Does Inspection During Insertion Improve Adenoma Yields During Colonoscopy?
研究概览
详细说明
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 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.
Study procedure: In this study, we plan to investigate whether a specified interval of inspection during insertion can increase overall adenoma detection. We will conduct a randomized controlled trial, in which patients will be randomized to have all of the inspection performed during the withdrawal phase (as is usual care) versus having several minutes of examination specifically devoted to inspection during insertion.
研究类型
注册 (实际的)
阶段
- 不适用
联系人和位置
学习地点
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Indiana
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Indianapolis、Indiana、美国、46202
- Indiana University Hospital
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Indianapolis、Indiana、美国、46280
- Beltway Surgery Center
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
Inclusion Criteria:
- Age ≥ 50 years
- Patients undergoing colonoscopy for screening or surveillance indications
Exclusion Criteria:
- Previous surgical resection of all or part of the colon.
- Inability to give informed consent.
- Ulcerative colitis or Crohn's disease.
- Polyposis syndrome or Lynch syndrome (HNPCC)
- Any comorbid condition which the investigator deems would put the patient at increased risk from a slightly prolonged procedure
学习计划
研究是如何设计的?
设计细节
- 主要用途:诊断
- 分配:随机化
- 介入模型:并行分配
- 屏蔽:无(打开标签)
武器和干预
参与者组/臂 |
干预/治疗 |
---|---|
实验性的:Insertion
Inspection on colonoscope insertion in addition to inspection during withdrawal from the cecum.
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The colonic mucosa will be inspected for lesions during insertion of the instrument, and during withdrawal of the instrument.
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有源比较器:Withdrawal
Inspection during withdrawal (usual care) without deliberate inspection during insertion.
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The colonic mucosa will be inspected for lesions only during withdrawal of the instrument from the cecum.
The instrument will be inserted to the cecum without deliberate inspection.
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研究衡量的是什么?
主要结果指标
结果测量 |
大体时间 |
---|---|
Adenoma detection rate
大体时间:During colonoscopy
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During colonoscopy
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次要结果测量
结果测量 |
大体时间 |
---|---|
Sedation dose
大体时间:During colonoscopy
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During colonoscopy
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Post procedural pain scores
大体时间:Within 1 hour of colonoscopy
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Within 1 hour of colonoscopy
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Proportion of patients with at least one adenoma detected
大体时间:During colonoscopy
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During colonoscopy
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合作者和调查者
调查人员
- 首席研究员:Douglas K Rex, M.D.、Indiana University School of Medicine
出版物和有用的链接
研究记录日期
研究主要日期
学习开始
初级完成 (实际的)
研究完成 (实际的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (估计)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
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