Colon Polyp Clinical Trial
Official title:
Impacts of Inspection During Instrument Insertion on Colonoscopy Quality: a Prospective Randomized Controlled Trial
Small colon polyps which are found during colonoscopy insertion are sometimes difficult to find during withdrawal and thus missed. The investigators aim to evaluate the differences of colon polyp/adenoma detection rates of patients undergoing additional inspection and polypectomy during insertion as compared to the patients undergoing traditional practice of careful inspection and polypectomy performed entirely during withdrawal of colonoscopy.
Participants will be randomly assigned by a research assistant, by using a computer-generated
randomization sequence to undergo colonoscopy with either inspection and polypectomy during
both insertion and withdrawal of colonoscope (study group) or inspection and polypecotmy
entirely during withdrawal of colonoscope (control group). Randomization will be done via
concealed allocation with a sealed envelope that designate study group or control group.
Colonoscopies will be performed by two experienced investigators by using a standard
colonoscopy (CF-Q260AI or CF-Q260AL; Olympus Medical Systems Corp., Tokyo, Japan). All
procedures are performed under moderate conscious sedation with fentanyl (United Biomedical,
Taipei, Taiwan) and midazolam (Dormicum; Roche Pharmaceuticals, Basel, Switzerland) according
to the current guidelines. Carbon dioxide insufflation is used for all endoscopic procedures.
All participants receive 3-L polyethylene glycol (PEG; Klean-Prep, Helsinn Birex
Pharmaceuticals Ltd., Dublin, Ireland) for bowel preparation. A split-dose of the PEG
preparation is provided. The level of colon cleansing is prospectively evaluated with the
Boston Bowel Preparation Scale score.
For participants assigned into the study group, the colonic lumen is washed with saline and
the fluid and debris are suctioned as the instrument is slowly inserted from rectum to cecum.
Deliberate and systematic inspection of the colonic mucosa is performed with adequate luminal
insufflations during both the insertion and withdrawal phases. Polyp size is determined by
comparison with open colonoscopic biopsy forceps pushed against the polyp or, in some cases
of pedunculated polyp by direct measurement after retrieval. Polyps with size <10mm are
removed as they are identified on insertion and withdrawal. Polyps with size ≥10mm are
removed only during withdrawal.
For participants assigned into the control group, deliberate mucosal inspection and polyp
removal are performed exclusively on instrument withdrawal. During insertion, minimal mucosal
inspection and insufflation are applied to efficiently advance the instrument into cecum. If
a polyp is found during insertion, investigators are instructed to make a mental note of it
and find it during withdrawal for polypectomy.
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