A randomized comparison of ultrathin and standard colonoscope in cecal intubation rate and patient tolerance.

BACKGROUND: Complete colonoscopy examination cannot be performed in as many as 10% of cases. The new 9.2-mm ultrathin colonoscope (UTC) with an extra bending section may improve procedure tolerance and allow improvement in colonoscopy completion rate compared with a 12.9-mm standard colonoscope (SC). OBJECTIVE: To compare the performance of the 9.2-mm UTC with that of the 12.9-mm SC. DESIGN: Prospective, randomized, controlled trial. SETTING: Academic endoscopic unit. PATIENTS: Subjects 18 years and older undergoing their first colonoscopy. INTERVENTION: Subjects were randomized to either the UTC or SC group. MAIN OUTCOME MEASUREMENTS: First and rescue successful cecal intubation rates, subject satisfaction scores, and sedation requirements were compared. RESULTS: A total of 1121 patients (56% women, mean age 53.6 years) were randomized to the UTC group (n = 551) or the SC group (n = 570). There was no statistically significant difference in the first successful cecal intubation rate between the UTC and SC groups (98.9% vs 97.4%, P = .057). The mean (standard deviation) dose of midazolam and pethidine used was significantly lower in the UTC group (2.65 [0.65] mg vs 2.82 [0.85] mg, P < .001 and 27.6 [7.4] mg vs 29.7 [9.6] mg, P < .001, respectively). The mean (standard deviation) patient satisfaction score was similar between groups (6.99 [2.89] vs 7.04 [3.06], P = .762). Of the 21 patients (1.9%) with an incomplete initial colonoscopy (6 in the UTC group and 15 in the SC group), all 6 in the UTC group had their procedure completed with an SC. Eleven of 15 patients in the SC group had their procedures completed with a UTC in the same session. LIMITATIONS: Low failure rate may mask any difference between the 2 colonoscopes as a rescue instrument. CONCLUSIONS: The 9.2-mm UTC has performance characteristics similar to those of an SC in Chinese subjects undergoing their first colonoscopy performed by experienced and trainee endoscopists. ( CLINICAL TRIAL REGISTRATION NUMBER: NCT01142167.).

Patients with polyps larger than 5 mm in computed tomography colonoscopy screening have high risk for advanced colonic neoplasia in Asia.

BACKGROUND & AIMS: Computed tomography colonography (CTC) is a recommended screening modality for colorectal cancer (CRC). It is not known whether polyps 6-9 mm based on CRC are likely to have advanced histologic features in Asian patients. We estimated the risk of advanced colonic neoplasia (ACN) from polyps <10 mm and the risk of ACN detection failure if patients with polyps <10 mm are not referred for colonoscopy. METHODS: The study included 1457 subjects from the Asia-Pacific Working Group on CRC screening and the Hong Kong CRC screening program. Polyps and ACN found during colonoscopy examinations were classified by size and histology. RESULTS: Of the subjects, 38.2% had polyps; 16.7% of these were ACN, 5.4% of ACN were ≤5 mm, and 24.7% of the ACN were 6-9 mm. Adopting the policy of reporting polyps found by CTC of <5 mm as normal and repeating CTC in patients with polyps of 6-9 mm, 5.4% of subjects with ACN, 4.5% of male subjects, and 11.5% of subjects with family history of CRC would be classified as normal. In referring patients with polyps of 6-9 mm for CTC surveillance, 20.4% of those with ACN, 22.4% of those that are male, and 23.1% of those with family histories of CRC would have polypectomies delayed by at least 3 years. CONCLUSIONS: A substantial proportion of polyps <10 mm have advanced histologic features in Asia, so patients with a polyp of 6 mm or more at CTC should be offered colonoscopies with polypectomies, rather than CTC surveillance of polyps.