Improve Adenoma Detection Rate Research Articles

One or two operator technique and quality performance of colonoscopy: A randomised controlled trial

The two-operator technique for colonoscopy, with the endoscopy assistant actively advancing and withdrawing the scope, is still commonly practiced in Europe. As uncontrolled data has suggested that the one-operator technique is associated with a higher adenoma detection rate, we tested the hypothesis that the two-operator-technique can achieve comparable performances in terms of adenoma detection. Non-inferiority trial in which consecutive adult outpatients were randomised to undergo colonoscopy by one (one-operator) or by four endoscopists. Each performed half the procedures by one-operator and half by two-operator technique independently of routine clinical practice. Main outcome measure was adenoma detection rate. 352 subjects (49% males, mean age 60 ± 12.1 years) were randomised to one (n=176) or to two-operator technique (n=176) colonoscopy. No significant differences were found in adenoma detection (33% vs. 30.7%, p=0.65), or cecal intubation rate, procedure times, and patient tolerability. No differences were found in the subgroup analysis according to routinely adopted colonoscopy technique. This study does not confirm a higher adenoma detection rate for one-operator technique colonoscopy. Changing current practice to improve adenoma detection rate for endoscopists routinely using two-operator technique is not warranted.

L-menthol improves adenoma detection rate during colonoscopy: a randomized trial

Colonoscopy is one of the most reliable methods for the detection of colorectal neoplasms. However, colonic peristalsis during colonoscopy results in some neoplastic lesions being hidden from view and commonly requires an intravenous or intramuscular injection of antispasmodic agents, which may sometimes causes unexpected adverse reactions. The aim of this study was to evaluate the efficacy of L-menthol spray as an antiperistaltic agent and its effect on adenoma detection. This was a prospective, randomized, single-blind placebo-controlled trial. A total of 226 patients who were scheduled to undergo colonoscopy were randomly assigned to receive either 20 mL of 1.6 % L-menthol (n = 118) or placebo (n = 108). Both treatments were sprayed locally onto the colonic mucosa via an endoscope. The adenoma detection rate (ADR) and the proportion of patients with no peristalsis were the primary and secondary outcomes, respectively. The ADR was significantly higher in the L-menthol group than in the placebo group (60.2 % vs. 42.6 %; P = 0.0083). The proportion of patients with no peristalsis after treatment with L-menthol was significantly higher than in the placebo group (71.2 % vs. 30.9 %; P < 0.0001). There were no adverse effects in either group. The results suggest that the suppression of colonic peristalsis by L-menthol sprayed directly onto the colonic mucosa improves the ADR. ID: UMIN 000007972.

Incidence of Diagnostic Change in Colorectal Polyp Specimens After Deeper Sectioning at 2 Different Laboratories Staffed by the Same Pathologists

To calculate the incidence of nondiagnostic (ND) colorectal (CR) polyp cases in which deeper tissue sectioning rendered new diagnostic information--particularly adenomas--in 2 laboratories staffed by the same pathologists. After initial diagnosis, 100 ND CR polyps from each laboratory were reexamined with 3 deeper levels to establish rates of diagnostic conversion based on biopsy specimen location and original observation(s). Deeper sectioning rendered new diagnostic information in 43 (21.5%) of 200 biopsy specimens and specifically adenomas in 16 (8.0%) of 200 biopsy specimens. These results support routine ordering of deeper levels on ND CR polyps to improve adenoma detection rates, especially those cases without any histologic abnormality. If another biopsy in the same case already is adenomatous, examination of deeper levels may not be necessary, as it may not have any significant effect on the clinical management of the patient.

PTH-162 The Challenges of Implementing Evidence into Endoscopic Practice: A Qualitative Study

IntroductionThe Quality Improvement in Colonoscopy (QIC) study was a region wide service improvement study that aimed to improve adenoma detection rate (ADR), and thusly quality in colonoscopy, through implementation of...

Mo1594 A Simple Method to Improve Adenoma Detection Rate During Colonoscopy: Changing the Position of Patients

Mo1594 A Simple Method to Improve Adenoma Detection Rate During Colonoscopy: Changing the Position of Patients

At Long Last, a Cure for Poor Adenoma Detection?

Improving adenoma detection rates (ADRs) during colonoscopy has proven difficult. The most successful program to date entailed physician education and

Experience with water-aided colonoscopy in a Canadian community population

Purpose: Water-aided colonoscopy, immersion (WI) or exchange (We), minimizes insertion pain and reduces sedation. We improves adenoma detection rates (ADR). In a performance improvement program, we assessed water-aided methods in a busy community GI practice in c anada. Methods: Over a 13 month period patients were offered water-aided colonoscopy with an option to complete the examination with on-demand sedation. WI was used in the first 1-2 months and replaced exclusively with W e thereafter. procedural outcomes were compared to a continuous retrospective cohort of standard sedated air insufflation (AI) colonoscopy. Results: 200 (106M/94F) water-aided colonoscopies were completed. cecal intubation without air insufflation was achieved in 93%. sedation was not required in 95% of patients accepting on-demand sedation. Average insertion time was 15 min with an average withdrawal time of 6 min. 145 (87M/58F) water-aided colonoscopies, completed for screening or surveillance were compared to a cohort of 145 (77M/68F) AI colonoscopies in the immediate prior period. The overall ADR of water-aided colonoscopy was 30% (43/145) with a proximal ADR of 21%. Using AI the overall ADR was 27.6% (40/145) with a proximal ADR of 14.5% (21/145). In males, the proximal colon ADR was 25% in water-aided colonoscopies and 14.3% using AI (p=0.0397). Conclusions: Water-aided colonoscopy is feasible in a busy community practice with respectable cecal intubation rates. A large percentage of patients consenting to on-demand sedation completed without sedation. ADR in male subjects is consistent with similar prior reports of a significantly higher ADR in the proximal colon using W e when compared to AI.

A Simple Method to Improve Adenoma Detection Rate During Colonoscopy: Altering Patient Position

Colonoscopy is currently considered to be the gold standard method for detecting and removing adenomatous polyps. However, tandem colonoscopy studies reveal a pooled polyp miss rate of 22%. A prospective randomized trial was conducted to assess whether alteration of patient position during colonoscopy withdrawal increases the adenoma detection rate (ADR). The study group included 120 patients who presented for elective colonoscopic examination. After reaching the cecum, patients were randomly assigned in a 1:1 ratio to examination in either the left lateral position or other positions (left lateral position for the cecum, ascending colon and hepatic flexure; supine for transverse colon; and supine and right lateral position for splenic flexure, descending and sigmoid colon) first. Examination of the colon was performed segment by segment. The size, morphology and location of all polyps were recorded. Polyps were removed immediately after examination of a colon segment when all positions were completed. ADR and polyp detection rates (PDR) were calculated. A total of 102 patients completed the study. Examination in the left lateral position revealed 66 polyps in 31 patients (PDR 30.3%) and 42 adenomas in 24 patients (ADR 23.5%). PDR increased to 43.1% (81 polyps in 44 patients) and the ADR to 33.3% (53 adenomas in 34 patients) after the colon was examined in the additional positions (P<0.001 and P=0.002, respectively). The increase in the number of adenomas detected was statistically significant in the transverse and sigmoid colon. The addition of position changes led to a 9.8% increase in the ADR in the transverse colon, splenic flexure, and descending and sigmoid colon. The frequency of surveillance interval was shortened in nine (8.8%) patients after examination of the colon in dynamic positions. Alteration of patient position during colonoscopy withdrawal is a simple and effective method to improve ADR.

Advanced Imaging Endoscopy: Developing the Better Endoscopist

Purpose: Optical imaging techniques such as narrow band imaging (NBI) have demonstrated a promising in-vivo modality that enables one to predict adenomatous polyps. Previous studies have demonstrated that in experienced hands, up to 80% of colorectal polyps were accurately identified. Other studies demonstrated training gastroenterologist and physicians learning NBI to differentiate hyperplastic polyps from adenomatous polyps can result in an increased accuracy from 60% to 94%. We propose that advanced imaging endoscopy may provide the endoscopist-in-training a foundation for in-vivo polyp evaluation and ultimately improve adenoma detection. This study evaluated the ability of one first year fellow, after six months of training, to accurately predict adenomas based upon digital chromoendoscopy and Kudo pit pattern. The endoscopist performed 48 colonoscopies during his first 6 months of training. Methods: The study utilized the narrow band imaging capabilities of the Olympus high definition CF-H180AL, PCF-H180AL and the I-Scan of the Pentax EC3890Li endoscopes, respectively. Endoscopies were conducted in white light and then polyps were evaluated in blue light with Kudo score documentation suggesting hyperplastic or adenomatous polyps on the endoscopy report. Subsequently, pathology findings were retrospectively evaluated by chart review. Results: 19 patients were evaluated and a total of 22 polyps were removed. The most common Kudo classification was type II (41%). Overall accuracy of predicting adenomas was 68% (P=0.307). Conclusion: The data in this study was not statistically significant, but this raises the important question about the role of advanced imaging techniques during endoscopic training and how this may be utilized to monitor a trainee's performance progress. We propose that larger studies monitoring digital chromoendoscopy and prediction of adenomatous polyps may provide an objective measure of a trainee's progress and ultimately improve adenoma detection rates for newly trained gastroenterologists.

Impact of Withdrawal Time on Adenoma Detection Rates: Analysis of Average Risk Screening Colonoscopy Examinations

Purpose: In average risk individuals undergoing screening colonoscopy, withdrawal time of at least six minutes or more in normal exams is considered as a quality indicator. However, data is conflicting on the correlation of withdrawal time and detection of adenomas. The aim of this study is to estimate the impact of withdrawal time on detection of adenomas and polyps. Methods: Retrospective analysis of average risk screening colonoscopies performed at a university hospital using the electronic reporting system was done. All patients who underwent a colonoscopy with the indication “screening-average risk” during the study period [2006-2011] were included. Surveillance procedures and patients with high risk family history were excluded since they are expected to have higher adenoma rate. We reviewed demographic details, procedural data and corresponding pathology reports. Polyp detection rate (PDR) is defined as the number of colonoscopies with at least one polyp removed/total number of procedures. Adenoma detection rate (ADR) is defined as the number of colonoscopies with removal of at least one pathologically confirmed adenoma/total number of procedures. Withdrawal time is defined as the time spent withdrawing from cecum to anus. Colonoscopies where polyps or malignancies were found were excluded, and only normal colonoscopies were included to calculate the mean withdrawal time for each endoscopist. Spearman Rank Correlation coefficient was calculated to estimate the degree of correlation between the withdrawal time and ADR/PDR. Results: A total of 2370 patients fulfilled the inclusion criteria. ADR, PDR, and mean withdrawal times for each of the participating endoscopists were calculated (see Table). The spearman rank correlation coefficient (S) for withdrawal time and ADR was 1.0 [P=0.016] confirming a perfect positive correlation between withdrawal time and ADR. The S coefficient for withdrawal time and PDR was 0.9, [P=0.083].Table: No Caption available.Conclusion: This study confirms that a longer duration of withdrawal time during screening colonoscopy improves adenoma detection rate.

Cap-Fitted Colonoscopy Marginally Improves Polyp Detection

Placement of a hood or cap on the tip of an endoscope is a simple approach proposed to improve adenoma detection rates. However, study results are

Comparison of High Definition with Standard White Light Endoscopy for Detection of Dysplastic Lesions During Surveillance Colonoscopy in Patients with Colonic Inflammatory Bowel Disease

Dysplasia in colonic inflammatory bowel disease (IBD) is often multifocal and flat. High-definition (HD) colonoscopy improves adenoma detection rates by improving the ability to detect subtle mucosal changes. The utility of HD colonoscopy in dysplasia detection in patients with IBD has not been reported so far. We aimed to compare the yield of dysplastic lesions detected by standard definition (SD) white light endoscopy with HD endoscopy. A retrospective cohort study of patients with long-standing (>7 years) colonic IBD undergoing surveillance colonoscopy at Nottingham University Hospital was studied between September 2008 and February 2010. Details of diagnosis, duration of disease, and outcomes of the colonoscopy were collected from the endoscopy database, electronic patient records, and patient notes. There were 160 colonoscopies (101 ulcerative colitis [UC] and 59 Crohn's disease [CD]) in the SD group and 209 colonoscopies (147 UC and 62 CD) in the HD group. The groups were well matched for all demographic variables. Thirty-two dysplastic lesions (27 on targeted biopsy) were detected in 24 patients in the HD group and 11 dysplastic lesions (six on targeted biopsy) were detected in eight patients the SD group. The adjusted prevalence ratio of detecting any dysplastic lesion and dysplastic lesion on targeted biopsy was 2.21 (95% confidence interval [CI] 1.09-4.45) and 2.99 (95% CI 1.16-7.79), respectively, for HD colonoscopy. HD colonoscopy improves targeted detection of dysplastic lesions during surveillance colonoscopy of patients with colonic IBD in routine clinical practice. Randomized controlled studies are required to confirm these findings.

Sa1142 Withdrawal Time Improves Adenoma Detection Rates During Retroflexion in the Right Colon

Background: The efficacy of colonoscopy in preventing right sided colon cancers by polypectomy has recently been questioned. The value of examining the right colon with retroflexion for the purposes of detecting additional adenomas has been reported, however the largest study to date involved examination of the ascending but not transverse colon. Aims: To describe the additional yield of right colon retroflexed exam of the transverse colon on adenoma detection rate in a series of patients undergoing right colon retroflexion during screening or surveillance colonoscopy. Methods: Consecutive patients presenting for elective outpatient screening or surveillance colonoscopy were prospectively enrolled. Exclusion criteria included previous bowel resection, unsatisfactory bowel preparation, or an indication for colonoscopy other than screening or polyp surveillance. Colonoscopy was performed to the cecum, examination of the right colon from cecum to splenic flexure was performed in a conventional antegrade fashion and any polyps identified were removed. The colonoscope was re-inserted to the cecum and retroflexion was attempted. When possible, retroflexion was carried out to the splenic flexure, and any additional polyps identified were removed. Results: Retroflexion was attempted in 172 patients and only those in whom it was successful[148 (86%)] were included in the study. Significant looping was the reason for inability to retroflex in all 24 excluded cases. An adult colonoscope was used in 147 patients. The mean age was 58.8 years (SD 9.8) and there were 94 women (63.5%). The bowel preparation was excellent in 18.2%, good in 70.3%, fair in 11.5% and poor in 0%.The overall adenoma detection rate (ADR) was 37.8%, the antegrade ADR was 35.1% and the retrograde ADR 8.8%. For endoscopic exam from the cecum to the hepatic flexure, 44 polyps were detected antegrade and 9 detected retrograde for a per-polyps miss rate of 17%. Antegrade transverse colon exam detected 36 adenomas and 6 adenomas were detected retrograde for a perpolyp miss rate of 14.3%. A small descending colon perforation occurred in a patient in whom retroflexion was performed to the transverse colon; no polyps were seen. Conclusion: By extending right colon retroflexion to the splenic flexure, an additional 6 adenomas were detected for an ADR of 4%, suggesting a modest additional adenoma detection resulting from extending retroflexion to the splenic flexure.

Su1325 New Closure Technique for Difficult Colorectal Endoscopic Submucosal Dissection

several potential advantages to UEMR that deserve further study. Water immersion “floats” the mucosa and submucosa away from the deeper muscularis propria, which may make EMR technically easier and safer. Thermal coagulation under water immersion may protect against injury to deeper wall layers (‘heat sink’ effect ). Colonoscopy using water immersion has generated growing interest as an alternative to air-insufflation with potential advantages of enhanced patient comfort, decreased sedation requirements and an improved adenoma detection rate. Conceivably, water immersion polypectomy and EMR could be performed seamlessly in sequence without any air insufflation.

797 Comparison of Adenoma Detection by Inspection During Both Insertion and Withdrawal Phases Versus Only Withdrawal Phase of Colonoscopy: A Randomized Controlled Trial

Standard method of colonoscopy is to insert the colonoscope rapidly to reach the cecum, with careful inspection and polyp removal during the withdrawal phase (WP). However, some polyps seen during insertion phase (IP) are difficult to find during withdrawal phase. Also, colon is in different conformation during insertion and withdrawal phases. Hence we hypothesized that careful inspection and removal of polyps during insertion also may improve adenoma detection rate (ADR).

Sa1602 Improved Adenoma Detection Rate During Colonoscopy With Use of a Retrograde-Viewing Auxiliary Imaging Device

Sa1602 Improved Adenoma Detection Rate During Colonoscopy With Use of a Retrograde-Viewing Auxiliary Imaging Device

Retrograde-viewing device improves adenoma detection rate in colonoscopies for surveillance and diagnostic workup

To determine which patients might benefit most from retrograde viewing during colonoscopy through subset analysis of randomized, controlled trial data. The Third Eye® Retroscope® Randomized Clinical Evaluation (TERRACE) was a randomized, controlled, multicenter trial designed to evaluate the efficacy of a retrograde-viewing auxiliary imaging device that is used during colonoscopy to provide a second video image which allows viewing of areas on the proximal aspect of haustral folds and flexures that are difficult to see with the colonoscope's forward view. We performed a post-hoc analysis of the TERRACE data to determine whether certain subsets of the patient population would gain more benefit than others from use of the device. Subjects were patients scheduled for colonoscopy for screening, surveillance or diagnostic workup, and each underwent same-day tandem examinations with standard colonoscopy (SC) and Third Eye colonoscopy (TEC), randomized to SC followed by TEC or vice versa. Indication for colonoscopy was screening in 176/345 subjects (51.0%), surveillance after previous polypectomy in 87 (25.2%) and diagnostic workup in 82 (23.8%). In 4 subjects no indication was specified. Previously reported overall results had shown a net additional adenoma detection rate (ADR) with TEC of 23.2% compared to SC. Relative risk (RR) of missing adenomas with SC vs TEC as the initial procedure was 1.92 (P = 0.029). Post-hoc subset analysis shows additional ADRs for TEC compared to SC were 4.4% for screening, 35.7% for surveillance, 55.4% for diagnostic and 40.7% for surveillance and diagnostic combined. The RR of missing adenomas with SC vs TEC was 1.11 (P = 0.815) for screening, 3.15 (P = 0.014) for surveillance, 8.64 (P = 0.039) for diagnostic and 3.34 (P = 0.003) for surveillance and diagnostic combined. Although a multivariate Poisson regression suggested gender as a possibly significant factor, subset analysis showed that the difference between genders was not statistically significant. Age, bowel prep quality and withdrawal time did not significantly affect the RR of missing adenomas with SC vs TEC. Mean sizes of adenomas detected with TEC and SC were similar at 0.59 cm and 0.56 cm, respectively (P = NS). TEC allows detection of significantly more adenomas compared to SC in patients undergoing surveillance or diagnostic workup, but not in screening patients (ClinicalTrials.gov Identifier: NCT01044732).

Improvement in the Adenoma Detection Rate with High Definition Colonoscopes (HD-C)

Purpose: Development of high definition endoscopes has been a recent technological advancement in endoscopic imaging. Whether these improve adenoma detection rates during screening colonoscopies(SC) is not clear. The aim of the study was to compare standard definition colonoscopes(SD-C) and HD-C for: 1. Proportion of subjects with adenomas and number of adenomas detected per subject. 2. Proportion of subjects with advanced adenomas and number of advanced adenomas detected per subject. 3. Proportion of subjects with right sided adenomas and number of right sided adenomas detected per subject. Methods: We conducted a retrospective review of all SC performed at a tertiary referral center during two different time periods by 4 experienced endoscopists with or without a trainee. Between Jan 2005 and Dec 2006, all SC were performed with SD-C (Olympus 140 and 160 series) and were included in the SD-C arm. After HD-C (Olympus 180 series) were acquired by our unit, the older generation colonoscopes were phased out. All SC performed with HD-C between Jan 2008 to Sep 2010 were included in the HD-C arm. Detailed review of the patient records, endoscopy reports and histology reports was conducted. Fisher's exact test, unpaired t test and Wilcoxon rank sum test were used for statistical analysis. Results: A total of 2,015 SC were reviewed; 1056 in SD-C arm and 959 in HDC arm. Mean age was higher in the SD-C arm compared to HD-C arm (60.4 yrs vs 58.5 yrs; p <0.001). There were higher number of males in SD-C arm (98% vs 96%; p = 0.002). 74% subjects in SD-C arm were Caucasians compared to 71% in HD-C arm (p = 0.06). There were no significant differences between the two groups with respect to the inadequacy of bowel prep (p>0.99). The proportion of subjects with adenomas, number of adenomas per subject, proportion of subjects with advanced adenomas, number of advanced adenomas per subject, proportion of subjects with right sided adenomas and right sided adenomas per subject are shown in the Table.Table: No Caption available.Conclusion: 1. HD-C detected a 10% higher number of subjects with adenomas and a 41% higher number of adenomas per subject. 2. HD-C also detected a significantly higher number of advanced adenomas and right sided adenomas. 3. HD-C is a significant advancement in endoscopic imaging that can improve adenoma detection rates and may have a positive impact on the effectiveness of colonoscopy in preventing colorectal cancer. Disclosure: Deepthi Rao - No financial relationship with Olympus. Neil Gupta - No financial relationship with Olympus. Prateek Sharma - Olympus Grant / Research support. Ajay Bansal - No financial relationship with Olympus. Amit Rastogi - Olympus Grant / Research support.

MegaPixels - Does It Really Matter in Screening Colonoscopy?

Purpose: High definition (HD) colonoscopy with a 1.25 megapixel image has the potential to identify more polyps, which could be missed during a standard (SD) colonoscopy. This advantage may be important in screening high risk patients. Its utility in average risk screening colonoscopy has shown variable results. Methods: 545 consecutive patients undergoing average risk screening colonoscopy with two experienced gastroenterologists over a six month period in one endoscopy center were included. 207 patients were examined with a standard scope and monitor (Olympus PCF-160AL)in the initial 3 months. 338 patients were examined with a high definition scope and 26 inch HD monitor (Pentax EC-3890Li HD) in the later 3 months. Patients with history of polyps, family history of colorectal neoplasia, inflammatory bowel disease, and those referred for reasons other than screening were excluded. Results: Both groups were well matched in age (mean age 56 vs 57 yrs), but the SD group had more females (66% vs 50.8%). A total of 77 (37%) patients had at least one polyp detected during standard colonoscopy vs 125 (37%) of patients with high definition colonoscopy. 38 (18%) patients had at least 1 adenoma detected on standard colonoscopy vs 89 (26.3%) of patients undergoing high definition colonoscopy. The adenoma detection rate between the two groups was statistically significant (p=0.027). Conclusion: High definition colonoscopy with 1.25 MegaPixel resolution significantly improved adenoma detection rates in our average risk screening colonoscopy population. Our study is limited by a female preponderance in the SD group, lack of correction for quality of bowel preparation and retrospective nature. However investment in HD technology has the potential to improve quality.

Comparison of high definition with standard white light endoscopy for detection of dysplastic lesions during surveillance colonoscopy in patients with inflammatory bowel disease

IntroductionDysplasia in colonic inflammatory bowel disease (IBD) is often multifocal and flat, making it easy for significant lesions to be overlooked. Dye spraying the mucosal surface is believed to enhance...