Shorter Cecal Intubation Time Research Articles

Optimal Timing of Simethicone Supplement for Bowel Preparation: A Prospective Randomized Controlled Trial.

Background and Aims Simethicone (SIM), as an antifoaming agent, has been shown to improve bowel preparation during colonoscopy. However, the optimal timing of SIM addition remained undetermined. We aimed to investigate the optimal timing of SIM addition to polyethylene glycol (PEG) to improve bowel preparation. Methods Eligible patients were randomly assigned to two groups: the SIM evening group (SIM addition to PEG in the evening of the day prior to colonoscopy) and the SIM morning group (SIM addition to PEG in the morning of colonoscopy). The primary outcome was Bubble Scale (BS). The secondary outcomes were Boston Bowel Preparation Scale (BBPS) and adenoma detection rate (ADR). Results A total of 419 patients were enrolled in this study. The baseline characteristics of the patients were similar in both groups. No significant differences were observed in terms of BS (8.76 ± 0.90 vs. 8.65 ± 1.16, P = 0.81), ADR (34.1% vs. 30.8%, P = 0.47), Boston Bowel Preparation Scale (BBPS) (8.59 ± 0.94 vs. 8.45 ± 1.00, P = 0.15), and withdrawal time (8.22 ± 2.04 vs. 8.01 ± 2.51, P = 0.094) between the two groups. Moreover, safety and compliance were similar in both groups. However, the SIM evening group was associated with shorter cecal intubation time (3.80 ± 1.81 vs. 4.42 ± 2.03, P < 0.001), higher BS (2.95 ± 0.26 vs. 2.88 ± 0.38, P = 0.04) in the right colon, and diminutive ADR (62.5% vs. 38.6%, P = 0.022) in the right colon, when compared to the SIM evening group. Conclusions The SIM addition to PEG in the evening of the day prior to colonoscopy can shorten cecal intubation time and improve BS scores and diminutive ADR of the right colon compared with the SIM addition to PEG in the morning of colonoscopy in bowel preparation.

AmplifEYE assisted colonoscopy versus standard colonoscopy: A randomized controlled study.

AmplifEYE is a mucosal exposure device mounted to the tip of colonoscope to improve polyp or adenoma detection. We aim to compare the adenoma detection rates (ADR) of AmplifEYE-assisted colonoscopy (AC) with standard colonoscopy (SC). We performed a randomized controlled trial involving patients aged 50 to 79 who underwent AC or SC in two centers. Procedures were performed by five experienced colonoscopists. Three hundred fifty-five patients were recruited, with 334 patients (170 AC and 164 SC) included into analysis. The ADR was numerically higher in AC (47.1%) versus SC (40.9%), P=0.253. The polyp detection rate (PDR) in AC was 68.2% versus 54.3% in SC, P=0.009, and serrated polyp detection rate (SDR) in AC was 37.6% versus 20.1% in SC, P<0.001, both statistically significant higher in the study group. The mean cecal intubation time was shorter with AmplifEYE (8.0min in AC vs 8.9min in SC, P=0.030), and there was no difference in pain score (3 in AC vs 4 in SC, P=0.121). AmplifEYE-assisted colonoscopy significantly improved the PDR and SDR, while the ADR was numerically higher in AC that did not reach statistical significance. Using the device resulted in shorter cecal intubation time and did not cause more pain.

Endocuff vision-assisted vs. standard polyp resection in the colorectum (the EVASTA study): a prospective randomized study

Cap-assisted colonoscopy is frequently used to facilitate adenoma detection during endoscopy. However, data on how cap assistance influences polyp resection are scarce. We aimed to evaluate the impact of cap assistance with the Endocuff vision device (EVD) on the resection time for colorectal polyps in patients undergoing colonoscopy. METHODS : A randomized, prospective study was performed in a university hospital in Germany. A total of 250 patients were randomly assigned 1:1 to undergo either colonoscopy with the EVD (EVD arm) or standard colonoscopy without the use of a cap (standard arm). The primary outcome was the average duration of polypectomy. Secondary outcomes included adenoma detection rate, cecal and ileal intubation times, and propofol dosage. The use of EVD led to a significant reduction in the median polypectomy time in the EVD vs. standard arm (54 vs. 80 seconds, respectively; P = 0.02). This effect was strongest for polyps ≥ 6 mm. Compared with the standard group, Endocuff assistance also resulted in a shorter cecal intubation time (6 vs. 8 minutes; P = 0.03) and overall colonoscopy time (23 vs. 27 minutes; P = 0.02). In contrast, no difference in withdrawal time was observed. The polyp and adenoma detection rates did not differ significantly between the two groups. Endocuff-assisted colonoscopy reduces the duration of polypectomy, which may be due to a more stable scope position during resection. Further studies are needed to investigate whether comparable effects will be seen for other interventions, such as clipping or biopsy sampling.

Cecal intubation time during colonoscopy: Do waist circumference and waist-to-hip ratio play better roles than body mass index?

Backgroundand Aim: Among the factors that influence cecal intubation time (CIT) are gender, the quality of bowel preparation, age, prior abdominal surgery, constipation, the experience of the endoscopist, body mass index (BMI), the amount of visceral fat, and waist circumference (WC). This study aimed to compare the effects of WC and waist-to-hip ratio (WHR) to that of BMI on CIT. Patients and Methods: One hundred patients had colonoscopy during the study period. The height and weight of each patient were taken using a stadiometer. BMI was calculated by dividing the weight in kilogram by the square of the height in meter. WC (cm) was measured at a point midway between the subcostal margin and the upper border of the iliac crest. Hip circumference (HC in cm) was measured at the greatest point between the iliac crest and the thighs. WHR was calculated by dividing the WC by the HC. Results: There were 60 (60%) males and 40 (40%) females. Mean age was 60.0 ± 13.1 years (range 27.0–87.0 years). Mean CIT was 1009.5 ± 410.7 s (range 329.0–2110.0 s). Mean BMI, WC, HC, and WHR were 25.5 ± 5.6, 92.2 ± 13.7 cm, 97.5 ± 11.7 cm, and 0.9 ± 0.1, respectively. Age ≥60 years and BMI ≤24.9 kg/m2 were significantly associated with a prolonged CIT in males. In both genders, WC and WHR were not significantly associated with CIT. Conclusion: Higher BMI, WC, and WHR were associated with shorter CIT. However, among these parameters, only BMI was found to be significantly associated with CIT in males.

Simethicone improves bowel cleansing with low-volume polyethylene glycol: a multicenter randomized trial.

For bowel preparation, using a reduced volume of polyethylene glycol (PEG) solution without influencing its effectiveness would be preferable. While simethicone shows great potential as an adjunctive agent, data on its use are limited. We aimed to clarify whether simethicone added to low-volume PEG solution improved bowel cleansing. PATIENTS AND METHODS : Consecutive adult patients registered for colonoscopy were recruited from seven medical centers in South China between 15 April and 15 July 2015 and prospectively randomized into two groups: 2 L PEG (conventional group) and 2 L PEG plus simethicone (simethicone group). The primary endpoint was the effectiveness of bowel cleansing according to the Boston Bowel Preparation Scale (BBPS). Secondary endpoints included cecal intubation time, adenoma detection rate (ADR), patient safety and compliance, and adverse events. RESULTS : We included 290 and 289 patients in the conventional and simethicone groups, respectively, for analysis. The proportion with acceptable bowel cleansing (BBPS ≥ 6) was significantly higher in the simethicone group than in the conventional group (88.2 % vs. 76.6 %; P < 0.001). The mean (SD) BBPS score was significantly lower in the conventional group (6.5 [1.8] vs. 7.3 [1.7]; P < 0.001), as was the bubble score (2.5 [0.7] vs. 2.8 [0.5]; P < 0.001). The average cecal intubation time was significantly shorter in the simethicone group (6.3 [3.1] vs. 7.5 [5.1] minutes; P < 0.001). The ADR in the right colon was higher in the simethicone group than in the conventional group (16.6 % vs. 10.3 %; P = 0.03). Safety and compliance, including the taste, smell, and dosage of PEG, were similar for both groups. Simethicone added to low-volume PEG solution improves bowel-cleansing efficacy, with similar safety and compliance, shorter cecal intubation time, and higher ADR.

Benefits and Limitations of Cap-Fitted Colonoscopy in Screening Colonoscopy

Colonoscopy is widely used to detect colorectal cancer and to remove precancerous lesions to reduce the risk of colonic cancer. To examine the benefits and limitations of cap-fitted colonoscopy compared to conventional colonoscopy in terms of technical performance and colorectal adenoma detection rate. Screening colonoscopies performed from 2009 to 2010 with or without a transparent cap were retrospectively examined to compare the rate of successful intubation, cecal intubation time, and number, size, shape, and location of adenomas detected. An inclusion criterion was visualization of >95 % of the right colon. Data from 2,301 colonoscopies (1,165 with cap-fitted colonoscopy, 1,136 without the transparent cap) were retrospectively analyzed. Procedures were performed by four experienced endoscopists. The subjects' demographic characteristics and technical performances were similar between the two methods. The only significant difference in the technical performance between the two techniques was a shorter cecal intubation time with cap-fitted colonoscopy (5.3 vs. 6.6 min; p = 0.045) by one endoscopist. The total number of adenomas detected was significantly higher with cap-fitted colonoscopy than without the cap (586 vs. 484, respectively; p < 0.0001). Adenoma detection with cap-fitted endoscopy was significantly higher in the right colon than in the left colon (19 vs. 12 %, respectively; p = 0.0001). Cap-fitted colonoscopy did not improve the technical aspects of colonoscopy but significantly increased adenoma detection, especially in the right colon. It did not increase the detection rate of flat or depressed adenomas.

The cap-assisted technique enhances colonoscopy training: prospective randomized study of six trainees

Colonoscopy and polypectomy procedures have effectively reduced the incidence of colorectal cancer. Currently, competence in colonoscopy is an essential part of the education program for gastrointestinal (GI) trainees. However, considerable training is required for the optimal performance of a colonoscopy. This study involved six colonoscopy trainees, three of whom used the cap whereas the others did not. Each trainee managed 100 cases of screening colonoscopy from beginning to end. The cecal intubation success rate, cecal intubation time, polyp detection rate, adenoma detection rate, advanced adenoma detection rate, and adenocarcinoma detection rate were checked. The rate of successful cecal intubation and the cecal intubation time were reviewed every 10 cases. The cecal intubation rate was 80.7 % (242/300) in the cap group and 63.3 % (190/300) in the non-cap group. The average cecal intubation time was 13.7 min in the cap group and 18.7 min in the non-cap group. The statistical analysis of these results suggested that the cap group had a significantly higher success rate (p < 0.001) and a shorter cecal intubation time (p < 0.001) than the non-cap group. However, the two groups did not differ significantly in the detection rate for polyps (45.3 vs 43 %; p = 0.565), adenomas (26.3 vs 25 %; p = 0.709), advanced adenomas (2.6 vs 0.6 %; p = 0.056), or adenocarcinomas (5.3 vs 3 %; p = 0.153). Cap-assisted colonoscopies might help to increase the rate of cecal intubation success and shorten the cecal intubation time for GI trainees.

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

Background: CAC has been shown to improve detection of polyps, adenomas, cecal intubation rates and decrease cecal intubation times. However, conflicting results have been reported with regards to these endpoints. Aims:To compare CAC with standard colonoscopy (SC) with respect to:(i) proportion of subjects detected with polyps, (ii) proportion of subjects detected with adenoma and advanced adenoma, and (iii)cecal intubation time. Methods:Studies were identified by searching Ovid MEDLINE, PubMed, and Cochrane Library database for studies published in English language between 1966 to October 2011 using a reproducible search strategy. References from retrieved articles and national meeting abstracts for past 3yrs were manually reviewed. Only prospective studies comparing CAC with SC in adult subjects were included. 2 reviewers independently scored identified studies for methodology and abstracted pertinent data. Pooling was conducted by random-effects model using MantelHaenszel method for dichotomous outcomes and inverse variance method for continuous outcomes. Cochran's Q-test with inverse variance weights and I2 test were used to assess heterogeneity. Outcomes measured were:(i)prevalence of polyps (number of subjects with polyps),(ii)prevalence of adenoma and advanced adenoma, and (iii)cecal intubation time. Results:14 studies met defined inclusion criteria (CAC-3172 and SC-3233 subjects). CAC detected a higher proportion of subjects with polyps [40% vs. 36%, OR 1.23 (95% CI 1.021.49), p=0.03]; with low heterogeneity (p=0.4, I2=2%) across 6 studies (CAC-970, SC1012) (Figure 1). There was no difference between the two groups with regards to proportion of subjects detected with adenomas [32% vs. 34%, OR 1.08 (95% CI 0.81-1.45), p=0.59], but significant heterogeneity (p<0.01, I2=72%) noted among the five studies with 3771 subjects (CAC-1972, SC-1799). Similarly, there was no difference between the two groups with regards to detection rates of advanced adenomas [10.7% vs. 12.4%, OR 0.9 (95% CI 0.57-1.4), p=0.63], with significant heterogeneity (p=0.04, I2=69%) noted across 3 studies with 2647 subjects (CAC-1316, SC-1331). CACwas associated with a shorter cecal intubation time [7.63 vs. 8.98 min, mean difference 0.88 (95% CI 0.35-1.42), p=0.001]; with significant heterogeneity (p<0.001, I2=84%) across the 13 studies included with 4984 subjects (CAC2473, SC-2511) (Figure 2). No complications attributable to CAC were noted in any of the studies. Conclusions:CAC is associated with improved polyp detection rate as well as shorter cecal intubation times. Although the adenoma detection rates were not different with CAC; given the heterogeneity of studies, more data are needed to make definite conclusions. CAC is a simple and efficient technique that has the potential to decrease the risk of interval colon cancer by improving the detection of polyps.

Colonoscope with a sub-distal hyper-flaccid segment for improved insertion at colonoscopy: a randomized study

Background. In sharp bends, particularly in the colonic flexures, the axial pushing force conveyed to the distal actively bending tip of the endoscope may cause impaction rather than progression. It is hypothesized that colonoscopes with a very flaccid segment immediately proximal to the distal bending tip might reduce this problem. Material and methods. Two prototype colonoscopes with a flaccid passively bending segment (either progressively graded or ungraded flaccidity) positioned immediately proximal to the distal actively bending tip was evaluated in a single-blinded randomized study. The primary end-point was patients' evaluation of pain. Results. Altogether, 400 patients were randomized 1:1 to examination with a prototype (60 patients to endoscope with graded flaccidity; 141 to the endoscope with ungraded flaccidity) or a standard colonoscope. The groups were similar regarding age, sex and previous abdominal surgery. Severe pain was reported by 7% of patients in the prototype and 18% in the standard group (p = 0.001). There was a trend toward shorter cecal intubation time in the prototype group (mean 14.1 min, 95% CI 12.8–15.3) compared to the standard group (mean 15.5 min, 95% CI 14.3–16.7) (p = 0.12) and similar intubation rates (89% and 85%, respectively). Results for first (ungraded flaccidity) and second (graded flaccidity) generation prototypes collectively were similar to the second generation separately. Conclusions. The concept of an endoscope with a hyper-flaccid segment may facilitate negotiation of sharp bends and reduce pain without compromising cecal intubation rate or intubation time.

Benefit of intravenous antispasmodic (hyoscyamine sulfate) as premedication for colonoscopy

Background: We sought to determine whether premedication for colonoscopy with intravenous hyoscyamine sulfate (Levsin) was helpful from the standpoint of the colonoscopist and the patient. Methods: One hundred sixteen adult patients were randomized to receive either 0.5 mg hyoscyamine sulfate intravenous (n = 57) or placebo (n = 59). After administration of study drug, patients were given meperidine and midazolam. Parameters measured included the time required to reach the cecum, total procedure time, and the endoscopist’s perception of the adequacy of sedation, difficulty of insertion, and amount of colonic spasm on insertion and withdrawal. Patients were given a postprocedure questionnaire assessing their experience. Results: In patients receiving hyoscyamine, there was a shorter cecal intubation time (median 9.2 vs. 12.9 minutes; p = 0.01), shorter total colonoscopy time (median 20.5 vs. 25.0 minutes; p = 0.01), better patient sedation ( p = 0.02), easier colonic insertion ( p = 0.001), and less spasm on insertion ( p = 0.01). No difference was found in the amount of spasm during withdrawal or the total dosages of meperidine or midazolam used. Patients receiving hyoscyamine sulfate reported being more comfortable during their procedures ( p < 0.001) and were more willing to repeat colonoscopy in the future ( p = 0.0001). The only adverse effect seen during the study was a 27% incidence of sinus tachycardia that occurred in patients receiving hyoscyamine. Conclusions: Premedication with intravenous hyoscyamine sulfate was beneficial in terms of the time required for cecal intubation, total procedure time, adequacy of sedation, and scales of patient comfort. However, the high frequency of sinus tachycardia seen with the dose used in our study, which was extremely rapid in two patients, indicates the need for further study before the drug can be recommended as a routine premedication for colonoscopy. (Gastrointest Endosc 1999;49:720-6.)