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1. Adenoma detection with blue-water infusion colonoscopy: a randomized trial.

Author

Lesne A, Rouquette O, Touzet S, Petit-Laurent F, Tourlonias G, Pasquion A, Rivory J, Aguero Garcete G, Scanzi J, Chalumeau S, Chambon-Augoyard C, Moussata D, Leger-Nguyen F, Degeorges S, Chauvenet M, Fontanges T, Baubet S, Brulet P, Billioud C, Thimonier E, Stroeymeyt-Martin K, Hamel B, Graillot E, Cruiziat C, Scalone O, O'Brien M, Péré-Vergé D, Souquet JC, Phelip JM, Poincloux L, Poupon-Bourdy S, Denis A, Magaud L, Ponchon T, and Pioche M

Subjects
Aged, Cecum, Color, Female, Humans, Intubation, Gastrointestinal, Male, Middle Aged, Operative Time, Water, Adenocarcinoma diagnostic imaging, Adenoma diagnostic imaging, Colonoscopy methods, Colorectal Neoplasms diagnostic imaging
Abstract

Background and aims  Colonoscopy is currently the reference method to detect colorectal neoplasia, yet some adenomas remain undetected. The water infusion technique and dying with indigo carmine has shown interesting results for reducing this miss rate. The aim of this study was to compare the adenoma detection rate (adenoma and adenocarcinoma; ADR) and the mean number of adenomas per patient (MAP) for blue-water infusion colonoscopy (BWIC) versus standard colonoscopy. Methods  We performed a multicenter, randomized controlled trial in eight units, including patients with a validated indication for colonoscopy (symptoms, familial or personal history, fecal occult blood test positive). Consenting patients were randomized 1:1 to BWIC or standard colonoscopy. All colonoscopies were performed by experienced colonoscopists. All colonoscopy quality indicators were prospectively recorded. Results  Among the 1065 patients included, colonoscopies were performed completely for 983 patients (514 men; mean age 59.1). The ADR was not significantly different between the groups; 40.4 % in the BWIC group versus 37.5 % in the standard colonoscopy group (odds ratio [OR] 1.13; 95 % confidence interval [CI] 0.87 - 1.48; P  = 0.35). MAP was significantly greater in the BWIC group (0.79) than in the standard colonoscopy group (0.64; P  = 0.005). For advanced adenomas, the results were 50 (10.2 %) and 36 (7.3 %), respectively ( P  = 0.10). The cecal intubation rate was not different but the time to cecal intubation was significantly longer in BWIC group (9.9 versus 6.2 minutes; P  < 0.001). Conclusion  Despite the higher MAP with BWIC, the routine use of BWIC does not translate to a higher ADR. Whether increased detection ultimately results in a lower rate of interval carcinoma is not yet known., Clinical Trials Registration: EudraCT 2012-A00548 - 35; NCT01937429., Competing Interests: Competing interests: None., (© Georg Thieme Verlag KG Stuttgart · New York.)

Published
2017
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2. Adenoma detection with blue-water infusion colonoscopy: a randomized trial

Author

Marc O’Brien, Olivia Scalone, D. Pere-Verge, Sandrine Baubet, Claire Billioud, Karine Stroeymeyt-Martin, Driffa Moussata, Christine Chambon-Augoyard, Guillermo Aguero Garcete, Stéphane Degeorges, Sandrine Touzet, Adriane Lesne, Thierry Ponchon, Jérôme Rivory, Audrey Pasquion, Claire Cruiziat, Sylvaine Chalumeau, Florence Léger-Nguyen, S. Poupon-Bourdy, Jean-Marc Phelip, Philippe Brulet, Benjamin Hamel, J. C. Souquet, Thierry Fontanges, Laurent Magaud, Fabien Petit-Laurent, Julien Scanzi, Laurent Poincloux, Angélique Denis, Marion Chauvenet, Mathieu Pioche, Olivier Rouquette, Gwenaelle Tourlonias, Elsa Thimonier, Emmanuelle Graillot, CHU Estaing [Clermont-Ferrand], Centre Hospitalier Lyon Sud [CHU - HCL] ( CHLS ), Hospices Civils de Lyon ( HCL ), Gastro-enterology department, CHU Clermont-Ferrand, Hepato-Gastroenterology, Hospices Civils de Lyon ( HCL ) -Hospices Civils de Lyon ( HCL ), Lipides - Nutrition - Cancer (U866) ( LNC ), Université de Bourgogne ( UB ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon ( ENSBANA ), Service d'hépato-gastro-entérologie, CH Pierre Oudot Bourgoin-Jallieu, Hôpital de la Croix-Rousse [CHU - HCL], Hôpital Villefranche sur Saône, Université Panthéon-Sorbonne ( UP1 ), Département de Gastroentérologie et hépatologie, Université Joseph Fourier - Grenoble 1 ( UJF ) -CHU Grenoble-Hôpital Michallon, Institut Pascal - Clermont Auvergne ( IP ), Sigma CLERMONT ( Sigma CLERMONT ) -Université Clermont Auvergne ( UCA ) -Centre National de la Recherche Scientifique ( CNRS ), Hôpital Edouard Herriot [CHU - HCL], Application des ultrasons à la thérapie ( LabTAU ), Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Université Paris 1 Panthéon-Sorbonne (UP1), Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, Institut Pascal (IP), SIGMA Clermont (SIGMA Clermont)-Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), Application des ultrasons à la thérapie (LabTAU), Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre Léon Bérard [Lyon]-Institut National de la Santé et de la Recherche Médicale (INSERM), and SIGMA Clermont (SIGMA Clermont)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS)

Subjects
Adenoma, Male, medicine.medical_specialty, medicine.medical_treatment, Operative Time, Color, Colonoscopy, Adenocarcinoma, Gastroenterology, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, medicine, Humans, Intubation, Cecum, Intubation, Gastrointestinal, ComputingMilieux_MISCELLANEOUS, Aged, medicine.diagnostic_test, business.industry, Fecal occult blood, Water, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, Odds ratio, Middle Aged, medicine.disease, Confidence interval, 3. Good health, Clinical trial, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, [ SDV.MHEP.HEG ] Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, Colorectal Neoplasms, business
Abstract

Background and aims Colonoscopy is currently the reference method to detect colorectal neoplasia, yet some adenomas remain undetected. The water infusion technique and dying with indigo carmine has shown interesting results for reducing this miss rate. The aim of this study was to compare the adenoma detection rate (adenoma and adenocarcinoma; ADR) and the mean number of adenomas per patient (MAP) for blue-water infusion colonoscopy (BWIC) versus standard colonoscopy. Methods We performed a multicenter, randomized controlled trial in eight units, including patients with a validated indication for colonoscopy (symptoms, familial or personal history, fecal occult blood test positive). Consenting patients were randomized 1:1 to BWIC or standard colonoscopy. All colonoscopies were performed by experienced colonoscopists. All colonoscopy quality indicators were prospectively recorded. Results Among the 1065 patients included, colonoscopies were performed completely for 983 patients (514 men; mean age 59.1). The ADR was not significantly different between the groups; 40.4 % in the BWIC group versus 37.5 % in the standard colonoscopy group (odds ratio [OR] 1.13; 95 % confidence interval [CI] 0.87 – 1.48; P = 0.35). MAP was significantly greater in the BWIC group (0.79) than in the standard colonoscopy group (0.64; P = 0.005). For advanced adenomas, the results were 50 (10.2 %) and 36 (7.3 %), respectively (P = 0.10). The cecal intubation rate was not different but the time to cecal intubation was significantly longer in BWIC group (9.9 versus 6.2 minutes; P Conclusion Despite the higher MAP with BWIC, the routine use of BWIC does not translate to a higher ADR. Whether increased detection ultimately results in a lower rate of interval carcinoma is not yet known.Clinical trials registration: EudraCT 2012-A00548 – 35; NCT01937429.

Published
2017
Full Text
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