Andrew W Yen1, Joseph W Leung, Felix W Leung. 1. Division of Gastroenterology, Sacramento Veterans Affairs Medical Center, VANCHCS ; Division of Gastroenterology and Hepatology, University of California Davis Medical Center.
Abstract
BACKGROUND & AIMS: Colonoscopy plays an important and central role in current colorectal cancer screening and prevention programs, but it is an imperfect tool. Adjunct techniques may help improve the performance of colonoscopy to increase the detection of polyps with neoplastic potential. This study investigates the novel approach of combined water-exchange and cap-assisted colonoscopy (WCC) and its impact on adenoma detection. METHODS: A single-center single-colonoscopist consecutive group observational study to compare WCC with conventional air insufflation colonoscopy was performed. Data were collected from 50 consecutive patients undergoing outpatient colorectal cancer screening or polyp surveillance with WCC. Adenoma detection rates (ADR) and adenomas detected per colonoscopy (APC) were compared to a control group of 101 consecutive patients examined with conventional air colonoscopy during the immediate prior period. RESULTS: Cecal intubation was achieved in all patients. As an emerging and alternative quality metric for colonoscopy, APC was significantly higher in the WCC group (3.08 vs. 1.50, p=0.0021). The conventional quality metric, overall ADR, was higher in the WCC group compared to the air colonoscopy group (70.0% vs. 59.4%, p=0.22). This difference was not statistically significant, likely due to a type II error. CONCLUSION: The observational data suggest APC is a more sensitive indicator of quality colonoscopy than ADR. WCC shows promise as a novel technique that merges two simple adjunct methods to help improve the performance of colonoscopy. The data suggest larger, prospective studies are necessary to determine the true impact of water-exchange combined with cap-assisted maneuvers.
BACKGROUND & AIMS: Colonoscopy plays an important and central role in current colorectal cancer screening and prevention programs, but it is an imperfect tool. Adjunct techniques may help improve the performance of colonoscopy to increase the detection of polyps with neoplastic potential. This study investigates the novel approach of combined water-exchange and cap-assisted colonoscopy (WCC) and its impact on adenoma detection. METHODS: A single-center single-colonoscopist consecutive group observational study to compare WCC with conventional air insufflation colonoscopy was performed. Data were collected from 50 consecutive patients undergoing outpatientcolorectal cancer screening or polyp surveillance with WCC. Adenoma detection rates (ADR) and adenomas detected per colonoscopy (APC) were compared to a control group of 101 consecutive patients examined with conventional air colonoscopy during the immediate prior period. RESULTS: Cecal intubation was achieved in all patients. As an emerging and alternative quality metric for colonoscopy, APC was significantly higher in the WCC group (3.08 vs. 1.50, p=0.0021). The conventional quality metric, overall ADR, was higher in the WCC group compared to the air colonoscopy group (70.0% vs. 59.4%, p=0.22). This difference was not statistically significant, likely due to a type II error. CONCLUSION: The observational data suggest APC is a more sensitive indicator of quality colonoscopy than ADR. WCC shows promise as a novel technique that merges two simple adjunct methods to help improve the performance of colonoscopy. The data suggest larger, prospective studies are necessary to determine the true impact of water-exchange combined with cap-assisted maneuvers.
Entities:
Keywords:
adenoma; cap-assisted colonoscopy; colon cancer; colonoscopy; screening; water colonoscopy
Authors: Thomas J W Lee; Matthew D Rutter; Roger G Blanks; Sue M Moss; Andrew F Goddard; Andrew Chilton; Claire Nickerson; Richard J Q McNally; Julietta Patnick; Colin J Rees Journal: Gut Date: 2011-09-22 Impact factor: 23.059
Authors: Charles J Kahi; David G Hewett; Dustin Lee Norton; George J Eckert; Douglas K Rex Journal: Clin Gastroenterol Hepatol Date: 2010-10-01 Impact factor: 11.382
Authors: Mandeep S Sawhney; Marcelo S Cury; Naama Neeman; Long H Ngo; Janet M Lewis; Ram Chuttani; Douglas K Pleskow; Mark D Aronson Journal: Gastroenterology Date: 2008-08-27 Impact factor: 22.682
Authors: S J Winawer; A G Zauber; M N Ho; M J O'Brien; L S Gottlieb; S S Sternberg; J D Waye; M Schapiro; J H Bond; J F Panish Journal: N Engl J Med Date: 1993-12-30 Impact factor: 91.245
Authors: Fazia A Mir; Christine Boumitri; Imran Ashraf; Michelle L Matteson-Kome; Douglas L Nguyen; Srinivas R Puli; Matthew L Bechtold Journal: Ann Gastroenterol Date: 2017-07-24