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Huang ES, Huang Q, Kenkare P, Mudiganti S, Martinez MC, Liang SY. Prevalence of "one and done" phenomenon in adenoma detection within a large community-based healthcare system. Gastrointest Endosc 2025; 101:1038-1050.e2. [PMID: 39481577 DOI: 10.1016/j.gie.2024.10.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Revised: 10/07/2024] [Accepted: 10/28/2024] [Indexed: 11/02/2024]
Abstract
BACKGROUND AND AIMS Adenoma detection rate (ADR) is a key quality metric in colonoscopy, reflecting the ability to detect adenomas. However, concerns remain regarding the robustness of ADR as a benchmark. In particular, the "one and done" phenomenon may exist in which physicians are less motivated to find additional adenomas after discovery of the first adenoma. To investigate this topic further, our goal was to understand the relationship between single and multiple adenoma detection. METHODS A retrospective cohort study was conducted by using data from 89,587 screening colonoscopies performed by 32 endoscopists within the Sutter Health-Palo Alto Medical Foundation between 2015 and 2020. ADR, single adenoma detection rate (ADR1), and multiple adenoma detection rate (ADR2+) were analyzed by using multivariate logistic regression and linear regression models. Endoscopists were then fit into 4 categories based on median ADR1 and ADR2+ (low ADR1, high ADR2+ ["all or none"], low ADR1, low ADR2+ ["none and done"], high ADR1, high ADR2+ ["all and done"], or high ADR1, low ADR2+ ["one and done"]). RESULTS The overall ADR was 45.4%. ADR, ADR1, and ADR2+ were significantly associated with similar factors, including older age, male sex, higher body mass index, smoking status, high-risk colonoscopies, Medicare insured, use of mucosal assist devices, longer withdrawal times, adequate preparation, and procedures performed by high-volume, female endoscopists with a longer duration in practice. The median ADR1 and ADR2+ were 23.95% and 21.29%, respectively. ADR1 and ADR2+ were positively correlated (Pearson correlation coefficient [r], .701; P < .001). Only 4 of 32 endoscopists fit our "one and done" category. CONCLUSIONS These findings suggest that ADR1 correlates with ADR2+. Despite concerns, the "one and done" phenomenon is not commonly seen in clinical practice. ADR remains a good surrogate marker for multiple adenoma detection.
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Affiliation(s)
- Edward S Huang
- Department of Gastroenterology, Palo Alto Medical Foundation, Sutter Health, San Jose, CA.
| | - Qiwen Huang
- Center for Health Systems Research, Palo Alto, CA
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Hagen R, Nguyen MTT, Anderson JC, Birk JW. Navigating Bowel Preparation for Colonoscopy: A Comprehensive Overview. J Clin Gastroenterol 2025; 59:285-297. [PMID: 39761153 DOI: 10.1097/mcg.0000000000002124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2025]
Abstract
Colorectal cancer (CRC) is the third most common cancer in the United States. Early detection through colonoscopy significantly improves survival rates. Detecting colon polyps depends on the quality of bowel preparation. However, inadequate bowel preparation remains a significant issue in clinical practice. Efforts to address this challenge have led to the development of bowel preparation regimens emphasizing efficacy, tolerability, and safety. Bowel preparation options can be categorized by their osmotic and volume properties. Isosmotic solutions based on polyethylene glycol-electrolyte lavage solutions (PEG-ELS) are available in both low-volume PEG-ELS with ascorbic acid (PEG-Asc) (e.g., MoviPrep, PLENVU) and high-volume formulations (e.g., GoLYTELY, CoLyte), as well as sulfate-free high-volume PEG-ELS formulations (SF-PEG-ELS). Hyperosmotic solutions include oral sulfate solution (OSS) (e.g., SUPREP), sodium phosphate tablets (NaP) (e.g., OsmoPrep), oral sulfate tablets (OST) (e.g., SUTAB), flavored PEG with sulfate salts (FPSS) (e.g., SUFLAVE), and magnesium citrate. Hypoosmotic solutions consist of PEG-sports drink (PEG-SD). In addition, combination solutions are available, such as sodium picosulfate with magnesium citrate (SPMC) with laxatives (e.g., CLENPIQ), and OSS with SF-PEG-ELS (Suclear). Each regimen differs in terms of cost, volume, taste, contraindications, and potential adverse effects. Therefore, clinicians must carefully evaluate each patient to determine the most suitable regimen for their patients.
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Affiliation(s)
| | - Minh Thu T Nguyen
- Department of Medicine
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Connecticut Health Center, Farmington, CT
| | - Joseph C Anderson
- Division of Gastroenterology and Hepatology, Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - John W Birk
- Department of Medicine
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Connecticut Health Center, Farmington, CT
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Maramraj S, Yeap E. Impact of Bowel Preparation Type on Colonoscopy Quality and Adenoma Detection: A Comparative Study. Cureus 2025; 17:e82969. [PMID: 40416163 PMCID: PMC12103923 DOI: 10.7759/cureus.82969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2025] [Indexed: 05/27/2025] Open
Abstract
Background Colorectal cancer (CRC) is a leading cause of cancer-related mortality worldwide. Colonoscopy is the gold standard for CRC screening, but its effectiveness depends on bowel preparation quality. This study compares polyethylene glycol (PEG)-based MoviPrep (Norgine Limited, Hengoed, UK) and sodium picosulfate-based Picolax (Ferring GmbH, Kiel, Germany) in terms of bowel cleansing quality, caecal and ileal intubation rates, and adenoma detection rate (ADR). Methods This retrospective observational study analysed 6,921 colonoscopies performed at University Hospital Crosshouse between June 2020 and June 2023. Bowel preparation quality was assessed using the modified Ottawa Bowel Preparation Scale, categorised as Excellent, Good, Fair, or Inadequate. ADR was determined by histologically confirmed adenomas. Statistical comparisons between the two groups were performed using chi-square tests. Results MoviPrep was used in 6,219 (89.9%) of cases, while Picolax was used in 702 (10.1%) cases. MoviPrep was associated with a lower inadequate preparation rate (343 (5.5%) vs. 63 (9.0%)), a higher caecal intubation rate (3,675 (59.1%) vs. 307 (43.7%)) and ileal intubation rate (1,119 (18.0%) vs. 81 (11.5%)), and a higher ADR (2,295 (36.9%) vs. 167 (23.8%)). Conclusion MoviPrep demonstrated superior bowel cleansing, higher completion rates, and greater adenoma detection, supporting its use as a preferred bowel preparation method for colonoscopy in clinical practice.
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Affiliation(s)
| | - Elaine Yeap
- General and Colorectal Surgery, University Hospital Crosshouse, Kilmarnock, GBR
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Zhang D, Zhao C, Tao Y, Zhang J, Zhang Q, Li D, Ye P, Yu X, Chen C. Remedial colon hydrotherapy device enema as a salvage strategy for inadequate bowel preparation for colonoscopy: A retrospective cohort study. PLoS One 2025; 20:e0319493. [PMID: 40106477 PMCID: PMC11922272 DOI: 10.1371/journal.pone.0319493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Accepted: 02/03/2025] [Indexed: 03/22/2025] Open
Abstract
OBJECTIVE Colon hydrotherapy devices serve as a physiotherapeutic modality to manage colonic disorders by promoting intestinal peristalsis and enhancing gastrointestinal functionality. This study aims to assess and compare the effectiveness, safety, and tolerability of two remedial strategies for inadequate bowel preparation: colon hydrotherapy device enema and oral polyethylene glycol electrolyte powder. METHODS A retrospective analysis was performed on 109 patients who failed to adequately prepare for colonoscopy. These patients received remedial bowel preparation on the same day as their procedure, with 55 undergoing colon hydrotherapy enema and 54 receiving oral polyethylene glycol electrolyte powder. Patient satisfaction and tolerance were evaluated through telephone follow-up. Key metrics included the Boston Bowel Preparation Scale scores, preparation time, incidence of adverse reactions, and patient tolerance and satisfaction. RESULTS No significant differences were observed in baseline characteristics between groups (P > 0.05). The Boston Bowel Preparation Scale scores for the entire colon were 7 (3) in the hydrotherapy group and 6.5 (1) in the oral group (z = -2.075, P = 0.038). Notably, scores for the left colon were significantly higher in the hydrotherapy group [3 (1) vs. 2 (0), z = -5.586, P < 0.001]. The hydrotherapy group also exhibited a shorter preparation time [80 (20) min vs. 92.5 (20) min, z = -3.961, P < 0.001] and a lower incidence of adverse effects (36.4% vs. 88.9%, χ² = 32.035, P < 0.001). Patient satisfaction metrics, including re-selection rates and tolerance of side effects, were significantly higher in the hydrotherapy group. CONCLUSIONS The colon hydrotherapy device enema is an effective, efficient, and well-tolerated method for bowel cleansing, demonstrating a low incidence of adverse events. It is recommended as an effective and safe remedial therapy for patients with inadequate bowel preparation prior to colonoscopy.
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Affiliation(s)
- Dongxuan Zhang
- Department of Gastroenterology, Beijing Changping Hospital of Traditional Chinese Medicine, Beijing, China
| | - Chunxia Zhao
- Department of Neurology, Aerospace Center Hospital, Beijing, China.
| | - Yuan Tao
- Department of Gastroenterology, Beijing Changping Hospital of Traditional Chinese Medicine, Beijing, China
| | - Jiao Zhang
- Department of Gastroenterology, Beijing Changping Hospital of Traditional Chinese Medicine, Beijing, China
| | - Qisheng Zhang
- Department of Gastroenterology, Beijing Changping Hospital of Traditional Chinese Medicine, Beijing, China
| | - Da Li
- Department of Gastroenterology, Beijing Changping Hospital of Traditional Chinese Medicine, Beijing, China
| | - Ping Ye
- Department of Gastroenterology, Beijing Changping Hospital of Traditional Chinese Medicine, Beijing, China
| | - Xiaobo Yu
- Department of Gastroenterology, Beijing Changping Hospital of Traditional Chinese Medicine, Beijing, China
| | - Chao Chen
- Department of Gastroenterology, Beijing Changping Hospital of Traditional Chinese Medicine, Beijing, China
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Machlab S, Lorenzo-Zúñiga V, Pantaleon MA, Sábado F, Arieira C, Pérez Arellano E, Cotter J, Carral D, Turbí Disla C, Gorjão R, Esteban JM, Rodriguez S. Real-world effectiveness and safety of 1L polyethylene glycol and ascorbic acid for bowel preparation in patients aged 80 years or older. Endosc Int Open 2025; 13:a25259938. [PMID: 40018074 PMCID: PMC11866040 DOI: 10.1055/a-2525-9938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Accepted: 01/15/2025] [Indexed: 03/01/2025] Open
Abstract
Background and study aims Clinical trials and real-world studies show a 1L polyethene glycol and ascorbic acid solution (1L PEG-ASC) to be an effective and safe bowel preparation for colonoscopy in the general population. Here, the effectiveness and safety of 1L PEG-ASC were evaluated in patients aged 80 years or older in a real-world setting. Patients and methods A post-hoc analysis of an observational, multicenter, retrospective study assessed the effectiveness and safety of 1L PEG-ASC on outpatients aged ≥ 80 years old undergoing colonoscopy at eight centers in Spain and Portugal. Cleansing quality was assessed using the Boston Bowel Preparation Scale, with overall scores ≥ 6 and all segmental scores ≥ 2 considered adequate colon cleansing, and overall scores ≥ 8 or 3 in the right colon considered high-quality cleansing. Cecal intubation rate, withdrawal time, polyp and adenoma detection rates (ADR), and adverse events (AEs) were also monitored. Results Data were analyzed from 423 patients aged ≥ 80 years; mean age 83.5 years (±3.2) and 49.2% males. The adequate colon cleansing success rate was 88.9%, with high-quality cleansing of the overall and right colon achieved in 54.1% and 46.1% of patients, respectively. Colonoscopy was complete in 94.1% of cases and the ADR was 51.3%. At least one AE was experienced by 4.5% of participants, the most frequent being mild dehydration (2.8%) and nausea (1.2%). Conclusions This post-hoc analysis confirms 1L PEG-ASC to be an effective and safe bowel cleansing preparation for patients aged 80 years or older in a real-world setting.
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Affiliation(s)
- Salvador Machlab
- Gastroenterology, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
| | | | | | - Fernando Sábado
- Gastroenterology, Consorcio Hospitalario Provincial de Castelló, Castellón, Spain
| | - Cátia Arieira
- Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | | | - José Cotter
- Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal
- School of Medicine, Universidade do Minho, Life and Health Sciences Research Institute (ICVS), Braga/Guimarães, Portugal
- Gastroenterology, ICVS/3B’s – PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - David Carral
- Gastroenterology, Hospital San Rafael, A Coruña, Spain
| | - Carmen Turbí Disla
- Medical Affairs, Norgine, Harefield, United Kingdom of Great Britain and Northern Ireland
| | - Ricardo Gorjão
- Gastroenterology, Hospital CUF Descobertas, Lisboa, Portugal
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Jacob C, Müller R, Schüler S, Rey A, Rey G, Armenian B, Vonlaufen A, Drepper M, Zimmerli M. Think-Aloud Testing of a Companion App for Colonoscopy Examinations: Usability Study. JMIR Hum Factors 2025; 12:e67043. [PMID: 39937786 PMCID: PMC11838146 DOI: 10.2196/67043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Revised: 12/08/2024] [Accepted: 12/08/2024] [Indexed: 01/11/2025] Open
Abstract
Background Colonoscopies are vital for initial screening, follow-ups, surveillance of neoplasia, and assessing symptoms such as rectal bleeding. Successful colonoscopies require thorough colon preparation, but up to 25% fail due to poor preparation. This can lead to longer procedures, repeat colonoscopies, inconvenience, poorer health outcomes, and higher costs. eHealth tools can enhance bowel preparation and potentially reduce the need for repeat procedures. Objective This usability study aimed to identify strengths and weaknesses in a prototype companion app for colonoscopy examinations. The objective was to obtain in-depth insights into the app's usability, ease of use, and content comprehension, with the aim of refining the tool to effectively fulfill its intended purpose, guided by feedback from potential users. Methods From February to August 2024, we conducted a qualitative study using the think-aloud procedure. Each session involved 6 tasks and a semistructured interview to delve deeper into participants' task experiences. All think-aloud sessions and interviews were recorded. Quantitative usability questions were analyzed using Microsoft Excel, while qualitative data underwent coding and analysis based on thematic analysis principles. Results In total, 17 individuals, all smartphone users, participated in this study. Participants were recruited from 1 hospital, 1 private clinic, and 1 patient organization in Switzerland. The study found that participants rated the app's usability metrics positively, with an overall mean rating of ease of use at 4.29 (SD 0.59), usefulness at 4.53 (SD 0.72), and comprehensibility at 4.29 (SD 0.92). For the individual features, the mean ratings for ease of use were between 4 and 4.65, usefulness ranged from 4.35 to 4.82, and comprehensibility received ratings between 4.29 and 4.53, all measured on a 5-point scale, where 1 represented low agreement and 5 indicated high agreement. Additionally, 100% of participants indicated they will or may use the app if they require a colonoscopy examination. Participants highlighted the need for reminders and alerts in the week leading up to the colonoscopy, along with tailored content, simplified language, and visual aids. Conclusions The app prototype demonstrated favorable results with the majority of participants, and the testing process enabled the prompt identification and resolution of usability issues. The next phase will prioritize and assess potential improvements based on urgency and feasibility to guide a focused development plan. Usability testing highlighted features such as push notifications and personalized content as top priorities for participants, making them key areas for immediate attention. Moving forward, the app has the potential to function effectively as a companion app for colonoscopy examinations. To achieve this, further studies with a larger sample in real-world settings will be crucial.
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Affiliation(s)
- Christine Jacob
- FHNW University of Applied Sciences and Arts Northwestern Switzerland, Riggenbachstrasse 16, Olten, 4600, Switzerland, 41 62 957 29 7
| | - Roman Müller
- FHNW University of Applied Sciences and Arts Northwestern Switzerland, Riggenbachstrasse 16, Olten, 4600, Switzerland, 41 62 957 29 7
| | - Sonja Schüler
- FHNW University of Applied Sciences and Arts Northwestern Switzerland, Riggenbachstrasse 16, Olten, 4600, Switzerland, 41 62 957 29 7
| | - Alix Rey
- Gimini Biosciences SàRL, Geneva, Switzerland
- International Institute for Management Development, Lausanne, Switzerland
| | | | - Berj Armenian
- GGHA Geneva Gastroenterology & Hepatology Associates SA, Geneva, Switzerland
| | - Alain Vonlaufen
- GGHA Geneva Gastroenterology & Hepatology Associates SA, Geneva, Switzerland
| | - Michael Drepper
- GGHA Geneva Gastroenterology & Hepatology Associates SA, Geneva, Switzerland
| | - Marius Zimmerli
- Clarunis University Digestive Health Care Center, Basel, Switzerland
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Tamai N, Sumiyama K. Optimal bowel preparation for colonoscopy. Dig Endosc 2025; 37:139-146. [PMID: 39229776 DOI: 10.1111/den.14914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 08/07/2024] [Indexed: 09/05/2024]
Abstract
There is robust evidence to indicate a strong correlation between the bowel preparation status and adenoma detection rate (ADR), which directly impacts the incidence and mortality rate of postcolonoscopy colorectal cancer. Therefore, improving bowel preparation has been of increasing interest. In Japan, commercially available bowel preparation agents include polyethylene glycol, oral sodium sulfate, sodium picosulfate-magnesium citrate, magnesium citrate, and oral sodium phosphate; each has its own strengths and limitations. The timing of administration can also influence the efficacy of bowel preparation and patient tolerability. Furthermore, meta-analyses have suggested predictive factors for inadequate bowel preparation. A detailed understanding of these factors could contribute to reducing the need for repeat colonoscopy within 1 year, as recommended for patients with inadequate bowel preparation. Recent advancements, such as oral sulfate tablets, present promising alternatives with higher patient satisfaction and ADRs than traditional methods. Achieving optimal bowel preparation requires enhanced instructions, individualized regimens, and a comprehensive understanding of patient backgrounds and the characteristics of various bowel preparation agents. This article provides a concise overview of the current status and advancements in bowel preparation for enhancing the quality and safety of colonoscopy.
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Affiliation(s)
- Naoto Tamai
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazuki Sumiyama
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
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Chen HY, Tu MH, Chen MY. Using a Mobile Health App (ColonClean) to Enhance the Effectiveness of Bowel Preparation: Development and Usability Study. JMIR Hum Factors 2025; 12:e58479. [PMID: 39791869 PMCID: PMC11735013 DOI: 10.2196/58479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 11/08/2024] [Accepted: 11/26/2024] [Indexed: 01/12/2025] Open
Abstract
Background Colonoscopy is the standard diagnostic method for colorectal cancer. Patients usually receive written and verbal instructions for bowel preparation (BP) before the procedure. Failure to understand the importance of BP can lead to inadequate BP in 25%-30% of patients. The quality of BP impacts the success of colonoscopy in diagnostic yield and adenoma detection. We developed the "ColonClean" mobile health (mHealth) app for Android devices. It incorporates visual representations of dietary guidelines, steps for using bowel cleansing agents, and observations of the last bowel movement. We used the Technology Acceptance Model to investigate whether the use of the ColonClean mHealth app can improve users' attitudes and behaviors toward BP. Objective This study aims to validate the effectiveness of the ColonClean app in enhancing user behavior and improving BP, providing safe and cost-effective outpatient colonoscopy guidance. Methods This study uses a structured questionnaire to assess perceived usefulness, perceived ease of use, and users' attitudes and behaviors toward BP regarding the ColonClean mHealth app. A total of 40 outpatients who were physically and mentally healthy and proficient in Chinese were randomly chosen for this study. The data were analyzed using SPSS 25.0, and we used Pearson product-moment correlation and simple regression analysis to predict the perception of ColonClean. Results The results showed that 75% (30/40) of participants achieved an "excellent" or "good" level of BP according to the Aronchick Bowel Preparation Scale. Perceived usefulness and perceived ease of use of the ColonClean mHealth app were positively correlated with users' attitudes and behaviors (P<.05). Conclusions The ColonClean mHealth app serves as an educational reference and enhances the effectiveness of BP. Users expressed their willingness to use the app again in the future and recommend it to family and friends, highlighting its effectiveness as an educational guide for BP.
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Affiliation(s)
- Hui-Yu Chen
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei City, Taiwan
- School of Nursing, National Taipei University of Nursing and Health Sciences, Room B631, No. 365, Ming-te Road, Peitou District, Taipei City, 11219, Taiwan, 886 2 28227101 ext 3186
| | - Ming-Hsiang Tu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Room B631, No. 365, Ming-te Road, Peitou District, Taipei City, 11219, Taiwan, 886 2 28227101 ext 3186
| | - Miao-Yen Chen
- School of Nursing, National Taipei University of Nursing and Health Sciences, Room B631, No. 365, Ming-te Road, Peitou District, Taipei City, 11219, Taiwan, 886 2 28227101 ext 3186
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Romańczyk M, Desai M, Kamiński MF, Abe S, Alkandari AA, Beyna T, Bisschops R, Budzyń K, Bugdol M, Grover SC, Gyawali CP, Inoue H, Iyer PG, Messmann H, Ragunath K, Saito Y, Srinivasan S, Teshima C, Yadlapati R, Hassan C, Sharma P. International Validation of a Novel PEACE Scale to Improve the Quality of Upper Gastrointestinal Mucosal Inspection During Endoscopy. Clin Transl Gastroenterol 2025; 16:e00786. [PMID: 39853720 PMCID: PMC11756887 DOI: 10.14309/ctg.0000000000000786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Accepted: 10/25/2024] [Indexed: 12/21/2024] Open
Abstract
INTRODUCTION The performance of a high quality esophagogastroduodenoscopy (EGD) is dependent on the mucosal cleanliness. Recently, the Polprep: Effective Assessment of Cleanliness in EGD (PEACE) scale was created to assess the degree of mucosal cleanliness during EGD. The aim of this study was to validate this scoring system in a cohort of international endoscopists. METHODS In total, 39 EGD videos, with different degrees of mucosal cleanliness were retrieved from a previously conducted prospective trial. All experts rated the cleanliness of the mucosa on each video using the PEACE scale. To evaluate agreement of all scores (0-3), intraclass correlation coefficient 2.1 was used. The agreement on adequate (scores 2 and 3) and inadequate (scores 0 and 1) cleanliness was assessed using kappa values. RESULTS Videos evaluating esophagus, stomach, and duodenum cleanliness were reviewed by 16 endoscopists. The PEACE scores demonstrated good agreement (intraclass correlation coefficient 0.82, 95% CI 0.75-0.89), especially for esophagus (0.84; 95% CI 0.71-0.95) and stomach (0.81; 95% CI 0.69-0.91), while agreement was moderate for the duodenum (0.69; 95% CI 0.51-0.87). The agreement was similar between Eastern (0.86; 95% CI 0.79-0.92) and Western experts (0.80; 95% CI 0.72-0.88). Similarly, agreement regarding adequate cleanliness was comparable between Eastern (0.70; 95% CI 0.55-0.85) and Western (0.74; 95% CI 0.64-0.84) endoscopists being overall 0.75 (95% CI 0.65-0.85). DISCUSSION The PEACE scoring system is a simple and reliable scale to assess the cleanliness during EGD. The score is now validated among international experts with high concordance, justifying its use in clinical practice.
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Affiliation(s)
- Marcin Romańczyk
- Department of Gastroenterology, Faculty of Medicine, Academy of Silesia, Katowice, Poland
- Department of Gastroenterology and Hepatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
- Endoterapia, H-T, Centrum Medyczne, Tychy, Poland
| | - Madhav Desai
- Interventional Gastroenterology, Department of Surgery, University of Texas Health Science Center, Houston, Texas, USA
| | - Michal F. Kamiński
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Seiichiro Abe
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | | | - Torsten Beyna
- Department of Internal Medicine, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Krzysztof Budzyń
- Department of Gastroenterology, Faculty of Medicine, Academy of Silesia, Katowice, Poland
- Department of Gastroenterology and Hepatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
- Endoterapia, H-T, Centrum Medyczne, Tychy, Poland
| | - Monika Bugdol
- Department of Medical Informatics and Artificial Intelligence, Faculty of Biomedical Engineering, Silesian University of Technology, Gliwice, Poland
| | - Samir C. Grover
- Division of Gastroenterology and Hepatology, Scarborough Health Network Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - C. Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Haruhiro Inoue
- Digestive Disease Centre, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Prasad G. Iyer
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Helmut Messmann
- Department of Gastroenterology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Krish Ragunath
- Faculty of Health Sciences, Curtin Medical School, Curtin University, Perth, Western Australia, Australia
- Department of Gastroenterology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Sachin Srinivasan
- Division of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Christopher Teshima
- Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, Division of Gastroenterology and Hepatology, Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | - Rena Yadlapati
- Division of Gastroenterology, University of California San Diego, San Diego, California, USA
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Prateek Sharma
- Division of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
- Division of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, Kansas, USA
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Ding Y, Vandeleur A, Chinchilla G, Littlemore K, Hodgson R, Rahman T. Online patient endoscopy education platform improves outpatient bowel preparation quality: Retrospective observational study. Endosc Int Open 2024; 12:E1326-E1333. [PMID: 39559418 PMCID: PMC11573465 DOI: 10.1055/a-2441-8166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Accepted: 10/12/2024] [Indexed: 11/20/2024] Open
Abstract
Background and study aims High-quality bowel preparation is integral to high-quality colonoscopy and adenoma detection. Studies evaluating the effect of pre-colonoscopy educational videos on bowel preparation quality have been variable. We investigated whether augmenting bowel preparation education using our professionally produced, patient-oriented, online educational video series would improve preparation quality, reduce need for repeat procedures, and improve adenoma detection rate (ADR). Patients and methods We conducted a pilot, retrospective, single-center observational study using endoscopy data from a tertiary hospital. Colonoscopy outcomes were compared between two discrete 6-month study periods, before (control group) and after (video group) implementation of the online video intervention. All patients received standard-of-care written and verbal instructions. The video group received a link providing access to the video platform. Primary outcome was adequacy of bowel preparation (defined by the Aronchick Scale). Secondary outcomes included rate of repeat colonoscopy due to inadequate preparation, ADR, and sessile serrated lesion (SSL) detection rate. Results The video intervention group had a lower rate of inadequate bowel preparation compared with the control group (6.3% vs 9.8%, P = 0.018). There was no difference between groups in rate of repeat colonoscopies due to inadequate preparation ( P = 0.62), ADR ( P = 0.11), or SSL detection rate ( P = 0.94). Multivariable analysis did not reveal any independent predictors of bowel preparation quality. Conclusions Our study supports the addition of a novel patient-oriented online educational video resource as an effective tool in enhancing bowel preparation adequacy while maintaining provision of high-quality colonoscopy.
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Affiliation(s)
- Yuming Ding
- Department of Gastroenterology & Hepatology, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Department of Gastroenterology, The Prince Charles Hospital, Chermside, Australia
| | - Ann Vandeleur
- Department of Gastroenterology, The Prince Charles Hospital, Chermside, Australia
| | - Gonzalo Chinchilla
- Department of Gastroenterology, The Prince Charles Hospital, Chermside, Australia
| | - Kimberley Littlemore
- Swansea University, Swansea, United Kingdom of Great Britain and Northern Ireland
| | - Ruth Hodgson
- Department of Gastroenterology, The Prince Charles Hospital, Chermside, Australia
| | - Tony Rahman
- Department of Gastroenterology, The Prince Charles Hospital, Chermside, Australia
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Lorenzo-Zúñiga García V, Sábado Martí F, Pantaleón Sánchez MÁ, Machlab Mashlab S, Carral Martínez D, Gómez Rodríguez BJ, López Cano A, Rodríguez Muñoz S, Pérez Arellano E, Turbi Disla C, Esteban López-Jamar JM. Effectiveness and safety of a 1-L polyethylene glycol and ascorbic acid preparation for colonoscopy in routine clinical practice in Spain. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024; 116:599-605. [PMID: 39087668 DOI: 10.17235/reed.2024.10426/2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
BACKGROUND AND AIMS large clinical trials and small real-world studies show that a 1-L polyethylene glycol and ascorbic acid solution (1-L PEG-ASC) is an effective and safe bowel preparation for colonoscopy. Here, the effectiveness and safety of 1-L PEG-ASC was evaluated in a large cohort of patients in routine clinical practice in Spain. METHODS a sub-analysis was performed in an observational, multicenter, retrospective study assessing the effectiveness and safety of 1-L PEG-ASC in adult patients undergoing a colonoscopy at ten centers in Spain. Cleansing quality was assessed with the Boston Bowel Preparation Scale, scores ≥ 6 with all segmental scores ≥ 2 were considered as adequate colon cleansing, and high-quality was considered as cleansing ≥ 8 or = 3 in the right colon. Polyp and adenoma detection rates, and adverse events were also assessed. RESULTS data were collected from 7,160 patients; 48.3 % were males, mean age was 58.0 and 33.6 % were ≥ 65 years old. Adequate overall bowel cleansing was achieved in 95.6 % of patients (95 % CI: 95.1-96.0 %), high quality cleansing in 74.4 % (95 % CI: 73.4-75.4 %) and high-quality right colon cleansing in 66.0 % (95 % CI: 64.9-67.1). The adequate overall cleansing rate was 97.0 % with a split-dose and 94.0 % with same-day regimen (p < 0.0001), and high-quality right colon cleansing was 69.0 % and 62.5 % (p < 0.0001), respectively. Colonoscopy was completed in 97.2 % of cases. A multivariate regression analysis revealed that an overnight split-dose regimen and age < 65 years were independent predictors of adequate bowel cleansing of the overall colon, age < 65 years and female gender were independent predictors of high quality (HQ) cleansing of the overall colon, and the three covariates were independent predictors of HQ cleansing of the right colon. At least one adverse event was experienced by 3.3 % of participants, with nausea (1.5 %) and vomiting (1.2 %) being the most frequent. CONCLUSION this sub-analysis confirmed 1-L PEG-ASC to be an effective and safe bowel cleansing preparation in a real world setting in Spain.
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12
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Solitano V, Siegel CA, Korzenik JR, Maratt JK, Rex DK, Maguire B, Bressler B, Grossmann J, Sedano R, McDonald JWD, Remillard J, Shackelton LM, Zou G, Feagan BG, Ma C, Jairath V. Performance of bowel preparation quality scales in patients with Crohn's disease. Aliment Pharmacol Ther 2024; 60:1042-1050. [PMID: 39129393 DOI: 10.1111/apt.18210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/08/2024] [Accepted: 08/01/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND The performance of bowel preparation (BP) in patients with Crohn's disease (CD) is unknown. AIMS To evaluate the operating properties of instruments used to assess BP quality in patients with CD. METHODS We used the Boston Bowel Preparation Scale, modified Boston Bowel Preparation Scale, Harefield Cleansing Scale, Food and Drug Administration Bowel Cleansing Assessment Scale (BCAS), and a 100-mm visual analogue scale of bowel cleanliness to assess BP quality in 50 videos from 40 patients with CD. We assessed endoscopic activity with the Simple Endoscopic Score for CD (SES-CD). Assessments were on endoscope insertion and withdrawal. Reliability was quantified using the intraclass correlation coefficient (ICC). We assessed validity by within-patient correlation between instruments and the visual analogue scale using mixed-effect models. The correlation between BP quality and SES-SD scores was assessed using Spearman's rho. RESULTS Inter- and intra-rater reliability for all BP quality instruments was substantial (ICC ≥0.61) except for the Food and Drug Administration BCAS on insertion (inter-rater reliability ICC ≥0.41). The visual analogue scale had substantial inter- and almost perfect (ICC ≥0.81) intra-rater reliability. Correlation coefficients for the validity of the instruments exceeded 0.58. BP quality and endoscopic disease activity scores in the colon were negatively correlated. CONCLUSION Most existing instruments reliably assess BP quality in patients with CD. These results support the use of these instruments in clinical practice, provide a framework for scoring BP quality in CD clinical trials, and support evaluation of novel BP agents in patients with CD.
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Affiliation(s)
- Virginia Solitano
- Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada
- Alimentiv Inc, London, Ontario, Canada
- Division of Gastroenterology and Gastrointestinal Endoscopy, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy
| | - Corey A Siegel
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Joshua R Korzenik
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer K Maratt
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, USA
| | - Douglas K Rex
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Brian Bressler
- Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, Canada
| | - Johannes Grossmann
- RKM740-Interdisciplinary Specialty-Clinic, Gastroenterology, Düsseldorf, Germany
| | - Rocio Sedano
- Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada
- Alimentiv Inc, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - John W D McDonald
- Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada
- Alimentiv Inc, London, Ontario, Canada
| | | | | | - Guangyong Zou
- Alimentiv Inc, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Brian G Feagan
- Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada
- Alimentiv Inc, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Christopher Ma
- Alimentiv Inc, London, Ontario, Canada
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Vipul Jairath
- Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada
- Alimentiv Inc, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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13
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Calderwood AH. Fair Is Not Square: More Evidence Linking Bowel Cleanliness to Colonoscopy Outcomes. Am J Gastroenterol 2024; 119:1981-1982. [PMID: 39082619 DOI: 10.14309/ajg.0000000000002931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 06/27/2024] [Indexed: 10/05/2024]
Affiliation(s)
- Audrey H Calderwood
- Department of Medicine, Dartmouth-Hitchcock Medical Cancer, Lebanon, New Hampshire, USA
- Geisel School of Medicine and The Dartmouth Institute at Geisel School of Medicine, Lebanon, New Hampshire, USA
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14
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McGuinness AJ, O’Hely M, Stupart D, Watters D, Dawson SL, Hair C, Berk M, Mohebbi M, Loughman A, Guest G, Jacka FN. Depressive Symptoms and Gut Microbiota after Bowel Preparation and Colonoscopy: A Pre-Post Intervention Study. Microorganisms 2024; 12:1960. [PMID: 39458270 PMCID: PMC11509487 DOI: 10.3390/microorganisms12101960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Revised: 09/18/2024] [Accepted: 09/18/2024] [Indexed: 10/28/2024] Open
Abstract
Mechanical bowel preparation (MBP) is essential for visualisation of the colon during colonoscopy. Previous studies have identified changes in gut microbiota composition after MBP and colonoscopy. Considering the gut microbiota is increasingly implicated in psychiatry, we explored the potential impact of this intervention on mood and the microbiota-gut-brain axis. We conducted a pre-post intervention study in adults, with timepoints of one week before and one month after MBP and colonoscopy. Our primary outcome was change in average Hospital Anxiety and Depression Scale depression sub-scores. We examined changes in average anxiety, stress, and quality of life scores and gut microbiota composition using 16S rRNA sequencing. We further explored associations between changes in depressive symptoms and gut microbiota and conducted post hoc analyses to explore potential effect modifiers. Average depressive symptom scores decreased one month post-procedure compared to baseline (n = 59; adjusted β = -0.64; 95%CI: -1.18, -0.11). Irritable bowel syndrome (IBS) appeared to moderate this relationship (β = 1.78; 95%CI: 0.292, 3.26); depressive symptoms increased in those with, and decreased in those without, IBS. Reduced alpha diversity, modest effects on beta-diversity, and increases in health-associated genera were observed one month post-procedure. Increases in the CLR-transformed abundances of Ruminococcaceae UCG-009 were associated with improvements in depressive symptoms. There is preliminary evidence of a potential mental health effect of MBP and colonoscopy, particularly for those with IBS, which may be associated with changes to the gut microbiota. Further research is required to confirm these findings and their clinical relevance.
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Affiliation(s)
- Amelia J. McGuinness
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine and Barwon Health, Deakin University, Geelong, VIC 3220, Australia; (A.J.M.); (M.O.); (S.L.D.); (M.B.); (A.L.)
| | - Martin O’Hely
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine and Barwon Health, Deakin University, Geelong, VIC 3220, Australia; (A.J.M.); (M.O.); (S.L.D.); (M.B.); (A.L.)
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
| | - Douglas Stupart
- School of Medicine, Deakin University, Geelong, VIC 3220, Australia; (D.S.); (D.W.); (C.H.); (G.G.)
- Department of Surgery, University Hospital Geelong, Barwon Health, Geelong, VIC 3220, Australia
| | - David Watters
- School of Medicine, Deakin University, Geelong, VIC 3220, Australia; (D.S.); (D.W.); (C.H.); (G.G.)
- Department of Surgery, University Hospital Geelong, Barwon Health, Geelong, VIC 3220, Australia
| | - Samantha L. Dawson
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine and Barwon Health, Deakin University, Geelong, VIC 3220, Australia; (A.J.M.); (M.O.); (S.L.D.); (M.B.); (A.L.)
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
| | - Christopher Hair
- School of Medicine, Deakin University, Geelong, VIC 3220, Australia; (D.S.); (D.W.); (C.H.); (G.G.)
- Department of Gastroenterology, Epworth Hospital, Waurn Ponds, VIC 3216, Australia
| | - Michael Berk
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine and Barwon Health, Deakin University, Geelong, VIC 3220, Australia; (A.J.M.); (M.O.); (S.L.D.); (M.B.); (A.L.)
- School of Medicine, Deakin University, Geelong, VIC 3220, Australia; (D.S.); (D.W.); (C.H.); (G.G.)
- Orygen, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Mohammadreza Mohebbi
- Biostatistics Unit, Faculty of Health, Deakin University, Burwood, VIC 3125, Australia;
| | - Amy Loughman
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine and Barwon Health, Deakin University, Geelong, VIC 3220, Australia; (A.J.M.); (M.O.); (S.L.D.); (M.B.); (A.L.)
| | - Glenn Guest
- School of Medicine, Deakin University, Geelong, VIC 3220, Australia; (D.S.); (D.W.); (C.H.); (G.G.)
- Department of Surgery, University Hospital Geelong, Barwon Health, Geelong, VIC 3220, Australia
| | - Felice N. Jacka
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine and Barwon Health, Deakin University, Geelong, VIC 3220, Australia; (A.J.M.); (M.O.); (S.L.D.); (M.B.); (A.L.)
- Centre for Adolescent Health, Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
- College of Public Health, Medical & Veterinary Sciences, James Cook University, Townsville, QLD 4814, Australia
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15
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Wongjarupong N, Are V, Westanmo A, Phung J, Huynh RK, Herman T, Murphy NR, Bilal M, Lou SM, Hanson B. Short Interval Repeat Colonoscopy After Inadequate Bowel Preparation Is Low Among Veterans. Fed Pract 2024; 41:306-311. [PMID: 39839819 PMCID: PMC11745378 DOI: 10.12788/fp.0510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2025]
Abstract
Background Adenoma detection rate and interval colon cancer rates are associated with bowel preparation quality. The US Multisociety Task Force recommends repeat colonoscopy for individuals with inadequate bowel preparation (IBP) within 1 year. However, little is known regarding the rate and associated factors of repeat colonoscopy after IBP. Methods Individuals undergoing colonoscopy for screening, surveillance, positive fecal immunohistochemistry test, and virtual colonoscopy at the Minneapolis Veterans Affairs Medical Center from January 2016 to October 2021 were included. IBP was classified based on Boston Bowel Preparation Scale score or Aronchick scale. Results A total of 10,466 individuals were included, of which 571 (5.5%) had IBP. Repeat colonoscopy within 1 year was recommended for 485 individuals (84.9%); 287 (59.2%) were completed within this time period and 126 (26.0%) never underwent repeat colonoscopy. Proximity to the endoscopy center was associated with a higher rate of repeat colonoscopy within 1 year (61.7% vs 51.0%, P = .02). Current smoking status was associated with a lower rate of repeat colonoscopy within 1 year (25.8% vs 35.9%, P = .02). There were no differences in age, sex, race, inflammatory bowel disease diagnosis, or opioid or anticoagulation use with adherence to repeat colonoscopy within 1 year. There was no difference in adherence to a timely repeat colonoscopy from 1 year before the COVID-19 pandemic (58.9%) vs 1 year postpandemic (59.9%). Conclusions The rate of IBP was 5.5%. Only 59.2% of those with IBP underwent recommended repeat colonoscopy within 1 year, and 26.0% never underwent repeat colonoscopy. Additional efforts are needed to ensure that individuals with IBP return for timely repeat colonoscopy.
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Affiliation(s)
- Nicha Wongjarupong
- University of Minnesota, Minneapolis
- Minneapolis Veterans Affairs Medical Center, Minnesota
| | - Vijay Are
- University of Minnesota, Minneapolis
- Minneapolis Veterans Affairs Medical Center, Minnesota
| | | | - Jenson Phung
- Minneapolis Veterans Affairs Medical Center, Minnesota
| | - Richie K. Huynh
- Department of Medicine, M Health Fairview Woodwinds Hospital, Woodbury, Minnesota
| | | | | | | | - Susan M. Lou
- Minneapolis Veterans Affairs Medical Center, Minnesota
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16
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Gomez Zuleta MA. Colon cancer screening: What to choose? World J Gastrointest Oncol 2024; 16:3393-3396. [PMID: 39171178 PMCID: PMC11334042 DOI: 10.4251/wjgo.v16.i8.3393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/11/2024] [Accepted: 05/24/2024] [Indexed: 08/07/2024] Open
Abstract
Colorectal cancer is one of the predominant tumors in the world, primarily generated by a progression from polyp to cancer which can last several years, giving a great opportunity to the scientific community for its prevention by screening programs that can be done with invasive and non-invasive tests. In this issue, Lopes et al show us an excellent review of screening, its options, its advantages and disadvantages.
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Affiliation(s)
- Martin Alonso Gomez Zuleta
- Department of Internal Medicine, Head of Gastroenterology Unit, Universidad Nacional de Colombia, Hospital Universitario Nacional de Colombi, Bogota 571, Colombia
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17
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Qureshi A, Vestal CC, Tanare M, Ajumobi AB. Online Educational Module Improves Knowledge of Nurses on Bowel Preparation for Colonoscopy. Gastroenterol Nurs 2024; 47:277-285. [PMID: 39087993 DOI: 10.1097/sga.0000000000000807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/16/2023] [Indexed: 08/02/2024] Open
Abstract
The effectiveness of colonoscopy is limited by the adequacy of bowel preparation. Nurses are essential in providing bowel cleansing agents and instructions for hospitalized patients before colonoscopy. This study aims to assess and improve the knowledge of nurses on bowel preparation for inpatient colonoscopy. Participants were asked to complete the survey before and after completing an educational module. The module and survey questions were placed in the NetLearning environment of the hospital intranet. A minimum post-test score of 80% was required to pass the course. A total of 1,107 nurses participated in the survey. Overall, the average score improved from 87% to 93% after the module (p < .0495). Knowledge of the different ways of consuming bowel cleansing agents improved from 54.3% to 83.6% (p = .0001). Only 56.2% of nurses knew how to carry out a split-dose bowel preparation regimen, which increased to 80.1% after the educational module (p = .0001). Nurses' knowledge about the different ways of consuming bowel cleansing agents before colonoscopy and the split-dose regimen is inadequate. A simple online educational module significantly improved the knowledge of nurses on bowel preparation for colonoscopy.
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Affiliation(s)
- Ammar Qureshi
- Ammar Qureshi, MD, Gastroenterology and Hepatology Fellow, University of California, Riverside
- Crystal C. Vestal, DNP, RN, CNOR, RN-Manager Perioperative Informatics & Education, Eisenhower Health, Rancho Mirage, California
- Marie Tanare, BSN, RN, Eisenhower Health, Rancho Mirage, California
- Adewale B. Ajumobi, MD, MBA, FACP, FACG, Associate Professor of Medicine, University of California, Riverside
| | - Crystal C Vestal
- Ammar Qureshi, MD, Gastroenterology and Hepatology Fellow, University of California, Riverside
- Crystal C. Vestal, DNP, RN, CNOR, RN-Manager Perioperative Informatics & Education, Eisenhower Health, Rancho Mirage, California
- Marie Tanare, BSN, RN, Eisenhower Health, Rancho Mirage, California
- Adewale B. Ajumobi, MD, MBA, FACP, FACG, Associate Professor of Medicine, University of California, Riverside
| | - Marie Tanare
- Ammar Qureshi, MD, Gastroenterology and Hepatology Fellow, University of California, Riverside
- Crystal C. Vestal, DNP, RN, CNOR, RN-Manager Perioperative Informatics & Education, Eisenhower Health, Rancho Mirage, California
- Marie Tanare, BSN, RN, Eisenhower Health, Rancho Mirage, California
- Adewale B. Ajumobi, MD, MBA, FACP, FACG, Associate Professor of Medicine, University of California, Riverside
| | - Adewale B Ajumobi
- Ammar Qureshi, MD, Gastroenterology and Hepatology Fellow, University of California, Riverside
- Crystal C. Vestal, DNP, RN, CNOR, RN-Manager Perioperative Informatics & Education, Eisenhower Health, Rancho Mirage, California
- Marie Tanare, BSN, RN, Eisenhower Health, Rancho Mirage, California
- Adewale B. Ajumobi, MD, MBA, FACP, FACG, Associate Professor of Medicine, University of California, Riverside
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Archer T, Corfe B, Dear K, Cole A, Foley S, Andreyev HJN, Fateen W, Baxter A, Riley S, The EBOPS study group , Parra-Blanco A, Thoufeeq M. Can an educational video improve the adequacy of bowel preparation for patients undergoing their first colonoscopy? Results of the EBOPS RCT. Endosc Int Open 2024; 12:E402-E412. [PMID: 38504742 PMCID: PMC10948272 DOI: 10.1055/a-2262-4023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 02/01/2024] [Indexed: 03/21/2024] Open
Abstract
Background and study aims The aim of this study was to assess the effect of an educational video on the quality of bowel preparation of patients from a UK population attending for their first colonoscopy. Patients and methods A prospective, endoscopist-blinded trial with 1:1 allocation was performed. Patients referred for their first colonoscopy were recruited between February 2019 and December 2019. All participants were prescribed Moviprep and received the trial site's standard written bowel preparation instructions, with the intervention group also receiving a bespoke educational video. Adequacy of bowel preparation (defined as a Boston Bowel Preparation Scale of ≥2 in each segment of the bowel) and polyp detection rates (PDRs) were compared. Fisher's chi squared test was utilized with P <0.05 as the threshold for significance. Results A total of 509 participants completed the trial from six centers; 251 were randomized to the intervention group. The mean age was 57 years and 52.3% were female. The primary endpoint was met with an adequacy rate of 216 of 251 (86.1%) in the intervention group, compared with 205 of 259 (79.1%) in the control group ( P <0.05, odds ratio [OR] 1.626, 95% CI 1.017-2.614). The PDR was significantly higher in the intervention group (39% vs 30%, OR 1.51, 95% CI 1.04-2.19, P <0.05). Conclusions An educational video leads to improved bowel preparation for patients attending for their first colonoscopy, and is also associated with greater detection of polyps. Widespread adoption of an educational video incurs minimal investment, but would reduce the number of inadequate procedures, missed pathology, and the cost that both these incur.
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Affiliation(s)
- Thomas Archer
- Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom of Great Britain and Northern Ireland
| | - Bernard Corfe
- Population and Health Science Institute, Newcastle University, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Keith Dear
- Gastroenterology, Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield, United Kingdom of Great Britain and Northern Ireland
| | - Andy Cole
- Department of Gastroenterology, Derby Digestive Disease Centre, Derby Teaching Hospitals NHS Foundation Trust, Derby, United Kingdom of Great Britain and Northern Ireland
| | - Stephen Foley
- Gastroenterology, Sherwood Forest Hospitals NHS Foundation Trust, Sutton-In-Ashfield, United Kingdom of Great Britain and Northern Ireland
| | - H Jervoise N Andreyev
- Gastroenterology, United Lincolnshire Hospitals NHS Trust, Lincoln, United Kingdom of Great Britain and Northern Ireland
- School of Medicine, University of Nottingham, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Waleed Fateen
- Gastroenterology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Andrew Baxter
- Gastroenterology, University of Nottingham, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Stuart Riley
- Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom of Great Britain and Northern Ireland
| | | | - Adolfo Parra-Blanco
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust, nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Mo Thoufeeq
- Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom of Great Britain and Northern Ireland
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19
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Vassallo R, Maida M, Zullo A, Venezia L, Montalbano L, Mitri RD, Peralta M, Virgilio C, Pallio S, Pluchino D, D'amore F, Santagati A, Sinagra E, Graceffa P, Nicosia G, Camilleri S, Gibiliaro G, Abdelhadi Y, Rancatore G, Scalisi G, Melita G, Magnano A, Conoscenti G, Facciorusso A. Efficacy of 1 L polyethylene glycol plus ascorbate versus 4 L polyethylene glycol in split-dose for colonoscopy cleansing in out and inpatient: A multicentre, randomized trial (OVER 2019). Dig Liver Dis 2024; 56:495-501. [PMID: 37574430 DOI: 10.1016/j.dld.2023.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/24/2023] [Accepted: 07/30/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND AND AIMS Adequate bowel cleansing is essential for colonoscopy quality. A novel 1 L polyethylene glycol plus ascorbate (1 L PEG+ASC) solution has been recently introduced. Nevertheless, the efficacy of 1 L PEG+ASC as compared to that of high-volume bowel preparation in both inpatients and outpatients is still unclear. PATIENTS AND METHODS This single-blinded, non-inferiority study randomized patients undergoing colonoscopy to receive split-dose 1 L PEG+ASC or 4 L PEG. The primary endpoint was the overall cleansing success. Secondary endpoints were excellent cleansing and high-quality cleansing of the right colon, as well as lesions detection rate, patient compliance, tolerability and safety. RESULTS Overall, 478 patients were randomized to 1 L PEG+ASC (N = 236) or 4 L PEG (N = 242). The 1 L PEG+ASC showed higher cleansing success rate (91.8% vs 83.6%; P=0.01) and a high-quality cleansing of the right colon (52.3% and 38.5%; P=0.004) compared to 4 L PEG. Moreover, 1 L PEG+ASC achieved a higher cleansing success in out-patients (96.3%% vs 88.6%; P=0.018), and a similar success rate in the in-patients (84.7% vs 76.7%; P=0.18). Adenoma detection rate, tolerability and incidence of adverse events were comparable between preparations. CONCLUSIONS The 1 L PEG+ASC showed higher efficacy in achieving adequate colon cleansing compared with 4 L PEG, particularly in the right colon. No differences in the tolerability and safety were detected.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Antonio Facciorusso
- Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Foggia, Foggia, Italy
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van Riswijk MLM, van Keulen KE, Neumann H, Siersema PD. An intraprocedural bowel cleansing system for difficult-to-prepare patients-A multicenter prospective feasibility study. United European Gastroenterol J 2024; 12:56-65. [PMID: 38213079 PMCID: PMC10859716 DOI: 10.1002/ueg2.12501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/18/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Adequate bowel preparation is a prerequisite for colonoscopy. However, up to 20% of colonoscopies remain inadequately prepared. Risk factors for inadequate bowel preparation often overlap with those of failed cecal intubation. This study aimed to assess the feasibility of an intraprocedural bowel cleansing system (BCS) in patients with a history of inadequate bowel preparation. METHODS Patients (n = 44) with a history of inadequate bowel preparation in the past 2 years were included. After a limited preparation with 300 mL split-dose sodium picosulfate magnesium citrate, additional cleansing during colonoscopy was performed with the BCS. The primary outcome was adequate bowel preparation using the Boston Bowel Preparation Scale (BBPS). Secondary outcomes included cecal intubation rate, procedure times, usability, and safety. RESULTS Median BBPS increased from 1-2-2 (IQR 1-2) to 3-3-3 (IQR) (p < 0.0001), with 31.8% and 88.6% of patients adequately prepared before and after using the BCS, respectively (p < 0.0001). Cecal intubation rate was 88.6%. Reasons for incomplete colonoscopy were looping (n = 2), technical failure (n = 1), relative stricture (n = 1), and residual feces (n = 1). In patients with complete colonoscopy, the adequate cleansing rate was 97.5%. Median total procedure time was 26 min, of which 5.3 min were spent on cleaning. General ease of use was scored with a median of 4 out of 5, representing "as good as conventional colonoscopy". No serious adverse events occurred. CONCLUSIONS Adequate bowel cleaning can be achieved with an intraprocedural BCS in patients with a history of inadequate bowel preparation, which may reduce repeat colonoscopies and clinical admissions for bowel preparation. However, since these patients more frequently have complicated anatomy (surgical scarring, diverticulosis, etc.), adequate patient selection is advised to avoid incomplete procedures.
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Affiliation(s)
- Milou L M van Riswijk
- Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kelly E van Keulen
- Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Helmut Neumann
- Department of Interdisciplinary Endoscopy, I. Medizinische Klinik und Poliklinik, University Hospital, Mainz, Germany
- GastroZentrum Lippe, Bad Salzuflen, Germany
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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21
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Feng L, Xu J, Ji X, Chen L, Xing S, Liu B, Han J, Zhao K, Li J, Xia S, Guan J, Yan C, Tong Q, Long H, Zhang J, Chen R, Tian D, Luo X, Xiao F, Liao J. Development and validation of a three-dimensional deep learning-based system for assessing bowel preparation on colonoscopy video. Front Med (Lausanne) 2023; 10:1296249. [PMID: 38164219 PMCID: PMC10757977 DOI: 10.3389/fmed.2023.1296249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024] Open
Abstract
Background The performance of existing image-based training models in evaluating bowel preparation on colonoscopy videos was relatively low, and only a few models used external data to prove their generalization. Therefore, this study attempted to develop a more precise and stable AI system for assessing bowel preparation of colonoscopy video. Methods We proposed a system named ViENDO to assess the bowel preparation quality, including two CNNs. First, Information-Net was used to identify and filter out colonoscopy video frames unsuitable for Boston bowel preparation scale (BBPS) scoring. Second, BBPS-Net was trained and tested with 5,566 suitable short video clips through three-dimensional (3D) convolutional neural network (CNN) technology to detect BBPS-based insufficient bowel preparation. Then, ViENDO was applied to complete withdrawal colonoscopy videos from multiple centers to predict BBPS segment scores in clinical settings. We also conducted a human-machine contest to compare its performance with endoscopists. Results In video clips, BBPS-Net for determining inadequate bowel preparation generated an area under the curve of up to 0.98 and accuracy of 95.2%. When applied to full-length withdrawal colonoscopy videos, ViENDO assessed bowel cleanliness with an accuracy of 93.8% in the internal test set and 91.7% in the external dataset. The human-machine contest demonstrated that the accuracy of ViENDO was slightly superior compared to most endoscopists, though no statistical significance was found. Conclusion The 3D-CNN-based AI model showed good performance in evaluating full-length bowel preparation on colonoscopy video. It has the potential as a substitute for endoscopists to provide BBPS-based assessments during daily clinical practice.
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Affiliation(s)
- Lina Feng
- Department of Gastroenterology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiaxin Xu
- Department of Gastroenterology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuantao Ji
- Wuhan United Imaging Healthcare Surgical Technology Co., Ltd., Wuhan, China
| | - Liping Chen
- Department of Gastroenterology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuai Xing
- Department of Gastroenterology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Liu
- Wuhan United Imaging Healthcare Surgical Technology Co., Ltd., Wuhan, China
| | - Jian Han
- Department of Gastroenterology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Zhao
- Department of Gastroenterology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junqi Li
- Changzhou United Imaging Healthcare Surgical Technology Co., Ltd., Changzhou, China
| | - Suhong Xia
- Department of Gastroenterology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jialun Guan
- Department of Gastroenterology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chenyu Yan
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Qiaoyun Tong
- Department of Gastroenterology, Yichang Central People’s Hospital, China Three Gorges University, Yichang, China
| | - Hui Long
- Department of Gastroenterology, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Juanli Zhang
- Department of Gastroenterology, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
- Department of Gastroenterology, Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China
| | - Ruihong Chen
- Department of Gastroenterology, Xiantao First People’s Hospital Affiliated to Yangtze University, Wuhan, China
| | - Dean Tian
- Department of Gastroenterology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoping Luo
- Department of Pediatrics, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fang Xiao
- Department of Gastroenterology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiazhi Liao
- Department of Gastroenterology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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22
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Hsu WF, Chiu HM. Optimization of colonoscopy quality: Comprehensive review of the literature and future perspectives. Dig Endosc 2023; 35:822-834. [PMID: 37381701 DOI: 10.1111/den.14627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/27/2023] [Indexed: 06/30/2023]
Abstract
Colonoscopy is crucial in preventing colorectal cancer (CRC) and reducing associated mortality. This comprehensive review examines the importance of high-quality colonoscopy and associated quality indicators, including bowel preparation, cecal intubation rate, withdrawal time, adenoma detection rate (ADR), complete resection, specimen retrieval, complication rates, and patient satisfaction, while also discussing other ADR-related metrics. Additionally, the review draws attention to often overlooked quality aspects, such as nonpolypoid lesion detection, as well as insertion and withdrawal skills. Moreover, it explores the potential of artificial intelligence in enhancing colonoscopy quality and highlights specific considerations for organized screening programs. The review also emphasizes the implications of organized screening programs and the need for continuous quality improvement. A high-quality colonoscopy is crucial for preventing postcolonoscopy CRC- and CRC-related deaths. Health-care professionals must develop a thorough understanding of colonoscopy quality components, including technical quality, patient safety, and patient experience. By prioritizing ongoing evaluation and refinement of these quality indicators, health-care providers can contribute to improved patient outcomes and develop more effective CRC screening programs.
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Affiliation(s)
- Wen-Feng Hsu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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23
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Maida M, Ventimiglia M, Facciorusso A, Vitello A, Sinagra E, Marasco G. Effectiveness and safety of 1-L PEG-ASC versus other bowel preparations for colonoscopy: A meta-analysis of nine randomized clinical trials. Dig Liver Dis 2023; 55:1010-1018. [PMID: 36470722 DOI: 10.1016/j.dld.2022.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/30/2022] [Accepted: 11/08/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND AND AIMS A 1-L polyethylene glycol plus ascorbate (PEG-ASC) preparation has been recently developed to improve patients' experience in colonoscopy. This meta-analysis aimed to evaluate the effectiveness and safety of 1-L PEG-ASC compared with those of other bowel preparations for colonoscopy. METHODS MEDLINE, Embase, Scopus, and the Cochrane Library were systematically searched for randomized controlled trials comparing 1-L PEG-ASC with other bowel preparations published through July 2022. A random-effects model was applied for pooling the results; heterogeneity was expressed as I2. RESULTS Nine studies met the inclusion criteria and were included. The analysis showed significantly higher cleansing success (CS) (OR = 1.50; 95% CI = 1.25-1.81; p < 0.01, I2 = 0%) and right-colon high-quality cleansing (HQC) (OR = 1.67; 95% CI = 1.21-2.31; p < 0.01, I2 = 43%) with 1-L PEG-ASC compared to the other preparations. The pooled estimate of the adenoma detection rate (ADR) did not significantly differ between the two groups either in the overall (OR = 1.02; 95% CI = 0.87-1.20; p = 0.79, I2 = 0%) or split-dosing regimen subgroup analysis (OR = 0.99; 95% CI = 0.84-1.18; p = 0.94, I2 = 0%). A significantly higher pooled estimate of the number of patients with adverse events (AEs) (OR = 1.51; 95% CI = 1.23-1.84; p<0.01, I2 = 0%) and incidence of AEs (IRR=1.33; 95% CI = 1.11-1.58; p<0.01, I2 = 71%) was observed with 1-L PEG-ASC than with the other preparations. No serious AEs or deaths occurred. CONCLUSIONS Compared to other preparations, 1-L PEG-ASC yielded higher overall CS, higher right-colon HQC rates, and similar ADR. The number of patients with AEs and incidence of the total AEs were significantly higher with 1-L PEG-ASC in the absence of serious AEs.
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Affiliation(s)
- M Maida
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta, Italy.
| | - M Ventimiglia
- Directorate General of Medical Device and Pharmaceutical Service, Italian Ministry of Health, Rome, Italy
| | - A Facciorusso
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - A Vitello
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta, Italy
| | - E Sinagra
- Gastroenterology and Endoscopy Unit, Fondazione Instituto San Raffaele Giglio, Cefalù, Italy
| | - G Marasco
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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24
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Au M, Low P, Rennie M, Mohseni M, Song Y, Kim N, Baraty B, Mitrev N, He E, Ho V, Leong R, Kariyawasam V. Determining efficacy of dynamic multimedia bowel preparation instructions versus standard instructions on adenoma detection and patient reported measures (DIGICLEAN trial): a study protocol for a multicentre, colonoscopist-blinded, randomised controlled trial. BMJ Open 2023; 13:e073843. [PMID: 37479508 PMCID: PMC10364173 DOI: 10.1136/bmjopen-2023-073843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 06/08/2023] [Indexed: 07/23/2023] Open
Abstract
INTRODUCTION Colonoscopy plays important roles in bowel cancer screening and treatment. Poor bowel preparation occurs in 20-25% of colonoscopies. This negatively impacts adenoma and sessile serrated lesion detection rates, procedural time, requirement for repeat colonoscopies, healthcare costs and likelihood of patient withdrawal from screening programmes. It is unclear whether a combination of multimedia modalities can improve bowel preparation quality, adenoma detection rates and patient-reported measures in those undergoing colonoscopy assessment. METHODS The DIGICLEAN trial is a prospective, parallel, multicentre, colonoscopist-blinded, randomised controlled trial. The trial will enrol 1294 participants aged 45 years and older who are indicated for a colonoscopy as an outpatient with a positive faecal occult blood test, iron deficiency anaemia or rectal bleeding. Participants will be randomised into the interventional arm, where bowel preparation instructions are delivered via a web-based application which uses scheduled short messaging service, regular patient survey assessment, email and videos; or the control arm, where routine standard written, verbal or emailed instructions are administered. The web-based application will assess patient-reported bloating, constipation and dietary adherence leading up to the colonoscopy. Depending on patient responses, additional aperients may be encouraged digitally in the interventional arm with same instructions made available in written format for the control arm. Patient-reported measures will be collected in both arms the day after the procedure using the validated Newcastle ENDOPREM questionnaire. In some sites, participants will undergo digital pre-anaesthetic screening as well. The co-primary endpoints are the adenoma detection rates and patient-reported measures taken after the colonoscopy. ETHICS AND DISSEMINATION Ethics approval for this study was obtained from the Western Sydney Local Health District Human Research Ethics Committee (2022/ETH00059). Findings will be reported at national and international gastroenterology meetings and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12622000747729.
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Affiliation(s)
- Michael Au
- Department of Gastroenterology and Hepatology, Western Sydney Local Health District, Blacktown, New South Wales, Australia
- School of Medicine, Western Sydney University, Blacktown, New South Wales, Australia
| | - Patrick Low
- School of Medicine, Western Sydney University, Blacktown, New South Wales, Australia
| | - Michael Rennie
- Department of Gastroenterology and Hepatology, Western Sydney Local Health District, Blacktown, New South Wales, Australia
| | - Marriam Mohseni
- Department of Gastroenterology and Hepatology, Western Sydney Local Health District, Blacktown, New South Wales, Australia
| | - Yang Song
- Clinical Research Support Unit, Research and Education Network, Western Sydney Local Health District, Westmead, New South Wales, Australia
| | - Narae Kim
- Clinical Research Support Unit, Research and Education Network, Western Sydney Local Health District, Westmead, New South Wales, Australia
| | - Brandon Baraty
- Department of Gastroenterology and Hepatology, Western Sydney Local Health District, Blacktown, New South Wales, Australia
| | - Nikola Mitrev
- Department of Gastroenterology and Hepatology, Western Sydney Local Health District, Blacktown, New South Wales, Australia
| | - Emily He
- Department of Gastroenterology and Hepatology, Sydney Local Health District, Concord, New South Wales, Australia
- The Daffodil Centre, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
| | - Vincent Ho
- School of Medicine, Western Sydney University, Penrith South, New South Wales, Australia
- Department of Gastroenterology and Hepatology, Campbelltown Hospital, Campbelltown, New South Wales, Australia
| | - Rupert Leong
- Department of Gastroenterology and Hepatology, Sydney Local Health District, Concord, New South Wales, Australia
- School of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Viraj Kariyawasam
- Department of Gastroenterology and Hepatology, Western Sydney Local Health District, Blacktown, New South Wales, Australia
- School of Medicine, Western Sydney University, Blacktown, New South Wales, Australia
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25
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Theunissen F, Lantinga MA, ter Borg PCJ, Ouwendijk RJT, Siersema PD, Bruno MJ, the Trans. IT foundation study group. Efficacy of different bowel preparation regimen volumes for colorectal cancer screening and compliance with European Society of Gastrointestinal Endoscopy performance measures. United European Gastroenterol J 2023; 11:448-457. [PMID: 37190897 PMCID: PMC10256997 DOI: 10.1002/ueg2.12386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/03/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Various volumes of bowel preparation are used in clinical practice. There is conflicting data on the effectiveness of individual regimens. This study aims to evaluate the efficacy and compliance of currently used bowel preparations with the European Society of Gastrointestinal Endoscopy (ESGE) performance measures using data of the Dutch nationwide colorectal cancer screening (CRC) program. METHODS In a prospective, multicenter endoscopy database, we identified all CRC screening colonoscopies performed in 15 Dutch endoscopy centers from 2016 to 2020. We excluded procedures without documented bowel preparation or the Boston Bowel Preparation Scale (BBPS) score. Bowel preparation regimens were categorized into three groups, that is, 4-L (polyethylene glycol (PEG)), 2-L (2-L PEG with ascorbic acid) and ≤1-L volumes (sodium picosulfate with magnesium citrate, 1L-PEG with sodium sulfate and ascorbic acid or oral sulfate solution). European Society of Gastrointestinal Endoscopy performance measures included adequate BBPS score (≥6) (>90%), cecal intubation rate (CIR, >90%), adenoma detection rate (ADR, >25%) and polyp detection rate (PDR, >40%). Logistic regression was performed to identify predictive factors for adequate BBPS and patient discomfort. RESULTS A total of 39,042 CRC screening colonoscopies were included. Boston Bowel Preparation Scale scores, CIR, ADR and PDR for 4L, 2L and ≤1L regimens all met the minimum ESGE performance measures standards. However, an adequate BBPS score was more frequently seen with 2L regimens (98.0%) as compared to 4L (97.1%) and ≤1L regimens (97.0%) (p < 0.001), respectively. In addition, CIR was higher for ≤1L (98.4%) versus 4L (97.7%) and 2L (97.9%) regimens (p = 0.001), ADR higher for lower volume (≤1L (60.0%) and 2L (61.2)) versus higher volume (4L (58.6%)) regimens (p < 0.001), and PDR higher for ≤1L (70.0%) and 2L (70.8%) versus 4L (67.2%) regimens (p < 0.001). Boston Bowel Preparation Scale for ≤1L regimens was higher when combined with bisacodyl (97.3%) than without (95.6%) (p < 0.001). Overall, bisacodyl use was independently associated with higher patient discomfort (odds ratios = 1.47, confidence intervals = 1.26-1.72). CONCLUSIONS Despite variations in bowel preparation volumes, all regimens meet the minimum ESGE performance measures for bowel preparation and other quality parameters. Boston Bowel Preparation Scale can be further improved if ultra low volume regimens are combined with bisacodyl. The choice for either bowel preparation volume can therefore be based on volume-tolerance and patient preference.
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Affiliation(s)
- Felix Theunissen
- Department of Gastroenterology and HepatologyErasmus Medical CenterRotterdamthe Netherlands
| | - Marten Alexander Lantinga
- Department of Gastroenterology and HepatologyRadboud University Medical CenterNijmegenthe Netherlands
- Department of Gastroenterology and HepatologyAmsterdam Gastroenterology and MetabolismUniversity Medical Centers AmsterdamAmsterdamThe Netherlands
| | - Pieter C. J. ter Borg
- Department of Gastroenterology and HepatologyIkazia ZiekenhuisRotterdamthe Netherlands
| | - Rob J. T. Ouwendijk
- Department of Gastroenterology and HepatologyIkazia ZiekenhuisRotterdamthe Netherlands
| | - Peter D. Siersema
- Department of Gastroenterology and HepatologyRadboud University Medical CenterNijmegenthe Netherlands
| | - Marco J. Bruno
- Department of Gastroenterology and HepatologyErasmus Medical CenterRotterdamthe Netherlands
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Keating E, Leyden J, O'Connor DB, Lahiff C. Unlocking quality in endoscopic mucosal resection. World J Gastrointest Endosc 2023; 15:338-353. [PMID: 37274555 PMCID: PMC10236981 DOI: 10.4253/wjge.v15.i5.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/24/2023] [Accepted: 04/12/2023] [Indexed: 05/16/2023] Open
Abstract
A review of the development of the key performance metrics of endoscopic mucosal resection (EMR), learning from the experience of the establishment of widespread colonoscopy quality measurements. Potential future performance markers for both colonoscopy and EMR are also evaluated to ensure continued high quality performance is maintained with a focus service framework and predictors of patient outcome.
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Affiliation(s)
- Eoin Keating
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Jan Leyden
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Donal B O'Connor
- Department of Surgery, Tallaght University Hospital, Dublin 24, Ireland
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Conor Lahiff
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
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27
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Bennett L, Knox R, Luscombe G, Egan J, Wallace L. The Colonoscopy Cookbook: Analysis of effect of a recipe resource on quality and experience of bowel preparation in colonoscopy. Endosc Int Open 2023; 11:E561-E565. [PMID: 37251792 PMCID: PMC10219782 DOI: 10.1055/a-2057-4374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/13/2023] [Indexed: 05/31/2023] Open
Abstract
Background High-quality bowel preparation for a colonoscopy improves identification of early lesions in the large bowel, decreases procedure time and increases intervals between colonoscopies. Current recommendations advise a low-residue diet in the days leading up to colonoscopy to improve quality of preparation. This study prepared and provided a recipe resource to patients undergoing colonoscopy and assessed the quality of bowel preparation and patient experience. Patients and methods A "Colonoscopy Cookbook" resource of recipes that comply with the preoperative diet recommendations was created and added to routine preoperative information given to patients undergoing elective colonoscopies at a regional Australian hospital over a 12-month period. Endoscopic reports were reviewed for each case and quality of bowel preparation was classified as "adequate'' or "inadequate". Data collected were compared to a representative local cohort from 2019. Results Procedure reports from 96 patients who were provided with the resource were compared with 96 patients who were not. Adequate bowel preparation was nine times as likely when the resource was available (odds ratio 8.54, 95 % confidence interval: 2.85 to 25.60, P < 0.001) compared to when it was not. The patient experience was assessed using a post-procedure survey, which demonstrated a positive experience in recipe preparation. Most patients would use the resource prior to future colonoscopies. Conclusions Further randomized controlled trials are required to validate this scoping review. Pre-procedure recipe resources may improve quality of bowel preparation in patients undergoing colonoscopy.
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Affiliation(s)
- Laura Bennett
- The Royal Melbourne Hospital City Campus, General Surgery, Victoria, Australia
- Orange Health Service, General Surgery, New South Wales, Australia
| | - Robert Knox
- Orange Health Service, General Surgery, New South Wales, Australia
| | - Georgina Luscombe
- The University of Sydney, School of Rural Health, Orange, New South Wales, Australia
| | - Jenny Egan
- Orange Health Service, Bowel Screen, Orange, South Wales, Australia
| | - Lauren Wallace
- The Royal Melbourne Hospital City Campus, General Surgery, Victoria, Australia
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Frazzoni L, La Marca M, DI Giorgio V, Laterza L, Bazzoli F, Hassan C, Fuccio L. Endoscopic surveillance after surgery for colorectal cancer. Minerva Med 2023; 114:224-236. [PMID: 32573518 DOI: 10.23736/s0026-4806.20.06732-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Colorectal cancer (CRC) is one of the most common cancers worldwide and its global incidence is rapidly increasing among adults younger than 50 years, especially in the 20-39 age group. Once a curative resection is achieved, surveillance is mandatory. Colonoscopy has a pivotal role aimed at resecting premalignant neoplasms and detecting cancer at a curable stage. In the current review, an update on the role of surveillance colonoscopy after CRC is provided, considered the most recent international guidelines and evidence published on this issue. In particular, several questions have been answered, why, how and how often colonoscopy should be performed, whether intensive surveillance is more effective than standard surveillance, how endoscopically resected T1 cancer should be followed, the different management existing between colon and rectal cancer, and, finally, how to improve the endoscopic surveillance. In a period of resource constraints, appropriateness will be mandatory, thus understanding how to optimize the role of colonoscopy in the surveillance of patients with a history of CRC is of crucial importance. Improving the quality of colonoscopy and identifying risk factors for recurrent and new-onset CRC, will allow us to individualize the surveillance program while sparing health care cost.
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Affiliation(s)
- Leonardo Frazzoni
- Unit of Gastroenterology, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Marina La Marca
- Unit of Gastroenterology, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Valentina DI Giorgio
- Unit of Gastroenterology, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Liboria Laterza
- Unit of Gastroenterology, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Franco Bazzoli
- Unit of Gastroenterology, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Cesare Hassan
- Unit of Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Lorenzo Fuccio
- Unit of Gastroenterology, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy -
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Shahini E, Sinagra E, Vitello A, Ranaldo R, Contaldo A, Facciorusso A, Maida M. Factors affecting the quality of bowel preparation for colonoscopy in hard-to-prepare patients: Evidence from the literature. World J Gastroenterol 2023; 29:1685-1707. [PMID: 37077514 PMCID: PMC10107216 DOI: 10.3748/wjg.v29.i11.1685] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/02/2023] [Accepted: 03/07/2023] [Indexed: 03/17/2023] Open
Abstract
Adequate bowel cleansing is critical for a high-quality colonoscopy because it affects diagnostic accuracy and adenoma detection. Nevertheless, almost a quarter of procedures are still carried out with suboptimal preparation, resulting in longer procedure times, higher risk of complications, and higher likelihood of missing lesions. Current guidelines recommend high-volume or low-volume polyethylene glycol (PEG)/non-PEG-based split-dose regimens. In patients who have had insufficient bowel cleansing, the colonoscopy should be repeated the same day or the next day with additional bowel cleansing as a salvage option. A strategy that includes a prolonged low-fiber diet, a split preparation regimen, and a colonoscopy within 5 h of the end of preparation may increase cleansing success rates in the elderly. Furthermore, even though no specific product is specifically recommended in the other cases for difficult-to-prepare patients, clinical evidence suggests that 1-L PEG plus ascorbic acid preparation are associated with higher cleansing success in hospitalized and inflammatory bowel disease patients. Patients with severe renal insufficiency (creatinine clearance < 30 mL/min) should be prepared with isotonic high volume PEG solutions. Few data on cirrhotic patients are currently available, and no trials have been conducted in this population. An accurate characterization of procedural and patient variables may lead to a more personalized approach to bowel preparation, especially in patients undergoing resection of left colon lesions, where intestinal preparation has a poor outcome. The purpose of this review was to summarize the evidence on the risk factors influencing the quality of bowel cleansing in difficult-to-prepare patients, as well as strategies to improve colonoscopy preparation in these patients.
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Affiliation(s)
- Endrit Shahini
- Gastroenterology Unit, National Institute of Gastroenterology-IRCCS “Saverio de Bellis”, Castellana Grotte, Bari 70013, Italy
| | - Emanuele Sinagra
- Gastroenterology and Endoscopy Unit, Fondazione Istituto G. Giglio, Cefalù 90015, Italy
| | - Alessandro Vitello
- Gastroenterology and Endoscopy Unit, S.Elia-Raimondi Hospital, Caltanissetta 93100, Italy
| | - Rocco Ranaldo
- Department of Internal Medicine, “Mazzolani-Vandini” Hospital, Digestive Endoscopy, Ferrara 744011, Italy
| | - Antonella Contaldo
- Gastroenterology Unit, National Institute of Gastroenterology “S de Bellis” Research Hospital, Bari 70013, Italy
| | - Antonio Facciorusso
- Department of Medical Sciences, University of Foggia, Section of Gastroenterology, Foggia 71122, Italy
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S.Elia-Raimondi Hospital, Caltanissetta 93100, Italy
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Ju J, Oh HS, Lee YJ, Jung H, Lee JH, Kang B, Choi S, Kim JH, Kim KO, Chung YJ. Clean mucosal area detection of gastroenterologists versus artificial intelligence in small bowel capsule endoscopy. Medicine (Baltimore) 2023; 102:e32883. [PMID: 36820545 PMCID: PMC9907992 DOI: 10.1097/md.0000000000032883] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 02/12/2023] Open
Abstract
Studies comparing the detection of clean mucosal areas in capsule endoscopy (CE) using human judgment versus artificial intelligence (AI) are rare. This study statistically analyzed gastroenterologist judgments and AI results. Three hundred CE video clips (100 patients) were prepared. Five gastroenterologists classified the video clips into 3 groups (≥75% [high], 50%-75% [middle], and < 50% [low]) according to their subjective judgment of cleanliness. Visualization scores were calculated using an AI algorithm based on the predicted visible area, and the 5 gastroenterologists' judgments and AI results were compared. The 5 gastroenterologists evaluated CE clip video quality as "high" in 10.7% to 36.7% and as "low" in 28.7% to 60.3% and 29.7% of cases, respectively. The AI evaluated CE clip video quality as "high" in 27.7% and as "low" in 29.7% of cases. Repeated-measures analysis of variance (ANOVA) revealed significant differences in the 6 evaluation indicators (5 gastroenterologists and 1 AI) (P < .001). Among the 300 judgments, 90 (30%) were consistent with 5 gastroenterologists' judgments, and 82 (91.1%) agreed with the AI judgments. The "high" and "low" judgments of the gastroenterologists and AI agreed in 95.0% and 94.9% of cases, respectively. Bonferroni's multiple comparison test showed no significant difference between 3 gastroenterologists and AI (P = .0961, P = 1.0000, and P = .0676, respectively) but a significant difference between the other 2 with AI (P < .0001). When evaluating CE images for cleanliness, the judgments of 5 gastroenterologists were relatively diverse. The AI produced a relatively universal judgment that was consistent with the gastroenterologists' judgements.
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Affiliation(s)
| | - Hyun Sook Oh
- Department of Applied Statistics, School of Social Science, Gachon University, Seongnam, Korea
| | - Yeoun Joo Lee
- Captos Co., Ltd., Yangsan, Korea
- Department of Pediatrics, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Heechul Jung
- Captos Co., Ltd., Yangsan, Korea
- Department of Artificial Intelligence, Kyungpook National University, Daegu, Korea
| | | | - Ben Kang
- Department of Pediatrics, Kyungpook National University School of Medicine, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Sujin Choi
- Department of Pediatrics, Kyungpook National University School of Medicine, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Ji Hyun Kim
- Department of Internal Medicine, Kangwon National University School of Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Kyeong Ok Kim
- Department of Internal Medicine, Yeungnam University College of Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Yun Jin Chung
- Department of Internal Medicine, Kyungpook National University Chilgok Hospital, Daegu, Korea
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Risk factors for inadequate bowel preparation in patients using high- and low-volume cleansing products. Eur J Gastroenterol Hepatol 2023; 35:159-166. [PMID: 36574306 DOI: 10.1097/meg.0000000000002467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Bowel preparation is crucial for colonoscopy completeness and lesions detection. Today, several cleansing products are equally recommended by guidelines, irrespective of patients' characteristics. Identification of preparation-specific risk factors for inadequate bowel preparation may lead to a personalized prescription of cleansing products to refine patients' tolerance and improve endoscopic outcomes. METHODS We prospectively enrolled consecutive outpatients referred for colonoscopy using either a high-volume [HV: 4 l polyethylene glycol (PEG)] or a low-volume (LV: 2 l PEG + bisacodyl) preparation. Day-before regimen or split-dose regimen was used for morning or afternoon colonoscopies, respectively. Univariate and multivariate analyses were conducted to identify risk factors related to inadequate bowel preparation, according to the Boston bowel preparation scale for HV and LV preparations. RESULTS We enrolled 2040 patients, of which 1815 were included in the final analysis (average age 60.6 years, 50.2% men). Half of them (52%) used LV preparation. Adequate preparation was achieved by 87.6% without differences between the HV and LV groups (89.2% vs. 86.6%; P = 0.098). The use of day-before regimen and incomplete assumption of PEG were independent predictors of poor visibility for either HV or LV preparation. However, different specific risk factors for HV [diabetes: odds ratio (OR), 3.81; 95% confidence interval (CI), 1.91-7.58; low level of instruction: OR, 1.95; 95% CI, 1.11-3.44; and previous abdominal surgery: OR, 2.27; 95% CI, 1.20-4.30] and for LV (heart disease: OR, 2.06; 95% CI, 1.09-3.88; age > 65 years: OR, 1.51; 95% CI, 1.01-2.27) preparations were identified. CONCLUSION Day-before preparation and incomplete assumption of the purgative agents affect bowel visibility irrespective of the preparation volume. LV should be preferred to HV preparations in patients with diabetes, low level of instruction, and previous abdominal surgery, whereas an HV preparation should be preferred in patients with heart disease and in older patients.
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Ding L, Duan J, Yang T, Jin C, Luo J, Ma A. Advanced intestinal regulation improves bowel preparation quality in patients with constipation: A systematic review and network meta-analysis. Front Pharmacol 2023; 13:964915. [PMID: 36761469 PMCID: PMC9904507 DOI: 10.3389/fphar.2022.964915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 12/30/2022] [Indexed: 01/26/2023] Open
Abstract
Background: Inadequate bowel preparation (IBP) has a critical influence on the colonoscopy procedure and is associated with significantly lower rates of detection of colorectal lesions. Constipation is an important risk factor of IBP, and some studies have attempted to address the bowel cleansing for constipated patients. However, there is still lack of consensus to guide the clinical work of bowel preparation (BP) for patients with constipation. Therefore, we aimed to perform a network meta-analysis to compare the overall efficacy of various regimens for BP in constipated patients. Methods: We performed a comprehensive search of PubMed, MEDLINE, EMBASE, Cochrane, and Web of science to identify randomized controlled trials (RCTs) of bowel preparation regimens in constipated patients, update to January 2021. Two investigators independently evaluated articles and extracted data. The odds ratio (OR) with a 95% confidence interval (CI) was used to combine dichotomous data of the primary outcome which was defined as adequate bowel preparation (ABP). Rank probability was used to exhibit the outcome of the network meta-analysis. Results: Eleven studies that included 1891 constipated patients were identified as suitable for inclusion. The proportion of ABP was associated with the administration of intensive regimen (OR 2.19, 95% CI 1.16-4.17, p = .02, I2 = 84%). Moreover, an intensive regimen had a significant efficacy and light heterogeneity when the same basic laxative program was used (OR 4.06, 95% CI 3.04-5.43, p < .0001, I2 = 0%). In the network meta-analysis, the protocol of a normal regimen + A (normal regimen plus advanced intestinal regulation) had a significant effect for bowel preparation compared with a normal regimen + IR (normal regimen plus irritating laxative regimen) (OR 5.21, 95% CI 1.18-24.55), H PEG (4L- polyethylene glycol) (OR 8.70, 95% CI 1.75-52.56), and normal regimen (NR) (OR 7.37, 95% CI 2.33-26.39). In the remaining protocols, no significant difference was observed in any comparison. No significant severe adverse events (AEs) associated with bowel preparation were reported in included studies. Conclusion: Intensive regimens could improve bowel cleansing quality for patients with constipation, and advanced intestinal regulation regimens may be superior to others.
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Affiliation(s)
- Liang Ding
- Department of Gastroenterology, Shaoxing People’s Hospital, Shaoxing, Zhejiang, China
| | - JinNan Duan
- Department of Infectious Diseases, Shaoxing People’s Hospital, Shaoxing, Zhejiang, China
| | - Tao Yang
- Department of Gastroenterology, Shaoxing People’s Hospital, Shaoxing, Zhejiang, China
| | - ChaoQiong Jin
- Department of Gastroenterology, Shaoxing People’s Hospital, Shaoxing, Zhejiang, China
| | - Jun Luo
- Department of Gastroenterology, Shaoxing People’s Hospital, Shaoxing, Zhejiang, China
| | - Ahuo Ma
- Department of Gastroenterology, Shaoxing People’s Hospital, Shaoxing, Zhejiang, China,*Correspondence: Ahuo Ma,
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Silva VM, Rosa B, Mendes F, Mascarenhas M, Saraiva MM, Cotter J. Small bowel and colon cleansing in capsule endoscopy. ARTIFICIAL INTELLIGENCE IN CAPSULE ENDOSCOPY 2023:181-197. [DOI: 10.1016/b978-0-323-99647-1.00015-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Maida M, Facciorusso A, Sinagra E, Morreale G, Sferrazza S, Scalisi G, Pallio S, Camilleri S. Predictive Factors of Adequate Bowel Cleansing for Colonoscopy in the Elderly: A Retrospective Analysis of a Prospective Cohort. Diagnostics (Basel) 2022; 12:2867. [PMID: 36428927 PMCID: PMC9689943 DOI: 10.3390/diagnostics12112867] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/13/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022] Open
Abstract
Factors affecting the quality of bowel preparation for colonoscopy in the elderly are not fully known, and current guidelines provide no specific recommendations. This study aimed to assess the difference in bowel cleansing in young and elderly patients and evaluate predictors of bowel cleansing in the elderly. We retrospectively reviewed a prospective cohort of 1289 patients performing colonoscopy after a 1-, 2-, or 4-L PEG-based preparation. All 1289 were included in the analysis. Overall, 44.6% of patients were aged ≥65 years. Cleansing success (CS) was achieved in 77.3% and 70.3% of patients aged <65 years and ≥65 years, respectively. At multivariable analysis, split regimen (OR = 2.43, 95% CI = 1.34−4.38; p = 0.003), adequate cleansing at previous colonoscopy (OR = 2.29, 95% CI = 1.14−4.73; p = 0.02), tolerability score (OR = 1.29, 95% CI = 1.16−1.44; p < 0.001), a low-fiber diet for at least 3 days (OR = 2.45, 95% CI = 1.42−4.24; p = 0.001), and colonoscopy within 5 h after the end of preparation (OR = 2.67, 95% CI = 1.28−5.56; p = 0.008) were independently associated with CS in the elderly. Combining a low-fiber diet for at least 3 days, split preparation, and colonoscopy within 5 h allowed a CS rate above 90% and should always be encouraged. A 1-L PEG-ASC preparation was also associated with greater high-quality cleansing of the right colon and may be preferred.
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Affiliation(s)
- Marcello Maida
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, 93100 Caltanissetta, Italy
| | - Antonio Facciorusso
- Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy
| | - Emanuele Sinagra
- Gastroenterology and Endoscopy Unit, Fondazione Istituto San Raffaele Giglio, 90015 Cefalù, Italy
| | - Gaetano Morreale
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, 93100 Caltanissetta, Italy
| | - Sandro Sferrazza
- Gastroenterology and Endoscopy Unit, Santa Chiara Hospital, 38100 Trento, Italy
| | | | - Socrate Pallio
- Digestive Diseases Endoscopy Unit, Policlinico G. Martino Hospital, University of Messina, 98100 Messina, Italy
| | - Salvatore Camilleri
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, 93100 Caltanissetta, Italy
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Maida M, Annibale B, Benedetti A, Burra P, Frulloni L, Ianiro G, Luzza F, Repici A, Savarino E, Sinagra E, Vecchi M, Ricciardiello L. Quality of endoscopic screening for colorectal cancer in Italy: A national survey. Dig Liver Dis 2022; 54:1410-1418. [PMID: 35753948 DOI: 10.1016/j.dld.2022.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 05/16/2022] [Accepted: 06/01/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) is a major healthcare problem all over the world and screening is effective in reducing mortality and increasing survival. Since colonoscopy has a central role in faecal immunochemical test (FIT)-based CRC screening and surveillance, consistent quality measures are essential to ensure quality and outcomes. Nevertheless, screening modalities in clinical practice may differ according to the centers experience and the local availability of instrumentation and devices. AIMS to assess the quality of endoscopic screening for CRC and adherence to international guidelines across Gastroenterology Departments in Italy. METHODS All members of the Italian Society of Gastroenterology (SIGE) were invited to answer a web-based survey. RESULTS Data from 64 hospitals from 17 Italian regions were analyzed. 32/64 (50.0%) were from northern, 12/64 (18.75%) from central and 20/64 (31.25%) from southern Italy. Each center is equipped with a median of 5.0 (3.5-7.0) endoscopists involved in CRC screening, 71.4% of which are gastroenterologists. After a positive FIT, most centers (93.8%) schedule a colonoscopy within 3 months. High-definition video endoscopy is routinely performed in 68.8% and chromoendoscopy in 53.1% of centers. Withdrawal time is ≥6 min in 79.9% and cecal intubation rate is ≥90% in 94.4% of departments. Finally, in 92.7% of centers adenoma detection rate (ADR) overcome the minimum standard of 25%. Analyzing the data by regional areas, a significant higher number of median endoscopic examinations/year (6500 vs 4000 and 3000, respectively, p = 0.024) and of endoscopists per center (6.5 vs 5.0 and 3.5, respectively, p < 0.001) has been registered in the northern compared to central-southern centers. CONCLUSIONS Data from this survey show adequacy and good quality of endoscopic screening for CRC in Italy, highlighting, at the same time, relevant deficiencies and a discrepancy in procedural attitudes between the different centers. These findings call for a urgent action to overcome the shortcomings, refine and homogenize the behaviour of all screening centers in the national territory and improve the outcomes.
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Affiliation(s)
- M Maida
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta, Italy.
| | - B Annibale
- Digestive Disease Unit, Sant'Andrea University Hospital, ENETS Center of Excellence, Rome, Italy
| | - A Benedetti
- Department of Gastroenterology and Hepatology, Università Politecnica delle Marche, Ancona, Italy
| | - P Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - L Frulloni
- Department of Medicine, Gastroenterology Unit, Pancreas Center, University of Verona, Verona, Italy
| | - G Ianiro
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Disease Center, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Luzza
- Department of Health Sciences, University Magna Graecia, Catanzaro, Italy
| | - A Repici
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Humanitas University, Rozzano, MI, Italy
| | - E Savarino
- Department of Surgery, Oncology and Gastroenterology - DiSCOG, University of Padua, Italy
| | - E Sinagra
- Gastroenterology and Endoscopy Unit, Fondazione Instituto San Raffaele Giglio, Cefalù, Italy
| | - M Vecchi
- Department of Internal Medicine Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - L Ricciardiello
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, Bologna, Italy
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Pantaleón Sánchez M, Gimeno Garcia A, Bernad Cabredo B, García‐Rodríguez A, Frago S, Nogales O, Diez Redondo P, Puig I, Romero Mascarell C, Romero Sánchez‐Miguel I, Caballero N, Ibañez I, Hernandez Negrín D, Bujedo Sadornill G, Pérez Oltra A, Pérez Berbegal R, Casals G, Seoane Urgorri A, Riu Pons F, Amorós J, Alvarez‐Gonzalez MA. Prevalence of missed lesions in patients with inadequate bowel preparation through a very early repeat colonoscopy. Dig Endosc 2022; 34:1176-1184. [PMID: 35189669 PMCID: PMC9545231 DOI: 10.1111/den.14278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/14/2022] [Accepted: 02/17/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVES When bowel preparation (BP) is inadequate, international guidelines recommend repeating the colonoscopy within 1 year to avoid missing clinically relevant lesions. We aimed to determine the rate of missed lesions in patients with inadequate BP through a very early repeat colonoscopy with adequate BP. METHODS Post hoc analysis was conducted using data collected from a prospective multicenter randomized clinical trial including patients with inadequate BP and then repeat colonoscopy. Inadequate BP was defined as the Boston Bowel Preparation Scale (BBPS) score <2 points in any segment. We included patients with any indication for colonoscopy. The adenoma detection rate (ADR), advanced ADR (AADR), and serrated polyp detection rate (SPDR) were calculated for index and repeat colonoscopies. RESULTS Of the 651 patients with inadequate BP from the original trial, 413 (63.4%) achieved adequate BP on repeat colonoscopy. The median interval between index and repeat colonoscopies was 28 days. On repeat colonoscopy, the ADR was 45.3% (95% confidence interval [CI] 40.5-50.1%), the AADR was 10.9% (95% CI 8.1-14.3%), and the SPDR was 14.3% (95% CI 10.9-17.7%). Cancer was discovered in four patients (1%; 95% CI 0.2-2.5%). A total of 60.2% of all advanced adenoma (AA) were discovered on repeat colonoscopy. A colon segment scored BBPS = 0 had most AA (66.1%) and all four cancers. CONCLUSION Patients with inadequate BP present a high rate of AAs on repeat colonoscopy. When a colonoscopy has a colon segment score BBPS = 0, we recommend repeating the colonoscopy as soon as possible.
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Affiliation(s)
| | | | | | | | - Santiago Frago
- Department of GastroenterologyComplejo Asistencial de SoriaSoriaSpain
| | - Oscar Nogales
- Department of GastroenterologyHospital General Universitario Gregorio MarañónMadridSpain
| | - Pilar Diez Redondo
- Department of GastroenterologyRío Hortega University HospitalValladolidSpain
| | - Ignasi Puig
- Department of GastroenterologyAlthaia Xarxa Assistencial Universitària de ManresaManresaSpain
| | | | | | - Noemí Caballero
- Department of GastroenterologyGermans Trias i Pujol HospitalBadalonaSpain
| | - Ines Ibañez
- Department of GastroenterologyHospital del MarBarcelonaSpain
| | | | | | | | | | - Gemma Casals
- Department of GastroenterologyHospital del MarBarcelonaSpain
| | | | - Faust Riu Pons
- Department of GastroenterologyHospital del MarBarcelonaSpain
| | - Jaume Amorós
- Faculty of Psychology and Educational SciencesOpen University of CataloniaBarcelonaSpain
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Chen C, Shi M, Liao Z, Chen W, Wu Y, Tian X. Oral sulfate solution benefits polyp and adenoma detection during colonoscopy: Meta-analysis of randomized controlled trials. Dig Endosc 2022; 34:1121-1133. [PMID: 35294782 PMCID: PMC9545996 DOI: 10.1111/den.14299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/07/2022] [Accepted: 03/14/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Although oral sulfate solution (OSS) has been revealed to be not only safe and efficacious but also noninferior to polyethylene glycol with ascorbic acid (PEG + ASC), it is unclear whether OSS can ultimately increase the polyp detection rate (PDR) and adenoma detection rate (ADR). We performed this meta-analysis to estimate the effect of OSS on PDR and ADR during colonoscopy. METHODS We searched PubMed, EMBASE, and the Cochrane Library to identify relevant randomized controlled trials (RCTs) investigating the comparative effect of OSS versus PEG + ASC on the PDR and ADR during colonoscopy. Cecal intubation time (CIT), cecal intubation rate (CIR), and bowel preparation score were also evaluated. Review Manager (RevMan) version 5.3.0 was used to perform statistical analysis. RESULTS Eight RCTs involving 2059 patients fulfilled the selection criteria. Meta-analysis suggested that OSS significantly increased the PDR (47.34% vs. 40.14%, risk ratio [RR] 1.13, 95% confidence interval [CI] 1.03-1.24, P = 0.01) and ADR (44.60% vs. 38.14%, RR 1.17, 95% CI 1.03-1.33, P = 0.01) during colonoscopy. Subgroup analysis showed that the beneficial effects of OSS on PDR and ADR were consistent among patients with mean age >55 years and with body mass index <25 kg/m2 receiving outpatient colonoscopy, morning colonoscopy, and the 2-L bowel preparation protocol. Meanwhile, patients receiving OSS had a beneficial bowel preparation score. CONCLUSION Compared with polyethylene glycol-based regimens, the OSS bowel preparation regimen significantly increased the PDR and ADR in patients undergoing colonoscopy.
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Affiliation(s)
- Cheng Chen
- Department of Gastroenterology, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized TreatmentChongqing University Cancer HospitalChongqingChina
| | - Mengyang Shi
- Department of Gastroenterology, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized TreatmentChongqing University Cancer HospitalChongqingChina
| | - Zhongli Liao
- Department of Gastroenterology, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized TreatmentChongqing University Cancer HospitalChongqingChina
| | - Weiqing Chen
- Department of Gastroenterology, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized TreatmentChongqing University Cancer HospitalChongqingChina
| | - Yongzhong Wu
- Radiation Oncology CenterChongqing University Cancer HospitalChongqingChina
| | - Xu Tian
- Nursing DepartmentUniversitat Rovira I VirgiliTarragonaSpain
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Zhao M, Xu Y, Zhu H, Chen J, Sun W, Yang D, Peng H. A prospective cohort study of the relationship between the withdrawal time and the detection rate of colorectal adenoma. Scand J Gastroenterol 2022; 57:1131-1137. [PMID: 35465795 DOI: 10.1080/00365521.2022.2064722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS The effect of colonoscopy withdrawal time (WT) beyond 6 min on colorectal adenoma detection rate (ADR) is unclear. We focused on the relationship between WT and ADR. MATERIALS AND METHODS This study was a prospective observational study involving 437 patients who underwent colonoscopy at Tongren Hospital in Shanghai from 1 July 2020 to 31 August 2020. Patients were divided into two groups according to whether the WT was >6 min. Age, sex, body mass index (BMI), defoaming rate score, Boston bowel preparation scale (BBPS), primary colonoscopy, hypertension, diabetes mellitus, dietary preparation 1 day before the examination, and abdominal surgery history factors were analysed by univariate and multivariable logistic regression to explore the odds ratios (ORs) of ADR in two WT groups. Restricted cubic spline regression was used to further analyze the relationship between WT and the ORs of adenoma detection. RESULTS The ADR among 437 patients was 17.16% (75/437). Multivariable regression analysis showed that in the group with WT >6 min, patients aged ≥50 years old and male could have an increased risk of adenoma detection (OR 5.80, 95% CI 2.32-14.47; p < .001; OR 2.30, 95% CI 1.19-4.43; p = .013). The cubic spline curve showed that the ADR increased with time for WT of 6-8 min, and the highest ADR was achieved when the WT was controlled at 8 min (WT = 5.997, OR = 0.997; WT = 8.240 min, OR = 3.092). CONCLUSION The highest ADR was achieved when the WT of colonoscopy was controlled at 8 min.
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Affiliation(s)
- Min Zhao
- Digestive Endoscopy Center, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ying Xu
- Digestive Endoscopy Center, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Haijing Zhu
- Digestive Endoscopy Center, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jiaying Chen
- Digestive Endoscopy Center, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weijie Sun
- Digestive Endoscopy Center, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Daming Yang
- Digestive Endoscopy Center, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Haixia Peng
- Digestive Endoscopy Center, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Liu C, Yuan X, Gao H, Zhang Z, Wang W, Xie J, Lu H, Chen J, Yu C, Xu L. Real-word evaluation of differences in bowel preparation for colonoscopy between the digestive and the non-digestive physicians: A retrospective study. FRONTIERS IN GASTROENTEROLOGY 2022; 1. [DOI: 10.3389/fgstr.2022.946459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2025]
Abstract
IntroductionUsing real-world data, we compared the quality of bowel preparation instructed by the digestive and non-digestive physicians in outpatients for colonoscopy and identified potential risk factors.MethodsThis was a retrospective study based on real-world data, which were collected from the Ningbo First Hospital in China from December 2019 to October 2020. Outpatients included were classified into the digestive and the non-digestive physician groups according to the referring physician. The primary outcome was adequate bowel preparation measured by the Boston Bowel Preparation Scale (BBPS), namely, a BBPS score of 2 or higher in any colonic segment and a total score ≥ 6. Secondary outcomes included the total mean BBPS scores and possible risk factors associated with poor bowel preparation.ResultsThere were 671 outpatients included, with 392 in the digestive physician group and 279 in the non-digestive physician group. Adequate bowel preparation was 84.2% in the digestive physician group and 71.0% in the non-digestive physician group (odds ratio [OR]: 1.50, p < 0.001), and the latter had lower total mean BBPS scores (6.12 ± 1.33 vs. 6.66 ± 1.29, p < 0.001). The non-digestive physician was an independent risk factor according to the multivariate logistic regression analysis (OR: 0.45, p < 0.001).ConclusionThe quality of bowel preparations instructed by non-digestive physicians was inferior to digestive physicians, which was a factor potentially associated with poor bowel preparation (ClinicalTrials.gov number: NCT04738578).
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Gajera A, South C, Cronley KM, Ziebert JJ, Wrigh CH, Levitan O, Burleson DB, Johnson DA. High-Volume Colonic Lavage Is a Safe and Preferred Colonoscopy Preparation for Patients With Inflammatory Bowel Disease. CROHN'S & COLITIS 360 2022; 4:otac024. [PMID: 36777430 PMCID: PMC9802306 DOI: 10.1093/crocol/otac024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Colonoscopies provide a crucial diagnostic and surveillance tool for inflammatory bowel disease (IBD). Accordingly, IBD patients undergo repeated and frequent colonoscopies. The oral purgative bowel prep (BP) is often burdensome on patients, resulting in delayed or missed colonoscopies due to patient noncompliance. Additionally, oral BP has been noted to possibly induce colon mucosal inflammatory changes in some patients, which may be misleading when assessing actual disease activity. METHODS In this retrospective clinical study, we evaluated the use of an FDA cleared, defecation-inducing high-volume colon irrigation (>40 L) BP to prepare IBD patients for colonoscopy. Data were collected at 4 US Hygieacare centers from September 2016 to March 2021. The IBD patient population consisted of 314 patients that underwent 343 BPs. The BPs were prescribed by 65 physicians and performed by 16 nurses and technicians. RESULTS Patient ages were 20-85 years old, 76% females, 24% males, and 97% of the patients were adequately prepared for their colonoscopy (n = 309). Patient satisfaction with the BP was very high, as reflected in postprocedure surveys and open-ended responses text analyses, and there were no serious adverse events. CONCLUSIONS We present data supporting that the defecation-inducing high-volume colon irrigation BP for colonoscopy is safe, effective, and preferred for IBD patients. Using this BP for IBD patients can allow earlier interventions, significantly impacting disease management and future outcomes.
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Affiliation(s)
- Amit Gajera
- Ohio GI & Gastro Health, Norwood Endoscopy Center, Cincinnati, Ohio, USA
| | - Christopher South
- Ohio GI & Gastro Health, Norwood Endoscopy Center, Cincinnati, Ohio, USA
| | - Kevin M Cronley
- Ohio GI & Gastro Health, Norwood Endoscopy Center, Cincinnati, Ohio, USA
| | - John J Ziebert
- Austin Gastro & GI Alliance, Endoscopy Center I (North) Austin, TexasUSA
| | - Cynthia H Wrigh
- GI Alliance, GI Associates and Endoscopy Center, Flowood, Mississippi, USA
| | - Orly Levitan
- Hygieacare Inc., Clinical & Regulatory, Norfolk, Virginia, USA
| | - Dawn B Burleson
- Hygieacare Inc., Clinical & Regulatory, Norfolk, Virginia, USA
| | - David A Johnson
- Eastern VA Medical School, Chief of Gastroenterology, Norfolk, Virginia, USA
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The Efficacy of Senna Bowel Preparation for Colonoscopy: A Systematic Review and Meta-analysis. Gastroenterol Nurs 2022; 45:428-439. [PMID: 35758925 DOI: 10.1097/sga.0000000000000664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 02/17/2022] [Indexed: 11/26/2022] Open
Abstract
The quality of bowel preparation is an extremely important determinant of colonoscopy results. However, the efficacy of senna regimens in improving bowel cleanliness is uncertain. We conducted a systematic review and meta-analysis to synthesize data on whether using a senna bowel preparation regimen enhances the bowel cleanliness. We searched Web of Science Core Collection, MEDLINE, PubMed, Embase, Cochrane Library, and Scopus databases (from the inception to August 2021). The primary efficacy outcome was bowel cleanliness. Secondary outcomes included patient compliance, tolerance, and adverse events. Eleven trials fulfilled the inclusion criteria (3,343 patients. Overall, we found no significant differences in bowel cleanliness between the senna regimen and other bowel preparation regimens (odds ratio [95% confidence interval]: 1.02 [0.63, 1.67], p = 0.93). There was significant difference in tolerance (odds ratio [95% confidence interval]: 1.66 [1.08, 2.54], p = .02) and compliance (odds ratio [95% confidence interval]: 3.05 [1.42, 6.55], p = .004). The senna regimen yielded a significantly greater proportion of no nausea (odds ratio [95% confidence interval]: 1.84 [1.45, 2.32]) and vomiting (odds ratio [95% confidence interval]: 1.65 [0.81, 3.35]). Compared with other bowel preparation regimens, the senna regimen may be effective and safe in bowel cleaning before colonoscopy, with superior compliance and tolerance.
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Bednarska O, Nyhlin N, Schmidt PT, Johansson GW, Toth E, Lindfors P. The Effectiveness and Tolerability of a Very Low-Volume Bowel Preparation for Colonoscopy Compared to Low and High-Volume Polyethylene Glycol-Solutions in the Real-Life Setting. Diagnostics (Basel) 2022; 12:1155. [PMID: 35626310 PMCID: PMC9140572 DOI: 10.3390/diagnostics12051155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/30/2022] [Accepted: 04/30/2022] [Indexed: 02/04/2023] Open
Abstract
Adequate bowel cleansing is essential for high-quality colonoscopy. Recently, a new very low-volume 1 litre (1L) polyethylene glycol (PEG) plus ascorbate solution (ASC) has been introduced. Our aims were to assess the effectiveness and tolerability of this product compared to low-volume 2L PEG-ASC and high-volume 4L PEG solutions, in a real-life setting. In six endoscopy units in Sweden, outpatients undergoing colonoscopy were either prescribed solutions according to local routines, or the very low-volume solution in split dose regimen. Bowel cleansing effectiveness and patient experience was assessed using the Boston Bowel preparation scale (BBPS) and a patient questionnaire. A total of 1098 patients (mean age 58 years, 52% women) were included. All subsegment and the total BBPS scores were significantly greater for 1L PEG-ASC in comparison to other solutions (p < 0.05 for 1L PEG-ASC and 4L PEG for transverse and left colon, otherwise p < 0.001). Nausea was more frequent with 1L PEG-ASC compared to 2L PEG-ASC (p < 0.001) and vomiting were more often reported compared to both other solutions (p < 0.01 and p < 0.05 for 2L PEG-ASC and 4L PEG, respectively). Smell, taste, and total experience was better for 1L PEG-ASC compared to 4L PEG (p < 0.001), and similar compared to the 2L PEG-ASC. In conclusion, 1L PEG-ASC leads to better bowel cleansing compared to 2L PEG-ASC or 4L PEG products, with similar or greater patient satisfaction.
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Affiliation(s)
- Olga Bednarska
- Department of Gastroenterology, Linköping University Hospital, S-581 85 Linköping, Sweden
| | - Nils Nyhlin
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, S-701 85 Örebro, Sweden
| | - Peter Thelin Schmidt
- Department of Medicine, Ersta Hospital, S-116 91 Stockholm, Sweden; or
- Department of Medicine, Karolinska Institutet, S-171 77 Solna, Sweden
| | - Gabriele Wurm Johansson
- Department of Gastroenterology, Skåne University Hospital, Lund University, S-205 02 Malmö, Sweden; (G.W.J.); (E.T.)
| | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Lund University, S-205 02 Malmö, Sweden; (G.W.J.); (E.T.)
| | - Perjohan Lindfors
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, S-171 77 Solna, Sweden; or
- Aleris Gastromottagningen City, S-111 37 Stockholm, Sweden
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Sadeghi A, Rajabnia M, Bagheri M, Jamshidizadeh S, Saberi S, Shahnazi P, Pasharavesh L, Pourhoseingholi MA, Mirzaei M, Asadzadeh Aghdaei H, Zali MR. Predictive factors of inadequate bowel preparation for elective colonoscopy. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2022; 15:66-78. [PMID: 35611256 PMCID: PMC9123630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/02/2022] [Indexed: 10/28/2022]
Abstract
Aim This study aimed to evaluate the effects of factors like demographic items, comorbidities, and drug history on the inadequacy of colonic preparation before colonoscopy. Background Inadequate bowel preparation can lead to lower polyp detection rates, longer procedure times, and lower cecal intubation rates. Methods This population-based study was conducted on 2476 Iranian adults who were referred to two tertiary centers for elective colonoscopy between 2017 and 2018. Bowel preparation quality was scored by the Boston bowel preparation scale (BBPS). Univariate and multivariate logistic regressions were used to find the independent predictors of bowel preparation inadequacy. Results The results showed that 31.8% of patients had inadequate bowel preparation before their colonoscopy. Higher age, BMI>25, abdominal circumference>95 cm, low fruit consumption, and history of smoking were independently correlated with bowel preparation inadequacy. Additionally, using NSAIDs and SSRIs were correlated with bowel preparation adequacy in multivariate regression analysis. Finally, age, gender, ethnicity, BMI, abdominal circumference, fruit consumption, smoking, NSAIDs, SSRIs, education, constipation, physical activity, and diabetes entered the predictive model of this study. The area under the curve (AUC) reached 0.70 in the final step. Conclusion The independent risk factors associated with colonic preparation inadequacy were identified, and herein, a predictive model is suggested for identifying patients with a high risk of bowel preparation inadequacy before a colonoscopy so that alternative preparation techniques can be employed among high-risk groups to yield optimal preparation quality.
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Chang WY, Chiu HM. Can image-enhanced endoscopy improve adenoma detection rate? Dig Endosc 2022; 34:284-296. [PMID: 34351014 DOI: 10.1111/den.14102] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/26/2021] [Accepted: 08/02/2021] [Indexed: 12/14/2022]
Abstract
An accumulating body of evidence has shown that detection and resection of pre-cancerous adenoma by colonoscopy could effectively prevent colorectal cancer (CRC) and its related mortality. Among various colonoscopy quality indicators, such as cecal intubation rate, withdrawal time, and adenoma detection rate (ADR); ADR is the most important and most closely associated with the subsequent risk of CRC. Image-enhanced endoscopy (IEE), including digital and dye-based IEE, was originally developed to discriminate neoplastic from non-neoplastic lesions but later studies have demonstrated that it can also enhance lesion detection by enhancing the contrast between the lesion and background colonic mucosa. Nevertheless, using IEE in colonoscopy for lesion detection is still not the standard way of practice in the real world. For a better understanding of current IEE modalities, this review introduces and compares the currently available IEE modalities and their efficacy in detecting adenoma from the results of randomized controlled trials or meta-analyses.
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Affiliation(s)
- Wei-Yuan Chang
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Occhipinti V, Soriani P, Bagolini F, Milani V, Rondonotti E, Annunziata ML, Cavallaro F, Vavassori S, Vecchi M, Pastorelli L, Tontini GE. Efficacy and tolerability of high and low-volume bowel preparation compared: A real-life single-blinded large-population study. World J Gastrointest Endosc 2021; 13:659-672. [PMID: 35070027 PMCID: PMC8716982 DOI: 10.4253/wjge.v13.i12.659] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/25/2021] [Accepted: 12/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Low-volume preparations for colonoscopy have shown similar efficacy compared to high-volume ones in randomized controlled trials (RCT). However, most RCTs do not provide data about clinical outcomes including lesions detection rate. Moreover, real-life comparisons are lacking.
AIM To compare efficacy (both in terms of adequate bowel preparation and detection of colorectal lesions) and tolerability of a high-volume (HV: 4 L polyethylene glycol, PEG) and a low-volume (LV: 2 L PEG plus bisacodyl) bowel preparation in a real-life setting.
METHODS Consecutive outpatients referred for colonoscopy were prospectively enrolled between 1 December 2014 and 31 December 2016. Patients could choose either LV or HV preparation, with a day-before schedule for morning colonoscopies and a split-dose for afternoon procedures. Adequate bowel preparation according to Boston Bowel Preparation Scale (BBPS), clinical outcomes including polyp detection rate (PDR), adenoma detection rate (ADR), advanced adenoma detection rate (AADR), sessile/serrated lesion detection rate (SDR) and cancer detection rate and self-reported tolerability of HV and LV were blindly assessed.
RESULTS Total 2040 patients were enrolled and 1815 (mean age 60.6 years, 50.2% men) finally included. LV was chosen by 52% of patients (50.8% of men, 54.9% of women). Split-dose schedule was more common with HV (44.7% vs 38.2%, P = 0.005). High-definition scopes were used in 33.4% of patients, without difference in the two groups (P = 0.605). HV and LV preparations showed similar adequate bowel preparation rates (89.2% vs 86.6%, P = 0.098), also considering the two different schedules (HV split-dose 93.8% vs LV split-dose 93.6%, P = 1; HV day-before 85.5% vs LV day-before 82.3%, P = 0.182). Mean global BBPS score was higher for HV preparations (7.1 ± 1.7 vs 6.8 ± 1.6, P < 0.001). After adjustment for sex, age and indications for colonoscopy, HV preparation resulted higher in PDR [Odds ratio (OR) 1.32, 95%CI: 1.07-1.63, P = 0.011] and ADR (OR 1.29, 95%CI 1.02–1.63, P = 0.038) and comparable to LV in AADR (OR 1.51, 95%CI 0.97-2.35, P = 0.069), SDR and cancer detection rate. The use of standard-definition colonoscopes was associated to lower PDR (adjusted OR 1.59, 95%CI: 1.22-2.08, P < 0.001), ADR (adjusted OR 1.71, 95%CI: 1.26–2.30, P < 0.001) and AADR (adjusted OR 1.97, 95%CI: 1.09-3.56, P = 0.025) in patients receiving LV preparation. Mean Visual Analogue Scale tolerability scored equally (7, P = 0.627) but a ≥ 75% dose intake was more frequent with LV (94.6% vs 92.1%, P = 0.003).
CONCLUSION In a real-life setting, PEG-based low-volume preparation with bisacodyl showed similar efficacy and tolerability compared to standard HV preparation. However, with higher PDR and ADR, HV should still be considered as the reference standard for clinical trials and the preferred option in screening colonoscopy, especially when colonoscopy is performed with standard resolution imaging.
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Affiliation(s)
- Vincenzo Occhipinti
- Digestive Endoscopy and Gastroenterology Unit, A. Manzoni Hospital, ASST Lecco, Lecco 23900, Italy
- Gastro-enterology Unit, IRCCS Policlinico San Donato, San Donato Milanese 20097, Italy
| | - Paola Soriani
- Gastro-enterology Unit, IRCCS Policlinico San Donato, San Donato Milanese 20097, Italy
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL Modena, Carpi Hospital, Carpi 41012, Italy
| | - Francesco Bagolini
- Gastro-enterology Unit, IRCCS Policlinico San Donato, San Donato Milanese 20097, Italy
| | - Valentina Milani
- Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese 20097, Italy
| | | | | | - Flaminia Cavallaro
- Gastro-enterology Unit, IRCCS Policlinico San Donato, San Donato Milanese 20097, Italy
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Sara Vavassori
- Gastro-enterology Unit, IRCCS Policlinico San Donato, San Donato Milanese 20097, Italy
- Gastroenterology and Hepatology Unit, ASST Santi Paolo e Carlo, Milan 20142, Italy
| | - Maurizio Vecchi
- Gastro-enterology Unit, IRCCS Policlinico San Donato, San Donato Milanese 20097, Italy
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan 20122, Italy
| | - Luca Pastorelli
- Gastro-enterology Unit, IRCCS Policlinico San Donato, San Donato Milanese 20097, Italy
- Gastroenterology and Hepatology Unit, ASST Santi Paolo e Carlo, Milan 20142, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan 20122, Italy
| | - Gian Eugenio Tontini
- Gastro-enterology Unit, IRCCS Policlinico San Donato, San Donato Milanese 20097, Italy
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan 20122, Italy
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Di Leo M, Iannone A, Arena M, Losurdo G, Palamara MA, Iabichino G, Consolo P, Rendina M, Luigiano C, Di Leo A. Novel frontiers of agents for bowel cleansing for colonoscopy. World J Gastroenterol 2021; 27:7748-7770. [PMID: 34963739 PMCID: PMC8661374 DOI: 10.3748/wjg.v27.i45.7748] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/23/2021] [Accepted: 11/24/2021] [Indexed: 02/06/2023] Open
Abstract
The incidence of colorectal cancer (CRC) is characterized by rapid declines in the wake of widespread screening. Colonoscopy is the gold standard for CRC screening, but its accuracy is related to high quality of bowel preparation (BP). In this review, we aimed to summarized the current strategy to increase bowel cleansing before colonoscopy. Newly bowel cleansing agents were developed with the same efficacy of previous agent but requiring less amount of liquid to improve patients' acceptability. The role of the diet before colonoscopy was also changed, as well the contribution of educational intervention and the use of adjunctive drugs to improve patients' tolerance and/or quality of BP. The review also described BP in special situations, as lower gastrointestinal bleeding, elderly people, patients with chronic kidney disease, patients with inflammatory bowel disease, patients with congestive heart failure, inpatient, patient with previous bowel resection, pregnant/lactating patients. The review underlined the quality of BP should be described using a validate scale in colonoscopy report and it explored the available scales. Finally, the review explored the possible contribution of bowel cleansing in post-colonoscopy syndrome that can be related by a transient alteration of gut microbiota. Moreover, the study underlined several points needed to further investigations.
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Affiliation(s)
- Milena Di Leo
- Unit of Digestive Endoscopy, San Paolo Hospital, Milan 20090, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Monica Arena
- Unit of Digestive Endoscopy, San Paolo Hospital, Milan 20090, Italy
| | - Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | | | | | - Pierluigi Consolo
- Unit of Digestive Endoscopy, University of Messina, Hospital "G. Martino", Messina 98121, Italy
| | - Maria Rendina
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Carmelo Luigiano
- Unit of Digestive Endoscopy, San Paolo Hospital, Milan 20090, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
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Wang T, Tsang T, Turshudzhyan A, Dacus H, Tadros M. Updates, Controversies, and Emerging Approaches in Colorectal Screening. Cureus 2021; 13:e17844. [PMID: 34660050 PMCID: PMC8501747 DOI: 10.7759/cureus.17844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2021] [Indexed: 12/24/2022] Open
Abstract
Colorectal cancer (CRC) is the third most common cancer worldwide and the second leading cause of cancer-related deaths. Despite the threatening statistics, the US burden for CRC has been decreasing, which is likely multifactorial and has partial contribution from widespread timely screening, more advanced CRC treatment, and daily aspirin use in some patients. While overall death rate from CRC decreased by approximately a half between 1975 and 2012, epidemiologic studies demonstrate that CRC incidence is increasing in the younger population. This pattern has prompted the American Cancer Society (ACS) to revise their guidelines. In this review, we plan to discuss the most recent changes in guidelines, data to support them, controversies concerning CRC screening methods, age to start and to stop screening, and post-colonoscopy/polypectomy surveillance guidelines.
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Affiliation(s)
- Tiffany Wang
- Internal Medicine, Albany Medical College, Albany, USA
| | - Tyler Tsang
- Internal Medicine, Albany Medical College, Albany, USA
| | | | - Heather Dacus
- Internal Medicine, New York State Department of Health, New York, USA
| | - Micheal Tadros
- Gastroenterology and Hepatology, Albany Medical Center, Albany, USA
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Lee JGH, Telford JJ, Galorport C, Yonge J, Macdonnell CA, Enns RA. Comparing the Real-World Effectiveness of High- Versus Low-Volume Split Colonoscopy Preparations: An Experience Through the British Columbia Colon Cancer Screening Program. J Can Assoc Gastroenterol 2021; 4:207-213. [PMID: 34617002 PMCID: PMC8489524 DOI: 10.1093/jcag/gwaa031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/22/2020] [Indexed: 12/18/2022] Open
Abstract
Background The British Columbia Colon Screening Program (BCCSP) is a population-based colon cancer screening program. In December 2018, physicians in Vancouver, Canada agreed to switch from a low-volume split preparation to a high-volume polyethylene glycol preparation after a meta-analysis of studies suggested superiority of the higher volume preparation in achieving adequate bowel cleansing and improving adenoma detection rates. Aims To compare the quality of bowel preparation and neoplasia detection rates using a high-volume split preparation (HVSP) versus a low-volume split preparation (LVSP) in patients undergoing colonoscopy in the BCCSP. Methods A retrospective review of patients undergoing colonoscopy through the BCCSP at St. Paul’s Hospital from July 2017 to November 2018 and December 2018 to November 2019 was conducted. Inclusion criteria included age 50 to 74 and patients undergoing colonoscopy through the BCCSP. Variables collected included patient demographics and bowel preparation quality. Rates of bowel preparation and neoplasia detection were analyzed using chi-squared test. Results A total of 1453 colonoscopies were included, 877 in the LVSP group and 576 in the HVSP group. No statistically significant difference was noted between rates of inadequate bowel preparation (LVSP 3.6% versus HVSP 2.8%; P = 0.364). Greater rates of excellent (48.4% versus 40.1%; P = 0.002) and optimal (90.1% versus 86.5%; P = 0.041) bowel preparation were achieved with HVSP. The overall adenoma detection rate was similar between the two groups (LVSP 53.1% versus HVSP 54.0%; P = 0.074). LVSP demonstrated higher overall sessile serrated lesion detection rate (9.5% versus 5.6%; P = 0.007). Conclusions Compared to LVSP, HVSP was associated with an increase in excellent and optimal bowel preparations, but without an improvement in overall neoplasia detection.
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Affiliation(s)
- Joseph G H Lee
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer J Telford
- Department of Medicine, Division of Gastroenterology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cherry Galorport
- Department of Medicine, Division of Gastroenterology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jordan Yonge
- Department of Medicine, Division of Gastroenterology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher A Macdonnell
- Department of Medicine, Division of Gastroenterology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert A Enns
- Department of Medicine, Division of Gastroenterology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Archer T, Shirazi-Nejad AR, Al-Rifaie A, Corfe BM, Riley S, Thoufeeq M. Is it time we split bowel preparation for all colonoscopies? Outcomes from a national survey of bowel preparation practice in the UK. BMJ Open Gastroenterol 2021; 8:bmjgast-2021-000736. [PMID: 34610925 PMCID: PMC8493910 DOI: 10.1136/bmjgast-2021-000736] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/08/2021] [Indexed: 01/05/2023] Open
Abstract
Introduction Adequate bowel preparation is a prerequisite for effective colonoscopy. Split bowel preparation results in optimal cleansing. This study assessed the bowel preparation regimes advised by endoscopy units across the UK, and correlated the differences with outcomes. Methods Trusts in the UK were surveyed, with data requested between January 2018 and January 2019, including: the type and timing of preparation, pre-endoscopy diet, adequacy rates and polyp detection. Trusts were grouped according to the timing of bowel preparation. χ2 test was used to assess for differences in bowel preparation adequacy. Results Moviprep was the first line bowel preparation in 79% of trusts. Only 7% of trusts advised splitting bowel preparation for all procedures, however, 91% used split bowel preparation for afternoon procedures. Trusts that split preparation for all procedures had an inadequacy rate of 6.7%, compared with 8.5% (p<0.001) for those that split preparation for PM procedures alone and 9.5% (p<0.001) for those that provided day before preparation for all procedures. Morning procedures with day-before preparation had a higher rate of inadequate cleansing than afternoon procedures that received split preparation (7.7% vs 6.5 %, p<0.001). The polyp detection rate for procedures with adequate preparation was 37.1%, compared with 26.4% for those that were inadequate. Conclusion Most trusts in the UK do not provide instructions optimising the timing of bowel preparation prior to colonoscopy. This correlated with an increased rate of inadequate cleansing. Splitting bowel preparation is likely to reduce the impacts of poor cleansing: missed lesions, repeat colonoscopies and significant costs.
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Affiliation(s)
- Thomas Archer
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK .,Molecular Gastroenterology Research Group, Department of Oncology & Metabolism, The University of Sheffield, Sheffield, UK
| | - Ahmad Reza Shirazi-Nejad
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Ammar Al-Rifaie
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Bernard M Corfe
- Population and Health Science Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Stuart Riley
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Mo Thoufeeq
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Repici A, Spada C, Cannizzaro R, Traina M, Maselli R, Maiero S, Galtieri A, Guarnieri G, Di Leo M, Lorenzetti R, Capogreco A, Spadaccini M, Antonelli G, Zullo A, Amata M, Ferrara E, Correale L, Granata A, Cesaro P, Radaelli F, Minelli Grazioli L, Anderloni A, Fugazza A, Finati E, Pellegatta G, Carrara S, Occhipinti P, Buda A, Fuccio L, Manno M, Hassan C. Novel 1-L polyethylene glycol + ascorbate versus high-volume polyethylene glycol regimen for colonoscopy cleansing: a multicenter, randomized, phase IV study. Gastrointest Endosc 2021; 94:823-831.e9. [PMID: 33940043 DOI: 10.1016/j.gie.2021.04.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 04/18/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Adequate bowel cleansing is critical to ensure quality and safety of a colonoscopy. A novel 1-L polyethylene glycol plus ascorbate (1L-PEG+ASC) regimen was previously validated against low-volume regimens but was never compared with high-volume regimens. METHODS In a phase IV study, patients undergoing colonoscopy were randomized 1:1 to receive split-dose 1L PEG+ASC or a split-dose 4-L PEG-based regimen (4L-PEG) in 5 Italian centers. Preparation was assessed with the Boston Bowel Preparation Scale (BBPS) by local endoscopists and centralized reading, both blinded to the randomization arm. The primary endpoint was noninferiority of 1L-PEG+ASC in colon cleansing. Secondary endpoints were superiority of 1L-PEG+ASC, patient compliance, segmental colon cleansing, adenoma detection rate, tolerability, and safety. RESULTS Three hundred eighty-eight patients (median age, 59.8 years) were randomized between January 2019 and October 2019: 195 to 1L-PEG+ASC and 193 to 4L-PEG. Noninferiority of 1L-PEG+ASC was demonstrated for cleansing in both the entire colon (BBPS ≥ 6: 97.9% vs 93%; relative risk [RR], 1.03; 95% confidence interval [CI], 1.001-1.04; P superiority = .027) and in the right-sided colon segment (98.4% vs 96.0%; RR, 1.02; 95% CI, .99-1.02; P noninferiority = .013). Compliance was higher with 1L-PEG+ASC than with 4L-PEG (178/192 [92.7%] vs 154/190 patients [81.1%]; RR, 1.10; 95% CI, 1.05-1.12), whereas no difference was found regarding safety (moderate/severe side effects: 20.8% vs 25.8%; P = .253). No difference in adenoma detection rate (38.8% vs 43.0%) was found. CONCLUSIONS One-liter PEG+ASC showed noninferiority compared with 4L-PEG in achieving adequate colon cleansing and provided a higher patient compliance. No differences in tolerability and safety were detected. (Clinical trial registration number: NCT03742232.).
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Affiliation(s)
- Alessandro Repici
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Cristiano Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy; Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Renato Cannizzaro
- UO Oncological Gastroenterology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Mario Traina
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, Istituto ISMETT, Palermo, Italy
| | - Roberta Maselli
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Stefania Maiero
- UO Oncological Gastroenterology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Alessia Galtieri
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Giovanni Guarnieri
- UO Oncological Gastroenterology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Milena Di Leo
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | | | - Antonio Capogreco
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Marco Spadaccini
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Giulio Antonelli
- Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Angelo Zullo
- Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Michele Amata
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, Istituto ISMETT, Palermo, Italy
| | - Elisa Ferrara
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | | | - Antonino Granata
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, Istituto ISMETT, Palermo, Italy
| | - Paola Cesaro
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy
| | | | | | - Andrea Anderloni
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Alessandro Fugazza
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Elena Finati
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Gaia Pellegatta
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Silvia Carrara
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Pietro Occhipinti
- Department of Gastroenterology, "Maggiore Della Carità" Hospital, Novara, Italy
| | - Andrea Buda
- Gastroenterology Unit, Santa Maria del Prato Hospital, Feltre, Italy
| | - Lorenzo Fuccio
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Mauro Manno
- Digestive Endoscopy Unit, Carpi-Mirandola Hospitals, Azienda USL Modena
| | - Cesare Hassan
- Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy
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