Colon Polyps Clinical Trial
Official title:
Retroflexion in the Entire Colon for the Detection of Colon-related Diseases
Colorectal cancer is one of the common gastrointestinal malignancies, and the incidence of
colorectal cancer in China increases by 3% to 4% annually . Colorectal adenoma is the most
important precancerous lesion of colorectal cancer. Timely screening for colorectal adenoma
and endoscopic resection is the most effective measure to prevent colorectal cancer .Removal
of pre-malignant colon polyps during colonoscopy reduces colorectal cancer mortality by over
50%. However,Conventional colonoscopy endoscopy is a direct-view type, and the visual field
is limited. About 10%-24% of the lesions may be missed. The ascending colon is more difficult
because of the deep folds, and the rate of missed diagnosis is higher. Our goal is to
determine if additional pre-cancerous colon polyps can be identified by looking at the total
colon in retroflexion. During retroflexion the tip of the colonoscope is turned 180 degrees;
allowing the doctor to view the backs of colonic folds. If additional polyps can be
identified in this manner colonoscopy will become a more efficient method of screening for
colon cancer.
In order to evaluate how effective colon retroflexion is at detecting polyps in the total
colon the investigators plan on performing a randomized, controlled trial. Patients
undergoing screening or follow up colonoscopy will be invited to participate in the study.
Those patients who agree to participate will be randomized into one of two groups once the
colonoscope is fully inserted. Group one will have their colon examined for polyps with the
endoscope looking forward (traditional form of examination) followed by repeat examination of
the total colon with the colonoscope in retroflexion (looking backwards). In group two the
colonoscopy will be completed in the usual manner. Polyps seen during each section of the
exam will be recorded. The duration of each portion of colonoscopy will be recorded. After
the procedure is completed the physician performing the colonoscopy will rate difficulty of
the procedure and confidence with quality of the examination. Assess and record the degree of
pain during and after the patient's examination.Pathology results for each polyp will be
recorded once available. There will be no study related follow up after the pathology results
are recorded.
Colorectal cancer is one of the common malignant tumors of the digestive tract. The incidence
of colorectal cancer in China has increased by 3%-4% annually . Colorectal adenoma is the
most precancerous lesion of colorectal cancer. Screening for colorectal adenoma and
endoscopic resection are the most effective measures to prevent colorectal cancer .
Colonoscopy and endoscopic polypectomy can effectively prevent the occurrence of colorectal
cancer, and it can reduce the mortality of colorectal cancer by more than 50% . Especially in
the rectum and sigmoid colon and other high-intestinal segments of colorectal cancer, the
reduction effect is very significant . However, colonoscopy, currently considered a "gold
standard," still misses a significant number of lesions. A foreign meta-analysis showed that
the rate of missed diagnosis of polyps in colonoscopy was as high as 22% . Especially for the
right colon, the protective effect of colonoscopy is not ideal, and the incidence of right
inter-coloanal cancer is significantly higher than that of the left colon . This difference
may be caused by tumorigenesis and polyp morphology in the right colon and left colon. Flat
polyps, which are more common in the right colon, are more likely to be missed than pedicle
polyps, which are more common in the left colon. In addition, it is more difficult to observe
the polyps in the right colon fold by conventional colonoscopy. Over the years, techniques to
improve the positive rate of diagnosis of the right Semi-colon have emerged, including
providing high-quality bowel preparation, setting up a standard time for the right Semi-colon
independent decolonisation, repeated screening of the right Semi-colon and the conduct of the
ascending colon inversion .
Inversion technique is a special method of examination in colonoscopy. It was first used by
Grobe in the examination of rectal lesions in 1982 and achieved good results. In addition,
for some polyps near the proximal rectum, which are difficult to reach with endoscopy, the
application of this technique can effectively perform polypectomy . At present, the most
popular in the lower digestive tract examination is the inversion technique of the rectal
abdomen, but it has not been popularized in colon examination . Conventional colonoscopy
endoscopy is a direct-view type, and the visual field is limited. About 10%-24% of the
lesions may be missed. The ascending colon is more difficult because of the deep folds, and
the rate of missed diagnosis is higher. The colon reversal technique can observe the oral
mucosa of the colonic meniscus, increase the observation of the colonic mucosa, and make up
for the defects of the conventional retrospective, which is crucial for improving the
positive rate of colonic lesion diagnosis. During retroflexion the tip of the colonoscope is
turned 180 degrees; allowing the doctor to view the backs of colonic folds. If additional
polyps can be identified in this manner colonoscopy will become a more efficient method of
screening for colon cancer.However, inversion techniques may increase the incidence of
complications and increase the time of examination to bring some painful experience to the
subject. At present, there are many endoscopic reversal studies on the right colon in China
and abroad. Luo Yuanqiang and Chen Peisong and other studies have found that ascending
colonic reversal can improve the detection rate of polyposis and reduce the rate of polyps
missed .A foreign meta-analysis showed that the inversion technique of the right colon can
significantly increase the rate of adenoma discovery without increasing the incidence of
adverse events . However, there is no research on total colon reversal at domestic and
abroad. Observation of reversal of the whole colon may increase the detection rate of related
lesions, but it may also increase the examination time and adverse events, and because
colonoscopy has a relatively high rate of detection of left colonic lesions, so the
investigators need to fully evaluate the overall colon inversion technique for disease
detection rate and the degree of pain and adverse events in the subject.
This study aimed to evaluate the value of inversion techniques in improving the detection
rate of colorectal polyps and its safety and operational feasibility by comparing the
inversion method with conventional direct observation method by randomized controlled method.
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