility spectrum disorder (HSD) is associated with increased pain during colonoscopy.Methods:We prospectively included patients undergoing routine colonoscopy. Subjects were assessed for HSD using the 2017 criteria, and IBS and functional dyspepsia using the Rome III criteria. After colonoscopy and recovery from sedation, patients were asked to report pain scores on a 100-mm visual analogue scale (VAS). In addition, caecal intubation time was measured, endoscopists scored the difficulty of the procedure (100-mm VAS) and procedure-related adverse events were registered.Results:Of 200 included patients, 22 (11%) met criteria for HSD. A female predominance was observed in patients with HSD (86.4% versus 49.4%, p < 0.001). A crude linear regression model demonstrated that pain scores were 13.30 mm higher in patients with HSD versus non-HSD patients (95% CI 0.07 – 26.53, p = 0.049). When subsequently correcting for possible confounding factors, however, this difference in pain scores could be explained by a confounding effect of female gender. Caecal intubation time, perceived procedural difficulty and complication rate did not differ significantly between groups.Conclusion:HSD does not seem to be a predictor of painful colonoscopy, probably due to female gender as a confounding factor. In addition, performing colonoscopy is not more complicated in patients with HSD versus non-HSD patients, nor is it associated with more adverse events.

Effects of Encircled Abdominal Compression Device in Colonoscopy: A Meta-Analysis.

Background and Aim: The efficacy of encircling abdominal compression devices in colonoscopies is inconsistent. We performed a meta-analysis of randomized controlled trials (RCTs) in which encircling abdominal compression devices were compared with control in colonoscopies. Methods: We systematically searched RCTs published in the Cochrane Library, PubMed, and the Igaku-Chuo-Zasshi database. The data from the eligible RCTs were combined using the random-effects model. The weighted mean differences (WMDs), pooled odds ratios (ORs), and 95% confidence intervals (CIs) were calculated. Results: Five RCTs were included in this meta-analysis. Compared to the control group, encircling abdominal compression devices significantly reduced the caecal intubation time (WMD: −1.31, 95% CI: −2.40 to −0.23, p = 0.02). Compared to the control group, encircling abdominal compression devices significantly decreased the frequency of postural change (OR 0.30, 95% CI: 0.22 to 0.41, p < 0.00001). Compared to the control group, the use of encircling abdominal compression devices significantly reduced the need for abdominal compression (OR: 0.35, 95% CI: 0.17 to 0.70, p = 0.003). Conclusions: Encircling abdominal compression devices in colonoscopies was found to reduce the caecal intubation time and the frequency of abdominal compression.

Fatigue evaluation of a hand‐held device for the automated colonoscope

AbstractAs knowledge about the colorectal disease becomes more widespread, an increasing demand for screening and high standards arises. This study focuses on the fatigue measurement of a prototype colonoscope that incorporates a holding structure to support the colonoscope and a hand‐held device that actuates distal tip steering. Experimentation was performed to compare the fatigue and learning curve of the prototype scope to a conventional scope. Fatigue was measured as a reduction in force corresponding to the maximum voluntary contraction of the left thumb and forearm. Results show that subjects using the conventional scope did not experience significant reduction in force in either the thumb or the forearm, while the prototype scope resulted in a force reduction of 17% and 16% in the forearm and thumb, respectively. Caecal intubation time and learning rate showed no significant decrease while using the prototype scope compared with a conventional scope to ensure the functionality of the prototype scope.

Impact of bowel preparation on caecal intubation time during colonoscopy.

Objective:To determine the caecal intubation time depending on bowel preparation as per Boston Bowel Preparation Scale.Methods:This cross-sectional study was conducted at Dr. Ruth K. M. Pfau, Civil Hospital Karachi between August 2018 to February 2019. A total of 201 patients were included in the study. Time was recorded from insertion of colonoscope to the time required to reach the cecum. Bowel preparation was graded during withdrawal of colonoscope by using Boston Bowel Preparation Scale. Pearson Correlation test was used to study correlation of BBPS scores with CIT, gender, BMI, adenoma and polyp detection.Results:In this study 201 patients undergoing colonoscopy were included. Mean ±SD of age of patients was 36.9 ±15.8 years. Out of the 201 patients 112 (56%) were males and 89 (44%) were females. The results of our study showed that increased Boston Bowel Preparation Scale Scores were associated with decreased caecal intubation time. The mean CIT was 10.7 ±5.4 minutes and Pearson correlation was significant at 0.002. Significant correlations of BBPS were also found with BMI and adenoma detection.Conclusion:The diagnostic effectiveness of colonoscopy depends upon the quality of the preparation. Good bowel preparation improves the speed of colonoscopy and its completeness.

Is water exchange superior to water immersion in detecting adenomas during colonoscopies? Results from a Bayesian network meta-analysis.

AimWater-assisted colonoscopy (water exchange [WE] and water immersion [WI]) has been shown to improve the adenoma detection rate. However, few studies have compared these two methods head-to-head. Thus, we conducted a network meta-analysis to integrate both direct and indirect evidence comparing the effectiveness of these two procedures.MethodWe searched PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials for original papers and abstracts published up to March 2018. Randomized controlled trials (RCTs) reporting data in accordance with the eligibility criteria were included in this study. We performed a Bayesian random effects network meta-analysis with mixed comparisons.ResultsTwenty-nine studies (n = 11464 patients) including 6 direct and 23 indirect comparisons were included in this network meta-analysis. There was a statistically significant difference in the efficacy of adenoma detection when WE was compared with WI (risk ratio [RR]: 1.2, 95% credible interval [CrI]: 1.1–1.3), air insufflation (AI; RR: 1.3, 95% CrI: 1.1–1.4), and carbon dioxide (CO2) insufflation (RR: 1.2, 95% CrI: 1.1–1.5). The different methods were ranked in order from the most to least effective in adenoma detection as follows: WE, WI, AI, and CO2. Moreover, although there were no significant differences in pain scores, willingness to repeat, caecal intubation rate, or total procedure time between WI and WE colonoscopy, WE required a longer caecal intubation time than WI.ConclusionThis network meta-analysis supposes that WE may be superior to WI in detecting adenomas during colonoscopies without affecting other technical features or patient acceptance.

The effect of premedication with peppermint oil capsules (Colpermin) prior to colonoscopy: A double blind randomized placebo-controlled trial

Background and study aimsColonoscopy is the cornerstone of diagnosing colonic diseases. Investigators have evaluated the effectiveness of antispasmodic agents in colonoscopy with conflicting evidence. The aim of this study is to determine the efficacy of enteric coated peppermint oil capsules (Colpermin®), an antispasmodic agent, on outcomes during colonoscopy. Patients and methodsA total of 80 patients undergoing elective colonoscopy were recruited and randomized in a double blinded fashion to receive either placebo or peppermint oil capsules administered 4 h prior to the procedure. ResultsPeppermint oil capsules did not affect caecal intubation time when compared with placebo. Patients’ tolerance, endoscopist’s satisfaction and demand on sedation were also not affected. ConclusionThis randomized controlled trial does not support the routine use of peppermint oil capsules prior to colonoscopy as a tool for procedure optimization, and patients’ and endoscopist’s satisfaction.

Full spectrum endoscopy (FUSE) versus standard forward-viewing endoscope (SFV) in a high-risk population

Objectives: To investigate the diagnostic performance of Full Spectrum Endoscopy (FUSE) compared to a conventional standard forward-viewing endoscope (SFV). The primary outcome was adenoma detection rate (ADR) and mean adenoma detection. Secondary outcome was feasibility of FUSE opposed to SFV.Materials and methods: Consecutive patients participating in the Danish colorectal cancer (CRC) screening programme were prospectively included in the study (n = 205). Demographic and health-related characteristics were obtained. Following procedural parameters were recorded: completion rate, caecal intubation time, fentanyl and midazolam sedation, CRC detection, ADR, diverticulosis, bowel preparation, patient discomfort and endoscopist difficulty rating. Participants underwent FUSE colonoscopy on days when the FUSE system was available, while the remaining participants had SFV. All colonoscopies were performed by two trained endoscopists.Results: A total of 109 patients were included in the FUSE group and 106 in the SFV group. Groups were comparable in baseline characteristics. Completion rate was 83.5% and 93.4% in the FUSE and SFV groups (p = .040). Caecal intubation time was 11.4 ± 6.7 min versus 9.1 ± 6.2 min in the FUSE and SFV groups (p = .040). ADR was 67.0% and 59.6% (p = .097), while the mean adenoma detection was 1.79 and 1.38 (p = .022) in the FUSE and SFV groups. Endoscopists reported increased difficulty rating with FUSE compared to SFV (p > .001).Conclusion: FUSE colonoscopy provides a higher mean adenoma detection and there is tendency toward higher ADR compared to SFV in a high-risk population. Nonetheless, FUSE colonoscopy has a lower completion rate, longer caecal intubation time and a higher difficulty rating from an endoscopist point of view.

Comparación de la prevalencia de adenomas detectados mediante colonoscopio con «CAP» accesorio (endocuff) versus colonoscopio estándar

IntroductionCAP-assisted colonoscopy (CAP) is a simple technique where use is made of plastic cylinder placed at the tip of the colonoscope. This plastic cylinder has extensions that can separate the colonic folds and enhance the field of observation, thus permitting the inspection of difficult to evaluate areas. Studies have been conducted to assess the effect of the CAP assisted colonoscopy in detecting polyps, with conflicting results. ObjectiveTo compare the number of polyps detected by CAP-assisted colonoscopy versus standard colonoscopy. Patients and MethodsA cross-sectional, comparative, randomized, experimental trial was conducted on patients that were randomised into 2 groups using a random numbers table. Group A was to standard colonoscopy, and the B group to CAP-assisted colonoscopy. ResultsA total of 147 patients were included, of which 2 were excluded because their work-up was incomplete. The remaining 145 patients, of whom 66.2% (96) were women and 33.8% (49) were men, were randomised into 2 groups. The mean age was 52.68 ±14.08 years. Group A included 72 (49.7%) patients, and Group B with 73 (50.3%) patients. There was no difference in the caecal intubation time between the 2 groups. A total of 33 (22.8%) colorectal polyps were found in 54 patients, of which 23 (31.9%) were detected with CAP and 10 (13.7%) without CAP. (P=.009). Mann-Whitney tests were also used, which showed that there was a significant difference in the number of polyps found between the CAP group and the standard colonoscopy group. ConclusionThe study demonstrated that the use of CAP is associated with improved detection of the number of polyps. The caecal intubation time is not affected by the use of CAP.

OC-012 The Effect of Mental Workload Experienced During Colonoscopy on Endoscopists Performance

<h3>Introduction</h3> Studies have shown that there are a multitude of factors that affect the quality of colonoscopy. However, the effect of the endoscopist mental workload on their performance has been neglected. It is shown that health professionals exposed to excessive workloads and fatigue show degraded performance. The aim of this study was to measure the effect of mental workload as represented by the National Aeronautics and Space Administration-Task Load Index (NASA-TLX), on colonoscopic performance relative to the experience of the endoscopist and colonoscopy scheduling. <h3>Methods</h3> Procedures were observed prospectively in one institution for 3 groups; trainees, consultants and bowel cancer specialist programme (BCSP) endoscopists. On reaching the caecum the endoscopist marked on a validated pro-forma their corresponding workload on six subscales; mental demand, physical demand, temporal demand, effort, frustration and own performance, to generate a NASA-TLX score. Data on performance which included caecal intubation times (CIT), patient comfort and polyp detection rate (PDR) were noted. In addition, withdrawal times, time of day (am or pm) and queue order for procedures were recorded. <h3>Results</h3> A total of 202 procedures were undertaken between 6 endoscopists with a mean CIT of 9.2 minutes and PDR of 42%. Increasing mental workload was associated with increasing CIT (r = 0.61, p = 0.07) and inversely associated with withdrawal time (r = 0.72, p = 0.03). The mean mental workload during colonoscopy was lower in BCSP endoscopist v consultants v trainees (188 v 254 v 352 p &lt;0.01). On multivariate analysis, absence of polyp detection was associated with a procedure that was undertaken in pm with an above mean mental workload (OR 1.62, 95% CI 1.38–2.07) and withdrawal time of &lt;5 minutes (OR 1.53, 95% CI 1.32–1.91). Increased patient discomfort was associated with increased frustration on the subscale of the NASA-TLX score (OR 1.59, 95% 1.37–1.93) and being a trainee (OR 1.11, 95% 1.03–1.22). The use of ScopeGuide reduced the mental workload of consultants (227 v 282 p&lt;0.01), but not trainees or experts. Queue position had no impact on any of the markers of performance. <h3>Conclusion</h3> This study shows that high mental workload experienced during colonoscopy has a significant detrimental effect on the performance of endoscopists. Drop in PDR in pm procedures when only associated with high mental workload may explain some of the conflicting results of daily variations of PDR in other studies. Further studies are now required to look into measures that may reduce excessive mental workload. <h3>Disclosure of Interest</h3> None Declared

PTU-030 Number of Significant Polyps Detected Per Six Minutes of Withdrawal Time at Colonoscopy (SP6): A New Measure of Colonoscopy Efficiency and Quality: Abstract PTU-030 Table 1

Introduction There is an increasing focus on quality, safety and efficiency of colonoscopy procedures. Colonoscopic efficiency could be defined as the ability to detect clinically relevant pathologies with a minimum expenditure of time and effort without compromising the safety of the procedure. Adenoma Detection Rate (ADR) is considered as a surrogate marker for quality of colonoscopic examination. However, ADR does not take into account sessile serrated polyps/adenomas (SSP/A) or the efficiency of detection. We therefore propose a new measure of colonoscopy efficiency the SP6 that can be used to evaluate both individual endoscopist’s performance and to compare different detection interventions. Our objective was to assess the SP6 for an individual colonoscopist during standard and Endocuff –assisted colonoscopy (EAC) Methods A prospective service evaluation of screening colonoscopies was performed by an experienced endoscopist between October 2014 and September 2015. For consecutive colonoscopies, patient demographics and procedural data were collected. Results 96 patients had screening colonoscopy during this period. The median age was 65 years (55–74 years). A distal disposable attachment such as Endocuff VisionTM was used at the endoscopists’ discretion. 49 patients had Endocuff Vision-assisted colonoscopy and the remainder had standard colonoscopy. Figure 1 summarises the main findings. There was no significant difference in caecal intubation time and withdrawal time between the two groups. Both ADR and SP6 were significantly improved and SP6 demonstrated that EAC appears to significantly improve colonoscopy efficiency with approximately twice as many pre-cancerous lesions detected and removed per 6 minutes of withdrawal time (1.11 vs 0.6, p = 0.004). Conclusion From this preliminary data an SP6 (colonoscopy efficiency metric) appeared significantly higher when Endocuff VisionTM is used. An SP6 >1 can be achieved in the context of bowel cancer screening FOBT positive colonoscopy and may act as a new benchmark to demonstrate high quality examinations. Disclosure of Interest None Declared

Complete colonoscopy: impact of patients' demographics and anthropometry on caecal intubation time

Background and aimFactors that affect caecal intubation during colonoscopy include age and sex of the patient, quality of bowel preparation, prior abdominal or pelvic surgery and pelvic inflammatory disease, among...

Forward-Viewing Colonoscopy Versus Full-Spectrum Endoscopy (Fuse) for Dysplasia Detection With and Without Chromoendoscopy In Inflammatory Bowel Diseases: A Prospective, Randomized-order, Crossover Tandem Surveillance Colonoscopy Study

Traditional forward-viewing colonoscopy (FVC) is impeded by a narrow field of view of <170 degrees with adenoma “miss-rates” of 24-42%. This limitation impairs dysplasia surveillance in chronic colitis. Chromoendoscopy improves visualisation of dysplasia but has never been used with FUSE, which provides 330 degree visualisation. This study compares FVC and FUSE with and without chromoendoscopy for the identification of dysplasia in IBD. This was a prospective, randomized-order, crossover tandem colonoscopy trial at an academic IBD centre. Inclusion criteria were left sided or extensive colitis for >10 years disease duration, primary sclerosing cholangitis (PSC) or previous dysplasia. Patients underwent same-day, back-to-back tandem colonoscopy with FVC (PCF/CF 180/190, Olympus, Japan) and the FUSE colonoscope (EndoChoice, USA) under propofol sedation. Order randomization was computer-generated. Patients and endoscopist were masked to group allocation until immediately prior to colonoscopy. All lesions detected during initial colonoscopy were removed and any additional lesions detected on subsequent colonoscopy were then removed. Chromoendoscopy (CE) was with methylene blue dye spray, additional random biopsies were performed during the second colonoscopy. The primary endpoint was dysplasia-yield. The secondary endpoint was detection of dysplasia on random biopsy versus CE-targeted biopsies. Logistic regression and Chi square statistics were performed. Twenty-four participants were randomized (16 males, mean age 37 years, Crohn’s colitis n=16, ulcerative colitis n=8, mean duration of colitis: 13.5 years). Two subjects had prior low-grade dysplasia and two had primary sclerosing cholangitis. Ileal-intubation rate was 100%. 46% were randomized to FVC first and 54% to FUSE first. All patients had cross-over CE as the second procedure. On a per-lesion analysis for lesion detection, FUSE odds ratio (OR) was 4.86 (95% CI: 1.43-16.49) vs FVC OR: 2.33 (95% CI: 0.74-7.13; P<0.01). Dysplasia detection with FUSE had an OR: 7.67 (95% CI: 9.85-69.6) vs FVC OR: 2.90 (95% CI: 0.50-16.67). Combined hyperplastic/ dysplasia detection with FUSE had an OR: 3.80 (95% CI: 1.07-13.52) vs FVC OR: 1.74 (95% CI 0.52-5.74). The mean lesion detection with FUSE vs FVC was 1.62 vs 0.45 (P<0.042), with mean dysplasia detection of 0.30 vs 0.09 respectively (P=0.21). FUSE +/- CE versus FVC +/- CE had a mean dysplasia detection of 0.25 vs 0.04 (P=0.04) and mean lesion detection of 2.25 vs 0.67 respectively (P=0.003). Lesional and dysplasia miss rates are shown in Table 1. Mean caecal intubation times for FUSE and FVC were 4.7 and 4.6 minutes respectively (ns). Dysplasia yield on targeted biopsies with CE yield was 10.8% vs 0% on random biopsies (P<0.0001). FUSE significantly increased dysplasia identification in IBD surveillance. We confirmed the dysplasia yield of random biopsies in the setting of IBD is extremely low.Table 1Miss rates for FUSE and forward-viewing colonoscope (FVC) for lesions and dysplasiaLesion miss rateDysplasia miss rateFUSE31%0%FVC78%66.7% Open table in a new tab

Bowel Preparation, Colonoscopy Withdrawal Time and Adenoma Detection Rate: A Prospective Study of Screening Colonoscopies

There are few studies on the determinants of poor bowel preparation among colorectal cancer screening participants, and current evidence on the association between bowel preparation and adenoma detection was inconclusive. We evaluated the independent factors associated with poor bowel preparation and its impact on adenoma detection. We included asymptomatic subjects aged between 50-70 years who self-referred for colorectal cancer screening and received colonoscopy between 2008 and 2012 in Hong Kong. The quality of the bowel preparation was assessed by colonoscopists, and the factors associated with poor bowel cleansing were evaluated by binary logistic regression analyses. A multivariate regression model was constructed to evaluate if poor bowel preparation was associated with detection of colorectal neoplasia. From 5,470 screening participants with an average age of 57.7 years (SD 4.9), up to 34.6% had poor or fair bowel preparation. The level of poor or fair bowel preparation was as high as 34.6%. After controlling for sociodemographic and clinical factors, older age (≥ 60 years; adjusted odds ratio [AOR]=1.19 to 1.38, P = .017-0.038), male gender (AOR=1.38, 95% C.I. 1.19-1.60, P < .001), and smokers (AOR=1.41, 95% C.I. 1.14-1.75, P = .002) were significantly associated with poor or fair bowel preparation. Poorer cleansing led to longer caecal intubation time and colonoscopy withdrawal time, yet resulted in significantly lower detection rates of colorectal neoplasia (AOR=0.35 to 0.62) and colorectal advanced neoplasia (AOR=0.39 to 0.50) irrespective of their diameter (< 5mm or ≥ 5mm). Steps to improve proper procedures of bowel preparation are warranted, especially among subjects at risk of poor bowel preparation. These include more intensive preparation protocols and measures to improve patient understanding of bowel preparation as parts of continuous quality-improvement programmes. This study supports bowel preparation as a definite quality indicator.

PWE-376 Endocuff-visiontm: impact on colonoscopist performance during screening

<h3>Introduction</h3> Although colonoscopy is considered the optimal procedure for bowel cancer screening, it remains an imperfect tool for cancer prevention, due to missed adenomas and early cancers. The Endocuff is a simple device attached at the end of the colonoscope that opens up the field of view by retracting folds during withdrawal. Little is known regarding the Endocuff’s impact on a colonoscopist’s performance. <h3>Method</h3> The aim of this study was to evaluate the impact of the Endocuff-vision^TM(ARC Design Ltd, UK) on the quality indicators for each operator. A prospective observational evaluation study was performed from April 2013 to September 2014, divided in three consecutive periods: pre-cuff (no device used), during-cuff (device used) and post-cuff (no device used). Four screening endoscopists (BPS, STG, NS, AH) utilised the Endocuff-vision^TMat their own discretion when device was available to them. Quality colonoscopy indicators {(Adenoma Detection Rate (ADR), Mean number of adenomas per procedure (MAP), Caecal intubation time (CIT)} were analysed (t-test two sample assuming equal variances) in equivalent number of procedures. The total number of procedures performed was 399, 133 per period (BPS/26, STG/53, NS/31, AH/23). <h3>Results</h3> The mean ADR was 55.13% in the pre-cuff period, 68.98% in the during-cuff period and 61.74% in the post-cuff period. All four operators showed significant improvement in detection when using the device, which resulted in an overall increased ADR of <b>13.8% </b>(p &lt; 0.05). During the post-cuff period, the detection performance of the three endoscopists declined while maintaining a high detection rate. The mean MAP was 1.2 in the pre-cuff period, 2.2 in the during-cuff period and 1.55 in the post-cuff period. The mean MAP increased significantly in all four operators at the during-cuff period (<b>83%</b>, p &lt; 0.05). During the post-cuff, 3 endoscopists returned almost to the baseline MAP pre-cuff level. The mean CIT was 9.66min in the pre-cuff period, 7.5min in the during-cuff period and 9.54min in the post-cuff period. A decrease in mean CIT was featured (<b>22.36%</b>, p &lt; 0.005) to all operators when using the device, returning to about the pre-cuff levels afterwards. No complications were reported from the use of the Endocuff-vision although it was electively removed in 4 cases with severe sigmoid colon diverticulosis and one case due to anal discomfort. <h3>Conclusion</h3> In this study, use of the Endocuff-vision^TMimproved overall performance by making colonoscopy a quicker (CIT) and more efficient (MAP/ADR) procedure. Further randomised evaluation of this simple novel device is warranted. <h3>Disclosure of interest</h3> None Declared.