Ignite Creation Date:
2024-05-06 @ 1:38 PM
Last Modification Date:
2024-10-26 @ 1:17 PM
Study NCT ID:
NCT04086706
Status:
COMPLETED
Last Update Posted:
2019-09-13
First Post:
2019-09-10
Brief Title:
Retroflexion In The Ascending Colon Is A Costless Endoscopic Maneuver Increasing Adenoma Detection Rate
Sponsor:
Alexandra Hospital Athens Greece
Organization:
Alexandra Hospital Athens Greece
Study Overview
Official Title:
Retroflexion In The Ascending Colon Is A Costless Endoscopic Maneuver Increasing Adenoma Detection Rate
Status:
COMPLETED
Status Verified Date:
2019-09
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
Missing polyps during colonoscopy is considered an important factor for interval cancer appearance especially in the ascending colon AC Aim of the study To evaluate the contribution of retroflexion to adenoma detection in the AC Patients-Methods Prospective observational study included consecutive patients with complete colonoscopy between June 2017 and June 2018 The AC was examined in two phases The first phase included two forward views from the hepatic flexure to the cecum and the second phase a retroflexion in the cecum inspection till the hepatic flexure then redressing to forward view and reinsertion to the cecum
Detailed Description:
We prospectively evaluated for polyp detection in the ascending colon a cohort of consecutive patients addressed intended for complete colonoscopy in Alexandra University Hospital Athens Greece for a predetermined period June 2017-June 2018 All colonoscopies were performed under conscious sedation by using midazolam andor propofol and continuous monitoring for vital signs The type of endoscopes used were adult high definition with variable stiffness colonoscopes Olympus Evis Exera CF-H185 and 190 Insufflation was performed by means of a CO2 insufflator OLYMPUS - UCR An irrigation pump OLYMPUS - OFP2 was used if needed either for washing or for water exchange technique according to the endoscopist judgement Oral sodium and potassium sulphate in combination Eziclen or PEG solutions Klean Prep or Fortrans were used for bowel preparation which was measured by means of the Segmental Boston Bowel Preparation Scale Inclusion criteria were as follows Patients older than 18 years with a complete colonoscopy for CRC screening or post-polypectomy surveillance or diagnostic assessment Exclusion criteria precluded patients with previous colectomy or an abdominal surgery in the last 6 months patients with polyposis syndromes or inflammatory bowel diseases and if they were unfit for polypectomy or the polyp specimen was not retrieved for histology The protocol of ascending colon examination encompassed 2 phases A first phase 1 divided in Forward view 1a videlicet insertion from the right flexure to the caecum followed by a second forward view 1b namely withdrawal till the right flexure and reinsertion to the caecum maintaining the endoscope straight and a second phase 2 Retroflexion with U-turn of the colonoscope in the caecum till the right flexure and then redressing to the forward view and reinsertion to the caecum
Concerning endoscopy 2 seniors and 4 trainees participated in the study All colonoscopies were performed with at least 2 operators one senior and one trainee The main investigator the most experienced endoscopist in the department was present during all the procedures for the ascending colon examination SM Only 3 attempts were permitted for retroflexion achievement performed by the main investigator if a younger trainee or senior gastroenterologist could not perform it Polyps were mapped during both phases and were not removed until the end of the inspection Polypectomy followed according to the previous mapping and all polyps were collected and sent for histological examination The protocol of this non-interventional study as well as the informed consent for the patients were submitted and approved by the local ethical committee
Adenoma detection rate ADR was defined as the number of colonoscopies in which one or more adenomas were detected divided by the total number of colonoscopies ADR in the ascending colon as the number of colonoscopies with at least one adenoma in the ascending colon divided by the total number of colonoscopies Adenoma miss rate AMR of the ascending colon was defined as the number of additional adenomas in ascending colon detected by retroflexed view divided by the total adenomas in ascending colon detected with two forward and retroflexion views The per-patient miss rate was calculated as the number of patients with additional adenomas detected on retroflexion divided by the total number of patients who underwent the examination
Finally we evaluated two additional quality parameters in order to assess the contribution of retroflexion in adenoma detection adenomas per colonoscopy APC calculated by dividing the number of detected adenomas by the total number of colonoscopies and adenomas per positive participant APP calculated by dividing the number of detected adenomas by the number of colonoscopies in which at least 1 adenoma was detected
Concerning endoscopy 2 seniors and 4 trainees participated in the study All colonoscopies were performed with at least 2 operators one senior and one trainee The main investigator the most experienced endoscopist in the department was present during all the procedures for the ascending colon examination SM Only 3 attempts were permitted for retroflexion achievement performed by the main investigator if a younger trainee or senior gastroenterologist could not perform it Polyps were mapped during both phases and were not removed until the end of the inspection Polypectomy followed according to the previous mapping and all polyps were collected and sent for histological examination The protocol of this non-interventional study as well as the informed consent for the patients were submitted and approved by the local ethical committee
Adenoma detection rate ADR was defined as the number of colonoscopies in which one or more adenomas were detected divided by the total number of colonoscopies ADR in the ascending colon as the number of colonoscopies with at least one adenoma in the ascending colon divided by the total number of colonoscopies Adenoma miss rate AMR of the ascending colon was defined as the number of additional adenomas in ascending colon detected by retroflexed view divided by the total adenomas in ascending colon detected with two forward and retroflexion views The per-patient miss rate was calculated as the number of patients with additional adenomas detected on retroflexion divided by the total number of patients who underwent the examination
Finally we evaluated two additional quality parameters in order to assess the contribution of retroflexion in adenoma detection adenomas per colonoscopy APC calculated by dividing the number of detected adenomas by the total number of colonoscopies and adenomas per positive participant APP calculated by dividing the number of detected adenomas by the number of colonoscopies in which at least 1 adenoma was detected
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None