A randomized controlled study of water exchange colonoscopy and air insufflation colonoscopy / 中华消化内镜杂志

Objective To investigate the clinical application prospect of water exchange colonoscopy.Methods A total of 300 outpatients who underwent unsedated colonoscopy were randomized to the WEC group (n =150)or the AIC group(n =150).The maximum pain score, insertion time, the cecal intubation rate and the polyp detection rate were reported by an assistant during the insertion phase and at the end of colonoscopy.Results The maximum abdominal pain scores were 1.77 ± 1.29 in the WEC group and 2.84 ± 1.55 in the AIC group with significant difference (P =0.000).The intubation time of WEC was longer than that of AIC (11.91 ± 3.58 VS 8.03 ± 3.19 ,P =0.000)with no significant difference.There was no significant difference in the cecal access rate between the two groups(97.3％ VS 94.0％ ,P =0.157).The polyp detection of WEC was higher than that of AIC (16.7％ VS 10.0％, P =0.089).In the post abdominal operation subject of colonoscopy procedure, WEC had higher rate of cecal intubation than AIC ,the maximum abdominal pain score were 2.25 ± 1.63 in the WEC group,lower than 3.48 ± 1.45 in the AIC group.Conclusion Water exchange colonoscopy can alleviate patients' abdominal pain symptoms, but with longer insertion time.There are no significant difference in the cecal access rate and the polyp detection rate between two groups.For difficult colonoscopy, water exchange colonoscopy is helpful to increase the rate of cecal intubation.

Does Metformin Affect The Incidence of Colonic Polyps and Adenomas in Patients with Type 2 Diabetes Mellitus?

BACKGROUND/AIMS: Colorectal cancer (CRC) develops from colonic adenomas. Type 2 diabetes mellitus (DM) is associated with a higher risk of CRC and metformin decreases CRC risk. However, it is not certain if metformin affects the development of colorectal polyps and adenomas. This study aimed to elucidate if metforminaffects the incidence of colonic polyps and adenomas in patients with type 2 DM. METHODS: Of 12,186 patients with type 2 DM, 3,775 underwent colonoscopy between May 2001 and March 2013. This study enrolled 3,105 of these patients, and divided them in two groups: 912 patients with metformin use and 2,193 patients without metformin use. Patient clinical characteristics, polyp and adenoma detection rate in the two groups were analyzed retrospectively. RESULTS: The Colorectal polyp detection rate was lower in the metformin group than in the non-meformin group (39.4% vs. 62.4%, P<0.01). Colorectal adenoma detection rate was significantly lower in the metformin group than in the non-metformin group (15.2% vs. 20.5%, P<0.01). Fewer advanced adenomas were detected in the metformin group than in the non-metformin group (12.2% vs. 22%, P<0.01). Multivariate analysis identified age, sex, Body mass index and metformin use as factors associated with polyp incidence, whereas only metforminwas independently associated with decreased adenoma incidence (Odd ratio=0.738, 95% CI=0.554-0.983, P=0.03). CONCLUSIONS: In patients with type 2 DM, metformin reduced the incidence of adenomas that may transform into CRC. Therefore, metformin may be useful for the prevention of CRC in patients with type 2 DM.

Endoscopy Nurse Participation May Increase the Polyp Detection Rate by Second-Year Fellows during Screening Colonoscopies

BACKGROUND/AIMS: The aim of this study was to assess the effects of endoscopy nurse participation on polyp detection rate (PDR) and adenoma detection rate (ADR) of second-year fellows during screening colonoscopies. METHODS: This was a single-center, prospective, randomized study comparing a fellow alone and a fellow plus an endoscopy nurse as an additional observer during afternoon outpatient screening colonoscopies. The primary end points were PDR and ADR. RESULTS: One hundred ninety-one colonoscopies performed by a fellow alone and 192 colonoscopies performed by a fellow plus an endoscopy nurse were analyzed. The PDR was significantly higher when the nurse was involved (53.1% vs. 41.3%, p or =2 polyps, advanced adenomas, polyp size, polyp location, and polyp shapes between the two groups. There was no difference in the PDR according to the level of experience of the endoscopy nurse. CONCLUSIONS: Endoscopy nurse participation as an additional observer during screening colonoscopy performed by second-year fellow increases the PDR; however, the level of experience of the nurse was not an important factor.

Efficacy of Hood-cap Assisted Colonoscopy; Comparison with Conventional Colonoscopy

BACKGROUND/AIMS: A few studies showed that hood-cap assisted colonoscopy (CAC) had improved cecal intubation rate and cecal intubation time but did not help in finding colon polyps in comparison with conventional colonoscopy (CC). However, other studies have shown different results. Therefore, we investigated the efficacy of CAC for the cecal intubation time and polyp detection rate. METHODS: Patients for colonoscopy in Busan St. Mary's Medical Center were enrolled to this randomized controlled trial between July 2010 and September 2010. The evaluated outcomes were polyp detection rate, adenoma detection rate, and cecal intubation time in all patients, in difficult cases (history of previous abdominal or pelvic surgery, obesity, old age), and in the expert and non-expert groups. RESULTS: A total of 260 patients enrolled in this study were randomly allocated to the CAC group (n=130), or CC group (n=130). The overall cecal intubation time was shorter in the CAC group (5.7+/-3.4 min vs. 7.8+/-5.7 min, P<0.001). The polyp detection rate was higher in the CAC group (58.4% vs. 43%, P=0.008). The cecal intubation time in the expert and non-expert groups were shorter in the CAC group (expert: 4.1+/-2.2 min vs. 5.5+/-2.0 min, P=0.001; non-expert: 6.7+/-3.7 min vs. 9.4+/-5.9 min, P=0.001). CONCLUSIONS: The use of CAC improved the detection rate of colon polyps and shortened the cecal intubation time for both the expert and non-expert groups.

Usefulness of Polyp Detection Rate as a Quality Indicator in Colonoscopy

BACKGROUND/AIMS: The adenoma detection rate (ADR) has been proposed as a quality indicator of colonoscopy; however, ADR cannot be measured easily with commonly used endoscopy reporting systems because substantial time and effort is required to acquire data from histologic assessments. The purpose of this study was to determine if polyp detection rate (PDR) could be used as a valid proxy for ADR. METHODS: A total of 1,156 consecutive, asymptomatic, individuals of average risk between 50 and 75 years-of-age who underwent screening colonoscopies at four tertiary medical centers by 27 gastroenterologists were included in this study. Each individual endoscopist performed at least 10 colonoscopies during the study period. The ADR and PDR were calculated as the proportion of an endoscopist's cases with an adenoma or polyp divided by the total number of colonoscopies. Pearson's correlation coefficient and the intraclass correlation coefficient were used to determine the level of agreement between ADR and PDR. RESULTS: The mean PDR and ADR for endoscopists was 47.4% (range, 21.7-75.0) and 36.5% (range, 13.0-66.7), respectively. There was a strong correlation between PDR and ADR (Pearson's correlation coefficient 0.94, P<0.001) and there was also good agreement between performance quintiles defined by ADR and PDR (intraclass correlation coefficient 0.94, P<0.001). CONCLUSIONS: PDR is a valid proxy for ADR and may be useful for quality assurance at centers where ADR cannot be easily measured.