Clinical Trial: Does Inspection During Insertion Improve Adenoma Yields During Colonoscopy?
Study Status: Completed
Recruit Status: Completed
Study Type: Interventional
Official Title: Does Inspection During Insertion Improve Adenoma Yields During Colonoscopy?
Brief Summary: Colonoscopy is not a perfect test. It misses a substantial number of neoplastic lesions and has some risk of missing cancer. Nearly all work on detection during colonoscopy has focused on the withdrawal phase of the examination. This randomized, controlled trial will compare the additional effect on the rate of adenoma detection of mucosal inspection during colonoscope insertion, with inspection during instrument withdrawal, in patients undergoing colonoscopy for colorectal cancer screening or surveillance.
Detailed Summary:
Background: Colonoscopy is not a perfect test. It misses a substantial number of neoplastic lesions and has some risk of missing cancer. Nearly all work on detection during colonoscopy has focused on the withdrawal phase of the examination. Thus, colonoscopy is typically performed by rapidly passing the instrument through the loops and bends of the colon in order to reach the tip of the cecum, and then performing a slow withdrawal in which the tip of the instrument is systematically deflected, and the mucosa is careful cleaned and suctioned, to expose all of the colonic mucosa for viewing.
Many experienced colonoscopists recognize that small polyps seen incidentally but not removed during insertion are sometimes quite difficult to find during withdrawal. The reason for this observation is probably because the colon is in a very different anatomical conformation during endoscope insertion and withdrawal. During insertion, the colon is in its natural conformation in which the sigmoid and transverse colon has several sharp bends or flexures, and the overall length has not yet been shortened. In this phase, the colon is often significantly stretched because of the formation of loops and bends in the colonoscope. This greatly affects the conformation of the colonic wall visualized proximal to the instrument tip. During withdrawal, the colon is shortened and pleated over the colonoscope, with successive regions of the colon being inspected as they slip off the end of the instrument. Thus, segments of visualized colon are often much straighter during withdrawal than during insertion. The insertion and withdrawal phases, therefore, expose somewhat different sections of the mucosal surface to the colonoscope and inspection on insertion and withdrawal are, quite possibly, complementary.
Aims: This randomized, controlled trial will c
Sponsor: Indiana University School of Medicine
Current Primary Outcome: Adenoma detection rate [ Time Frame: During colonoscopy ]
Original Primary Outcome: Same as current
Current Secondary Outcome:
- Sedation dose [ Time Frame: During colonoscopy ]
- Post procedural pain scores [ Time Frame: Within 1 hour of colonoscopy ]
- Proportion of patients with at least one adenoma detected [ Time Frame: During colonoscopy ]
Original Secondary Outcome: Same as current
Information By: Indiana University
Dates:
Date Received: December 18, 2009
Date Started: December 2009
Date Completion:
Last Updated: March 15, 2017
Last Verified: March 2017
