Total Colonoscopy Time Research Articles

Comparison of Colon Adenoma Detection Rate Using Transparent Cap-Assisted and Conventional Colonoscopy: Result from an International Trial in Asia.

Controversy remains regarding transparent cap-assisted technique improves adenoma detection rate (ADR) in colonoscopy. We aimed to investigate the effect of transparent cap-assisted colonoscopy (CAC) on ADR and other colonoscopy performance. We performed subanalysis of an international, multicenter, open-label database containing colonoscopy data from 11 centers in 4 Asian countries/regions on patients who underwent colonoscopy. The patient characteristics, procedure-related characteristics, and pathological findings of all detected lesions were prospectively recorded. The patients were divided into 2 groups as receiving colonoscopy with or without transparent cap attachment. The ADR and procedure time were compared between the 2 groups. Other procedural factors related to ADR were also investigated. Between November 2020 and January 2022, 3,029 who underwent colonoscopy (transparent CAC, n = 1,796; standard colonoscopy, n = 1,233) were enrolled in this study. The transparent CAC group ADR was significantly higher than the conventional colonoscopy (55.1% vs. 50.0%, p < 0.01). Transparent CAC detected a higher proportion of patients with adenoma (odd ratio [OR]: 1.59, 95% CI: 1.13-2.24, p < 0.01) and any polypoid lesion (OR: 1.49, 95% CI: 1.04-2.16, p = 0.03). Transparent CAC also reduced cecal intubation time (mean difference: -0.35 min) and total colonoscopy time (mean difference -3.4 min). In the other procedural factors, using linked-color imaging (OR: 1.75, 95% CI: 1.49-2.06, p < 0.01), patient body rotation (OR: 1.54, 95% CI: 1.12-2.13, p < 0.01), longer withdrawal time (OR: 1.12, 95% CI: 1.09-1.15, p < 0.01) were also significantly associated to adenoma detection. In real-world practice, transparent CAC is a safe and inexpensive technology that could improve adenoma and polyp detection.

Comparison of One-Person Technique and Two-Person Technique for Colonoscope Insertion: A Randomized Controlled Trial.

Background: The one-person technique (OPT) for colonoscope insertion is recommended by professional societies and regarded as standard practice. However, the two-person technique (TPT) has shown several advantages over the OPT. The aim of this study was to evaluate the performance of the TPT compared to the OPT. Methods: In this prospective study, consecutive individuals presenting for outpatient colonoscopy were randomized to undergo colonoscopy by OPT or by TPT. The colonoscopies were performed by six endoscopists, two of whom were beginners, two with intermediate skills, and two who were experts. The primary endpoints were quality indicators for colonoscopy, including adenoma detection rate, cecal intubation rate, cecal insertion time, and total colonoscopy time. A secondary outcome was procedure tolerability, as assessed by both the patients and the endoscopists. Results: Two hundred and four subjects (117 males, mean age 54.3) were randomized to either one- (n = 102) or two-person (n = 102) colonoscopy. The adenoma detection rate was 30.4% in OPT group and 34.3% in TPT group. (p = 0.55). No significant differences between the two groups were found in terms of cecal intubation rate (98/102 vs. 98/102), insertion time (411 vs. 381 s), and total examination time (1426 vs. 1296 s). However, patients receiving the TPT had lower pain scores than patients receiving the OPT. Endoscopist fatigue measured with the FACIT-F was also significantly lower in the TPT group. Conclusion: The two-person colonoscopy method was not shown to be technically or clinically inferior. Rather, the TPT can improve patient tolerance and reduce endoscopist fatigue.

Effect of Abdominal Corset on Completion of Colonoscopy and Cecal and Ileocecal Intubation Time in Patients with Central Obesity: A Prospective Randomized Controlled Trial.

This work investigated the effect of an abdominal corset on the colonoscopy completion rate, as well as cecum and ileum intubation time, total colonoscopy time, and pain score in centrally obese patients. Patients were randomized into two groups, with 50 patients in each group. A colonoscopy was performed using the abdominal corset in Group 1 and the standard method in Group 2. The comparison between the groups evaluated demographic data, procedure details, circulatory dynamics, anesthesia data, and visual analogue scale (VAS). Of the patients included in the study, 60 were female, and 40 were male, with a mean age of 57.3 ± 13.6 years. Cecal intubation time (Z: -2.66 p: 0.008), total colonoscopy time (Z: -2.180 p: 0.029), number of maneuvers (χ2: 8.391 p: 0.039), and VAS (Z: -3.087 p: 0.002) were significantly lower in the abdominal corset group. An abdominal corset that applies external abdominal compression reduces the cecal intubation time, the total colonoscopy time, the number of maneuvers, and the pain level. NCT03128645 (https://clinicaltrials.gov/study/NCT03128645?tab=results).

A comprehensive meta-analysis comparing the effectiveness and safety of cold snare polypectomy and hot snare polypectomy in removing colorectal polyps ≤ 10 mm.

The optimal methods for removing polyps remain controversial especially for polyps ≤10mm. We aim to combine the latest evidence to evaluate and compare the effectiveness and safety of cold snare polypectomy (CSP) and hot snare polypectomy (HSP) in the removal of colorectal polyps ≤10mm in size. We performed an extensive search across multiple databases, including PubMed, Embase, Cochrane, and Web of Science, with the search period ending in April 2023 for randomized controlled trials comparing the effectiveness and/or safety of CSP and HSP for the removal of ≤10mm colorectal polyps.The final outcomes included complete resection rate, operation time, and postoperative adverse events (including immediate bleeding, delayed bleeding, and perforation) rates. A total of 14 eligible randomized controlled trials were included, involving 7,460 patients and 15,829 polyps. The incidence of immediate bleeding was observed to be more prevalent in CSP in contrast to HSP, and the disparity was statistically notable (OR=2.18, 95% CI: 1.43-3.30, I2=36%, P=0.0003). The incidence of delayed bleeding was observed to be lower in CSP in contrast to HSP, and this difference was statistically significant (OR=0.30, 95% CI: 0.15-0.58, I2=0%, P=0.0003). Procedure time: both the total colonoscopy time and specific polypectomy time were shorter in CSP than in HSP (MD=-5.92, 95% CI: -9.70 to -2.14, I2=96%, P=0.002; MD=-0.56, 95% CI: -0.91 to -0.20, I2=77%, P=0.002). There were no statistically significant differences in complete resection and the polyp retrieval rate between CSP and HSP. CSP is as effective and safe as HSP for ≤10mm colorectal polyps, while effectively reducing the risk of delayed bleeding and shortening the procedure time.

HOT VERSUS COLD SNARE FOR COLORECTAL POLYPECTOMIES SIZED UP TO 10MM: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS.

Colorectal cancer is the third most common cancer, and prevention relies on screening programs with resection complete resection of neoplastic lesions. We aimed to evaluate the best snare polypectomy technique for colorectal lesions up to 10 mm, focusing on complete resection rate, and adverse events. A comprehensive search using electronic databases was conducted to identify randomized controlled trials comparing hot versus cold snare resection for polyps sized up to 10 mm, and following PRISMA guidelines, a meta-analysis was performed. Outcomes included complete resection rate, en bloc resection rate, polypectomy, procedure times, immediate, delayed bleeding, and perforation. Nineteen RCTs involving 8720 patients and 17588 polyps were included. Hot snare polypectomy showed a higher complete resection rate (RD, 0.02; 95%CI [+0.00,0.04]; P=0.03; I 2=63%), but also a higher rate of delayed bleeding (RD 0.00; 95%CI [0.00, 0.01]; P=0.01; I 2=0%), and severe delayed bleeding (RD 0.00; 95%CI [0.00, 0.00]; P=0.04; I 2=0%). Cold Snare was associated with shorter polypectomy time (MD -46.89 seconds; 95%CI [-62.99, -30.79]; P<0.00001; I 2=90%) and shorter total colonoscopy time (MD -7.17 minutes; 95%CI [-9.10, -5.25]; P<0.00001; I 2=41%). No significant differences were observed in en bloc resection rate or immediate bleeding. Hot snare polypectomy presents a slightly higher complete resection rate, but, as it is associated with a longer procedure time and a higher rate of delayed bleeding compared to Cold Snare, it cannot be recommended as the gold standard approach. Individual analysis and personal experience should be considered when selecting the best approach.

Endoscopic Detachable Snare Ligation Therapy for Colonic Diverticular Hemorrhage Improves Procedure Time Compared to Endoscopic Band Ligation.

The clipping method is widely used in endoscopic hemostasis for colonic diverticular hemorrhage. Recently, rebleeding was shown to be less common in ligation therapy than in clipping. Ligation methods include endoscopic band ligation (EBL) and endoscopic detachable snare ligation (EDSL). No studies have compared procedure times for EBL and EDSL. The present study aimed to compare EDSL and EBL in terms of procedure time. In this single-center retrospective observational cohort study, we evaluated the data of 39 patients who underwent EBL or EDSL for colonic diverticular hemorrhage. The primary and secondary outcomes measured were the total procedure time and early rebleeding rate, respectively. Among the 39 patients included in the study, 18 underwent EBL, and 21 underwent EDSL for hemostasis. The median total pro- cedure times for the EBL and EDSL groups were 50 (range, 30-80) minutes and 35 (range, 18-55) minutes, respectively, demonstrating that the total colonoscopy time was significantly shorter in the EDSL group (P < .001). The early rebleeding rate was 11.1% (2/18) in the EBL group and 4.8% (1/21) in the EDSL group (P = .246). Important improvements in procedure time were achieved in the EDSL group. Based on our results, we believe that EDSL may reduce patient and endoscopist burden.

Narrow band imaging versus white light for detecting sessile serrated lesion: A prospective randomized multicenter study.

ObjectivesColonoscopy is the gold standard diagnostic test used to detect early colorectal lesions and prevent colorectal carcinoma. Narrow band imaging (NBI) is an imaging technique that provides improved image resolution of the mucosa during endoscopy. Whether NBI improves the detection of sessile serrated lesion (SSL) is controversial—our aim was to assess this during routine colonoscopy.MethodsWe conducted a multicenter, prospective, randomized, controlled trial. Patients underwent colonoscopy for screening, surveillance, or symptoms. They were randomized to either high‐definition white light (HD‐WL) or NBI in a 1:1 ratio. The primary outcome was SSL detection rate. Secondary outcomes were adenoma detection rate (ADR) and polyp detection rate (PDR).ResultsA total of 400 patients were randomized to NBI (N = 200) or HD‐WL (N = 200). The total colonoscopy time was slightly longer in the NBI group compared to HD‐WL (median time 14 vs. 12 min, p = 0.033). There were no statistically significant differences in SSL detection rate (7.5% NBI vs. 8.0% HD‐WL; p = 0.852), ADR (41.0% NBI vs. 37.5% HD‐WL; p = 0.531), or PDR (61.0% NBI vs. 54.0% HD‐WL; p = 0.157) between the two groups. No significant predictors of SSL detection were found on univariable or multivariable analysis. Increasing age and increased withdrawal time were an independent predictors of polyp detection and increasing age was also an independent predictor of adenoma detection on multivariable analysis.ConclusionIn the hands of experienced colonoscopists, NBI does not improve SSL detection compared to HD‐WL. Withdrawal time and patient age remain important factors for polyp and adenoma detection.

S3116 Comparative Study of One-Person Technique and Two-Person Technique for Elective Colonoscopy in Ecuador

INTRODUCTION: Usually, colonoscopy insertion is performed by the colonoscopist (one-person technique). However, two-man method had shown several advantages over one-man method. The aim of this study is to evaluate the performance of two- person compared to one-person technique in colonoscopy. METHODS: In this prospective study, from July 2018 to February 2020, 876 colonoscopy examinations were recruited. These colonoscopy examinations were performed by five endoscopists in two centers. The primary end-point is adenoma detection rate. Secondary outcome measures included, cecal intubation rate (CIR), cecal intubation time (CIT), terminal ileum (TI) intubation rate, total colonoscopy time, procedure related complications, procedure tolerability between one-man and two-man method group were recorded. RESULTS: In this prospective study, from July 2018 to February 2020, 876 colonoscopy examinations were recruited. These colonoscopy examinations were performed by five endoscopists in two centers. The primary end-point is adenoma detection rate. Secondary outcome measures included, cecal intubation rate (CIR), cecal intubation time (CIT), terminal ileum (TI) intubation rate, total colonoscopy time, procedure related complications, procedure tolerability between one-man and two-man method group were recorded. CONCLUSION: Colonoscopy quality outcomes were not impaired between both groups, however two-man method can improve patient tolerance and reduce endoscopist fatigue.

S0259 Automated Polypectomy Time During Live Colonoscopy Using Convolutional Neural Networks - A Video Validation Study

INTRODUCTION: Numerous factors have been shown to influence total colonoscopy time such as patient characteristics, bowel preparation, and the skills of the endoscopist. Awareness of polypectomy time (PT) can be a useful tool to improve efficiency and more accurately document inspection time (withdrawal time minus polypectomy time). Manually recording PT is time-consuming and impractical. Our objective was to accurately measure PT at the point of care utilizing established convolutional neural networks (CNNs). METHODS: We previously reported the development and validation of CNNs for polyp detection (>99% accuracy, AUC 0.995)1 and tool detection ( >99% accuracy, AUC 0.999)2. These algorithms are run live during colonoscopy while recording video and time-stamped CNN prediction CSV files. A total of 118 consecutive CNN-assisted colonoscopies (Jan 2019 to April 2019) containing 184 polypectomies were analyzed to compare CNN predictions (CNN-PT) with a blinded expert video review (Expert-PT), regarded as the gold standard. The CNN-PT was defined by the first simultaneous predictions of a polyp and a device (biopsy forceps or snare) and the last prediction of a device. To account for repeated biopsies, piecemeal resection, or temporarily lost views during a single polyp encounter, a 6-second gap in CNN predictions of the device was allowed before resetting to a new CNN-PT encounter. Expert-PT was defined by the first and last appearance of a device(s) utilized to complete each polypectomy. The expert reviewer was blinded to the CNN-PT. Each Expert-PT was linked to its paired CNN-PT by timestamp. RESULTS: Compared to Expert-PTs, CNN-PTs were very accurate for polypectomy time (PT) (R2 = 0.935). The mean difference in polypectomy time between the expert video review and CNN predictions was 0.16 seconds. In 117 of 184 cases, there was no absolute difference between PTs predicted by CNNs versus expert video review. Outliers included cases of lost and refound polyps, poor preps and spasm.Figure 1.: Scatter plot comparing CNN-predicted polypectomy times to the expert video-validated review.Figure 2.: Histogram displaying the difference in seconds between expert review video-validated review and CNN-predicted polypectomy times.CONCLUSION: We have demonstrated the feasibility of using CNNs live during colonoscopy to automatically and accurately record PT. Such data could be used to monitor colonoscopy trainees for polypectomy efficiency, assess relative efficiencies of various polypectomy techniques and devices, and provide standardized measures of inspection time during withdrawal when a device is not being used.

Peppermint Oil to Improve Visualization in Screening Colonoscopy: A Randomized Controlled Clinical Trial

BackgroundScreening colonoscopy has been associated with reduced mortality from colorectal cancer by means of early detection and timely treatment. However, visualization during colonoscopy is often impaired since the colon is naturally prone to peristalsis and spasm. There is evidence to suggest benefit of topical peppermint oil in causing smooth muscle relaxation, thereby decreasing peristalsis. The aim of our study was to determine if peppermint oil helps reduce colonic spasticity so as to allow for better visualization during screening colonoscopy.MethodsWe performed a randomized controlled, double-blinded, clinical trial where patients undergoing screening colonoscopy were assigned to receive either peppermint oil or placebo. Once cecum was reached, 50 mL of either solution was directly injected via the working channel of the colonoscope. Colonic peristalsis, spasticity and bowel visibility were documented. Bowel preparation quality, withdrawal time and adenoma detection rate (ADR) were also assessed. Continuous variables were analyzed using t-test or Wilcoxon rank-sum test while categorical variables were compared using the two-way Chi-square test.ResultsForty-eight patients were included, of whom 24 patients received peppermint oil and 24 received placebo. Mean Boston bowel preparation score (BBPS) was excellent for both groups (8 points vs. 7.9 points; P = 0.98). Both mean total colonoscopy time (17.8 min vs. 21.9 min; P = 0.07) and mean cecal intubation time (7.2 min vs. 10.3 min; P = 0.04) were shorter with peppermint oil as compared to placebo. Complete absence of bowel spasticity was observed among 58.3% patients in the peppermint oil group as compared to 45.8% patients in the placebo group (P = 0.05). More than 75% of bowel was visualized in 83% of patients in both groups (P = 0.56). Mean ADR was higher in the peppermint group as compared to the placebo group (45.8% vs. 37.5%; P = 0.56).ConclusionOur study suggests that topical peppermint oil reduces bowel wall spasticity, which could lead to better visualization of the bowel during screening colonoscopy. Although use of peppermint oil was associated with better ADRs, these results did not achieve statistical significance. Larger sample size and use of alternative methods of peppermint oil administration allowing for more absorption time may establish stronger results.

Influence of Fellow Participation and Level of Fellowship Training on Adenoma Detection Rate of One Staff Endoscopist

Introduction: Adenoma detection rate (ADR) is the proportion of screening colonoscopies that detect at least one histologically confirmed tubular adenoma. In a study done with multiple endoscopists, we had shown that fellow participation did not influence ADR. To remove the influence of fellow participation with multiple endoscopists, we evaluated the influence of fellow participation on the ADR of a single endoscopist. We also assessed correlation between level of fellowship training and ADR. Methods: This was a retrospective chart review of screening colonoscopies done in a large medical center, performed/staffed by a single endoscopist, between April 2016 and June 2017. Fellows were classified based on year of training into first, second, and third. Those procedures with no documented cecal intubation, poor/ undocumented bowel preparation quality, ones with unrecovered tissue, were excluded. Data was analyzed using JMP 13 software. Results: 284 screening colonoscopies were analyzed, 206 (73%) done with fellow assistance, 78 (27%) without. 85.6 % of patients (n=243) were African American (AA) with a mean age of 58.3 vs. 59.6 in non-AA. Gender distribution by race was similar. The mean ages of patients were similar in both assisted and unassisted groups. ADR in AA was 57.8 % and 62.5 % in non-AA (p = 0.5). In the fellow-assisted group, ADR was 59.7%. ADR was 56.4 % in the unassisted group (p = 0.614). ADRs trended up with the year of fellowship training: Year 1 - 51%, Year 2 - 57.1%, Year 3 - 68.6% (p Conclusion: The mean age of our patients is considerably higher than recommended age of 50, which may partly explain the high ADR noted in the study. No significant difference was seen in ADR for AA vs. non-AA, probably due to the small number of non-AA. Involvement of a fellow does not impact the ADR of the staff endoscopist. Involvement of a Year 1 fellow, however, does increase the procedure duration. As fellows progress through levels of fellowship training the expected trend towards improvement in the ADR and decrease in the total colonoscopy time is confirmed.2757 Figure 1. Showing the duration of colonoscopies for assisted (divided into fellow year 1, 2 and 3) and the unassisted procedures.

Full‐spectrum versus standard colonoscopy for improving polyp detection rate: A systematic review and meta‐analysis

Full-spectrum endoscopy represents a new endoscopic platform allowing a panoramic 330 degree view of the colon, but evidence of its superiority over standard colonoscopy is still lacking. Our study is the first meta-analysis comparing the efficacy of full-spectrum endoscopy with standard colonoscopy. Through a systematic literature review until May 2017, we identified eight randomized-controlled trials. Primary outcomes were polyp detection rate and adenoma detection rate, while cecal intubation time and total colonoscopy time were secondary outcomes. Direct meta-analysis was performed using a random effects model. No difference in terms of polyp detection rate and adenoma detection rate was found (risk ratio: 1.00, 95% confidence interval 0.89-1.12, P=0.96, and 1.05, 0.94-1.17, P=0.40, respectively). Adenoma miss rate resulted significantly in favor of full-spectrum endoscopy (risk ratio: 0.35, 0.25-0.48, P<0.01), although the difference was not significant for greater (>5mm) and pedunculated lesions (risk ratio: 0.38, 0.09-1.60, P=0.19, and risk ratio: 0.15, 0.01-3.00, P=0.21, respectively). Cecal intubation time was not different between the two techniques (mean standardized difference: 0.22min, -1.18 to 1.62, P=0.76), while total colonoscopy time was significantly shorter when adopting full-spectrum endoscopy (mean difference: -2.60, -4.60 to -0.61, P=0.01). Sensitivity analysis confirmed all the findings. Full-spectrum endoscopy appears as a promising and reliable technology able to significantly decrease the number of adenomas missed and procedural times, while its superiority over standard colonoscopy in terms of adenoma detection rate results is still unclear.

Cap-assisted colonoscopy versus standard colonoscopy: is the cap beneficial? A meta-analysis of randomized controlled trials.

Background:In an effort to improve visualization during colonoscopy, a transparent plastic cap or hood may be placed on the end of the colonoscope. Cap-assisted colonoscopy (CAC) has been studied and is thought to improve polyp detection. Numerous studies have been conducted comparing pertinent clinical outcomes between CAC and standard colonoscopy (SC) with inconsistent results.Methods:Numerous databases were searched in November 2016. Only randomized controlled trials (RCTs) involving adult subjects that compared CAC to SC were included. Outcomes of total colonoscopy time, time to cecum, cecal intubation rate, terminal ileum intubation rate, polyp detection rate (PDR), and adenoma detection rate (ADR) were analyzed in terms of odds ratio (OR) or mean difference (MD) with fixed effect and random effects models.Results:Five hundred eighty-nine articles and abstracts were discovered. Of these, 23 RCTs (n=12,947) were included in the analysis. CAC showed statistically significant superiority in total colonoscopy time (MD -1.51 min; 95% confidence interval [CI] -2.67 to -0.34; P<0.01) and time to cecum (MD -0.82 min; 95%CI -1.20 to -0.44; P<0.01) compared to SC. CAC also showed better PDR (OR 1.17; 95%CI 1.06-1.29; P<0.01) but not ADR (OR 1.11; 95%CI 0.95-1.30; P=0.20). In contrast, on sensitivity analysis, ADR was better with CAC. Terminal ileum intubation and cecal intubation rates demonstrated no significant difference between the two groups (P=0.11 and P=0.73, respectively).Conclusions:The use of a transparent cap during colonoscopy improves PDR while reducing procedure times. ADR may improve in cap-assisted colonoscopy but further studies are required to confirm this.

Elimination of waste: creation of a successful Lean colonoscopy program at an academic medical center.

Lean processes involve streamlining methods and maximizing efficiency. Well established in the manufacturing industry, they are increasingly being applied to health care. The objective of this study was to determine feasibility and effectiveness of applying Lean principles to an academic medical center colonoscopy unit. Lean process improvement involved training endoscopy personnel, observing patients, mapping the value stream, analyzing patient flow, designing and implementing new processes, and finally re-observing the process. Our primary endpoint was total colonoscopy time (minutes from check-in to discharge) with secondary endpoints of individual segment times and unit colonoscopy capacity. A total of 217 patients were included (November 2013-May 2014), with 107 pre-Lean and 110 post-Lean intervention. Pre-Lean total colonoscopy time was 134min. After implementation of the Lean process, mean colonoscopy time decreased by 10% to 121min (p=0.01). The three steps of the process affected by the Lean intervention (time to achieve adequate sedation, time to recovery, and time to discharge) decreased from 3.7 to 2.4min (p<0.01), 4.0 to 3.4min (p=0.09), and 41.2 to 35.4min (p=0.05), respectively. Overall, unit capacity of colonoscopies increased from 39.6 per day to 43.6. Post-Lean patient satisfaction surveys demonstrated an average score of 4.5/5.0 (n=73) regarding waiting time, 4.9/5.0 (n=60) regarding how favorably this experienced compared to prior colonoscopy experiences, and 4.9/5.0 (n=74) regarding professionalism of staff. One hundred percentage of respondents (n=69) stated they would recommend our institution to a friend for colonoscopy. With no additional utilization of resources, a single Lean process improvement cycle increased productivity and capacity of our colonoscopy unit. We expect this to result in increased patient access and revenue while maintaining patient satisfaction. We believe these results are widely generalizable to other colonoscopy units as well as other process-based interventions in health care.

The Efficacy of Cap-Assisted Colonoscopy in Polyp Detection and Cecal Intubation: A Meta-Analysis of Randomized Controlled Trials

The role of cap-assisted colonoscopy (CAC) in polyp detection and cecal intubation is unclear. We conducted a meta-analysis to compare the efficacy of CAC vs. standard colonoscopy (SC). Publications in English and non-English literatures (OVID, MEDLINE, and EMBASE) and abstracts in major international conferences were searched for controlled trials comparing CAC and SC. Outcome measures included the proportion of patients with polyps or adenomas detected, cecal intubation rate, cecal intubation time, and total colonoscopy time. The statistical heterogeneity of trials was examined and the effects were pooled by random-effects model. The risk of bias was evaluated by the assessment tool from the Cochrane Handbook. Subgroup analyses were performed for possible clinical and methodological heterogeneities. From 2,358 citations, 16 randomized controlled clinical trials were included consisting of 8,991 subjects (CAC: 4,501; SC: 4,490). Mean age of subjects was 61.0 years old and 60% were males. CAC detected a higher proportion of patients with polyp(s) (relative risk (RR): 1.08; 95% confidence interval (CI): 1.00-1.17) and reduced the cecal intubation time (mean difference: -0.64 min; 95% CI: -1.19 to -0.10). Cecal intubation rate (RR: 1.00; 95% CI: 0.99-1.02) and total colonoscopy time (mean difference: -0.97 min; 95% CI: -2.33 to 0.40) were comparable between the two groups. In subgroup analyses, a short cap (≤4 mm) was associated with improved polyp detection, whereas a long cap (≥7 mm) was associated with a shorter cecal intubation time. CAC demonstrated marginal benefit over SC for polyp detection and shortened the cecal intubation time.

Increased Adenoma Detection Rate with System-wide Implementation of a Split-Dose Preparation for Colonoscopy

Purpose: Background: Effective colonoscopy depends on achieving a good quality bowel preparation. Split-dose preparations (SDP) appear to improve the quality of preparation and patient compliance. Its effects on other quality indicators of colonoscopy are not well delineated. Aim: To compare the quality of preparation, cecal intubation rates and adenoma detection rates (ADR) before and after implementation of a SDP as the primary choice in our colonoscopy practice. Methods: Data were obtained from our endoscopy and pathology databases from 1/2009 to 12/2009 (Pre-SDP) and from 10/2010 to 3/2011 (Post-SDP). SDP options were 4 L PEG solution or MoviPrep consumed half the night before and half on the day of the procedure. Patient demographics, the quality of preparation, cecal intubation rates, ADR, total colonoscopy time and withdrawal times were compared between the two study periods using Chisquare and t-test with significance set at p < 0.05. The odds ratio (95% CI) for adenoma detection was estimated using Generalized Estimating Equations to control for clustering among endoscopists. Results: Colonoscopy was completed in 5492 patients Pre-SDP and 2523 patients Post-SDP for all indications. After excluding patients with indications of bleeding/anemia, inflammatory bowel disease, and cancer and those with incomplete data, there were 3560 patients in the Pre-SDP group 1615 patients in the Post-SDP group. SDP use increased from 9% to 74% during Post-SDP period. Groups were similar in age, BMI and gender. Post-SDP, bowel preparation quality improved significantly, and the proportion of patients with good/excellent preps increased by 19% (p < 0.001). Post-SDP cecal intubation rates and ADR significantly increased. Post-SDP ADR increased from 20% to 28% in female patients (p=0.0001) and from 33% to 36% (p = 0.15) in male patients. Controlling for gender, age, and BMI, the odds of detecting an adenoma Post-SDP was 1.32 (95% CI 1.16-1.51) compared with Pre-SDP. Conclusion: System wide implementation of split-dose preparations as the primary choice for colonoscopy significantly improved quality of preparation, cecal intubation rates and adenoma detection rates.Table: No Caption available.

Appointment waiting times and education level influence the quality of bowel preparation in adult patients undergoing colonoscopy

BackgroundRisk factors for poor bowel preparation are recognized to be independent of the type of bowel preparation method used. Patient and administrative factors influencing bowel preparation are known to vary in different healthcare systems.MethodsA prospective, cross-sectional study of patients undergoing colonoscopy in an Asian tertiary centre was conducted to identify risk factors associated with poor bowel preparation, and to evaluate the impact of poor bowel preparation on technical performance and patient comfort.ResultsData on 501 patients (mean age 60.1 ± 14.0 years old, 51.2% males, 60.9% with secondary education or higher) was available for analysis. Poor bowel preparation was present in 151 patients (30.1%). Lower education level (OR = 2.35, 95% CI = 1.54 - 3.60), colonoscopy appointment waiting time beyond 16 weeks (OR = 1.86, 95% CI = 1.04 - 3.37) and non-adherence to bowel preparation instructions (OR = 4.76, 95% CI = 3.00 - 7.55) were identified as independent risk factors for poor bowel preparation. Poor bowel preparation was associated with a lower cecal intubation rate (78.1% versus 98.3%, p < 0.001), prolonged total colonoscopy time (25.4 ± 12.6 minutes versus 16.7 ± 10.2 minutes, p < 0.001), and increased patient discomfort during colonoscopy (patient with moderate to severe abdominal discomfort 31.8% versus 3.2%, p < 0.001).ConclusionsEducation levels and appointment waiting times, in addition to non-adherence to bowel preparation instructions, increase the risk of poor bowel preparation in adult patients undergoing colonoscopy. The latter has a significant impact on colonoscopy performance and patient comfort.

Transparent cap improves patients' tolerance of colonoscopy and shortens examination time by inexperienced endoscopists

Up to 10% of colonoscopy procedures cannot be completed and polyps may be missed because of patients' discomfort and the endoscopists' technique. The aim of this study was to test the feasibility and safety of attaching a transparent cap to improve the outcome, especially for inexperienced endoscopists. A total of 250 patients were randomized to undergoing either a cap-fitted colonoscopy (CCF) or a normal colonoscopy without a cap (NCCF). The procedures were performed by an experienced or inexperienced endoscopist, and the time to reach the cecum, the total colonoscopy time and the polyp detection rate were recorded. Visual analogue scales (VAS) assessing the severity of abdominal pain and distension were obtained. For the experienced endoscopist there was no difference between CCF and NCCF on the time to reach the cecum and the time for the whole procedure. But for the inexperienced endoscopist, both times were significantly shorter in the CCF group than in the NCCF group (9.48 min vs. 12.45 min; 18.50 min vs. 21.89 min, respectively, P < 0.05). No complication was observed except some abdominal pain and distension. The VAS scores of abdominal pain and distension were significantly lower in CCF group than those in the NCCF group for the two endoscopists. There was no significant difference in the number of polyps found between the two groups. A cap-fitted colonoscopy can shorten the examination time for inexperienced endoscopists. It can also reduce the patients' discomfort during the procedure.

Prospective randomized controlled trial evaluating cap-assisted colonoscopy vs standard colonoscopy

To study the significance of cap-fitted colonoscopy in improving cecal intubation time and polyp detection rate. This study was a prospective randomized controlled trial conducted from March 2008 to February 2009 in a tertiary referral hospital at Sydney. The primary end point was cecal intubation time and the secondary endpoint was polyp detection rate. Consecutive cases of total colonoscopy over a 1-year period were recruited. Randomization into either standard colonoscopy (SC) or cap-assisted colonoscopy (CAC) was performed after consent was obtained. For cases randomized to CAC, one of the three sizes of cap was used: D-201-15004 (with a diameter of 15.3 mm), D-201-14304 (14.6 mm) and D-201-12704 (13.0 mm). All of these caps were produced by Olympus Medical Systems, Japan. Independent predictors for faster cecal time and better polyp detection rate were also determined from this study. There were 200 cases in each group. There was no significant difference in terms of demographic characteristics between the two groups. CAC, when compared to the SC group, had no significant difference in terms of cecal intubation rate (96.0% vs 97.0%, P = 0.40) and time (9.94 +/- 7.05 min vs 10.34 +/- 6.82 min, P = 0.21), or polyp detection rate (32.8% vs 31.3%, P = 0.75). On the subgroup analysis, there was no significant difference in terms of cecal intubation time by trainees (88.1% vs 84.8%, P = 0.40), ileal intubation rate (82.5% vs 79.0%, P = 0.38) or total colonoscopy time (23.24 +/- 13.95 min vs 22.56 +/- 9.94 min, P = 0.88). On multivariate analysis, the independent determinants of faster cecal time were consultant-performed procedures (P < 0.001), male patients (P < 0.001), non-usage of hyoscine (P < 0.001) and better bowel preparation (P = 0.01). The determinants of better polyp detection rate were older age (P < 0.001), no history of previous abdominal surgery (P = 0.04), patients not having esophagogastroduodenoscopy in the same setting (P = 0.003), trainee-performed procedures (P = 0.01), usage of hyoscine (P = 0.01) and procedures performed for polyp follow-up (P = 0.01). The limitations of the study were that it was a single-center experience, no blinding was possible, and there were a large number of endoscopists. CAC did not significantly different from SC in term of cecal intubation time and polyp detection rate.

Efficacy of Transparent Cap-attached Colonoscopy: Does It Improve the Quality of Colonoscopy?

Purpose: Recently, the use of a transparent cap attached to the tip of the colonoscope has been revealed to be helpful in both detecting colorectal polyps and shortening the intubation time to the cecum. The aim of this study was to examine the usefulness of transparent cap-attached colonoscopy (CAC) as compared with conventional colonoscopy (CC) in terms of the technical ease and efficiency. Methods: Colonoscopies from a total of 228 patients between May and October 2008 were prospectively collected. All colonoscopies were performed by single colorectal surgeon whose experience exceeded 3,000 colonoscopies. Patients were assigned to the CAC group (n=114) or to the CC group (n=114). The cecal intubation rate and time, the polyp detection rate, the adenoma detection rate, the withdrawal time, and the visual analogue scale (VAS) of the patient’s pain were compared. Results: There were no significant differences in the age, sex, body mass index, previous history of abdominal operation, diverticulosis, and the degree of bowel preparation between the two groups. The cecal intubation rate was 100% in both groups. The cecal intubation time was significantly shorter in the CAC group than in the CC group overall (5.3 ±4.0 min vs. 7.6±4.3 min, P<0.001), as well as for female (6.1±2.8 min vs. 9.1±4.7 min, P<0.001) patients. There were no statistically significant differences in the total colonoscopy time (13.1±6.3 min vs. 14.5±5.2 min, P=0.066), the polyp detection rate (38.6% vs. 33.3%, P=0.408), the adenoma detection rate (28.1% vs. 25.4%, P=0.654), and the VAS scale of pain (2.48 vs. 2.74, P=0.353) between the CAC and the CC groups. Conclusion: The transparent cap is effective in shortening the cecal intubation time, especially in female patients.