World Congress at ACG2017

Simultaneous Plenary Session 1D: Late-Breaking Abstracts

22 - A Prospective RCT Comparing Proximal ADR (Primary Outcome) Using Combined Chromoendoscopy With Water Exchange (CWE) versus Water Exchange (WE) versus Air Insufflation (AI) in Screening Colonoscopy

Monday, October 16
4:50 PM - 5:00 PM
Location: W414 (Level 4)



Category: General Endoscopy       

J. Leung, MD, MACG1,2, A. Yen, MD, FACG1, C. Opada, RN1, A. Melnik, BSc1, C. Feller, RDN, CCRP1, M. Wilson, PhD3, F. Leung, MD, FACG4
1Sacramento VA Medical Center, Sacramento, CA; 2UC Davis Medical Center, Sacramento, CA; 3Clinical and Translational Science Center, UC Davis, Sacramento, CA; 4Sepulveda Ambulatory Care Center, VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA, Los Angeles, CA
Introduction: Low adenoma detection rate (ADR) increases risk of interval cancer which tend to cluster in the proximal colon. Methods to improve proximal colon ADR may reduce such risk. Aim is to determine proximal ADR (primary outcome) of chromoendoscopy with water exchange (CWE) in screening cases compared with water exchange (WE) alone and air insufflation (AI) in a RCT (NCT01607255).

Methods: In 4 years, 480 veterans were randomized prospectively comparing the 3 methods. Patients received split-dose preparation. AI was performed with conventional method. WE was done with air button turned off, and water was infused and exchanged until cecal intubation. Air was used on scope withdrawal to facilitate removal of lesions. CWE used dilute indigo carmine (0.008%) instead of plain water, and the method was similar to WE. Polyps were removed using biopsy forceps, cold or hot snare.

Results: Majority were males (424/480), without significant differences in patients’ age and BMI. Cecal intubation success rates were comparable. CWE and WE required less abdominal compression/position change (p<0.001). Significantly more water was used in CWE and WE groups. Overall bowel preparation on withdrawal was better for CWE and WE than AI (p<0.001). Mean cecal intubation time was comparable (13.3 vs 12.0 vs 12.2 min, respectively), and withdrawal time was significantly longer for CWE (p<0.001). There was no significant difference in pre- and post-procedural serum electrolytes (NA+ and K+) levels (Table 1). Primary outcome indicated no significant differences in proximal ADR (55.6% vs 53.4% vs 52.2%, respectively) amongst the 3 groups (Table 2). The adenoma per colonoscopy (APC) and adenoma per positive colonoscopy (APPC) were comparable. Limitations: single operator, only Veteran patients.

Discussion: Comparable demographic variables attest to satisfactory randomization. Comparable APC and APPC indicated equivalent withdrawal inspection techniques were used. Proximal ADR almost double recommended quality standard (30%) was achieved with AI. Use of WE and CWE did not further improve ADR results. In contrast to recent reports of WE significantly increasing ADR in colonoscopists with ADR meeting (Endoscopy 2017;49:456; GIE 2017;86:192) and not meeting (AJG 2017;112:568) quality standard, a high detector may not require WE or CWE to augment performance. Nevertheless, lower requirement for abdominal compression with WE and CWE may reduce costly assistant hand injury (GEN 2013;36:329).

Disclosures: Does Disclose

Joseph W. Leung: Royalty – Cook Endoscopy; Grant/Research Support – Olympus; Speakers Bureau - Cook Endoscopy.
All other authors have indicated no relevant financial relationships.

Citation: . A PROSPECTIVE RCT COMPARING PROXIMAL ADR (PRIMARY OUTCOME) USING COMBINED CHROMOENDOSCOPY WITH WATER EXCHANGE (CWE) VERSUS WATER EXCHANGE (WE) VERSUS AIR INSUFFLATION (AI) IN SCREENING COLONOSCOPY. Program No. 22. World Congress of Gastroenterology at ACG2017 Meeting Abstracts. Orlando, FL: American College of Gastroenterology.

Joseph W. Leung

Professor of Medicine, Chief of Gastroenterology
Sacramento VA Medical Center, VANCHCS
Mather, California

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