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Our previous study (Am. J. Gastroenterol. 2017 04;112(4)) showed that water exchange (WE) colonoscopy was able to increase the detection of flat adenomas as well as overall ADR. We hypothesized that WE based whole-colon acetic acid（AA） staining might be useful to improve the detection of flat lesions compared with WE alone.
Water exchange colonoscopy was performed as described previously (Am. J. Gastroenterol. 2017 04;112(4)). Patients were randomly allocated to WE group or WE+AA group. In WE+AA group, water containing 1% of AA was used during insertion of colonoscopy instead of water alone. A bottle of 20ml pure AA was placed abutting the water pump, which make it possible to keep patients blinded to group allocation. Endoscopist using a high-definition wide-angle Olympus or Fujinum colonoscope performed all of the colonoscopies, with a withdrawal time of at least 6 min. The observation was initially performed without the assistance of cap or the use of magnification or electronic staining (NBI, BLI, LCI or AFI et al.). Scopolamine butylbromide or glucogon was not routinely administrated.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| WE+AA group | Experimental | Water containing 1% of AA was used during insertion of colonoscopy using water exchange method. |
|
| WE group | Active Comparator | Water exchange colonoscopy was used for standard screening or surveillance colonoscopy. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| acetic acid staining | Other | The water exchange colonoscopy is used during insertion procedure, in which the water contains 1% acetic acid, and the liquid is absorbed during the withdrawal process for observation. |
| Measure | Description | Time Frame |
|---|---|---|
| Number of flat polyps per patient | average numbers of flat polyps, defined by Paris classification IIa/IIb/IIc, for each patient | 9 months |
| Measure | Description | Time Frame |
|---|---|---|
| Overall ADR | Adenoma detection rate, defined as the proportion of subjects with at least one adenoma of any size, in each group. | 9 months |
| Advanced ADR | Advanced adenoma detection rate. Advanced adenoma: any with 3 or more adenomas of any size, 1 or more large adenomas 1 cm, or 1 or more adenomas with villous architecture or highgrade dysplasia. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Gui Ren, MD | Contact | +86298477136 | renguigz@hotmail.com | |
| Yanglin Pan, MD | Contact | +862984771536 | yanglinpan@hotmail.com |
| Name | Affiliation | Role |
|---|---|---|
| Yanglin Pan, MD | Xijing Hospital of Digestive Diseases | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Gastroenterology, Second Affiliated Hospital, Lanzhou University | Recruiting | Lanzhou | Gansu | 730030 | China |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 24804989 | Background | Shibagaki K, Amano Y, Ishimura N, Yuki T, Taniguchi H, Fujita H, Kobayashi K, Kinoshita Y. Magnification endoscopy with acetic acid enhancement and a narrow-band imaging system for pit pattern diagnosis of colorectal neoplasms. J Clin Gastroenterol. 2015 Apr;49(4):306-12. doi: 10.1097/MCG.0000000000000148. | |
| 27922025 | Result |
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| Water exchange colonoscopy | Other | The water exchange colonoscopy is used during insertion procedure, and the liquid is absorbed during the withdrawal process for observation. |
|
| 9 months |
| SSA/P detection rate | SSA/P detection rate, defined as the proportion of subjects with at least one sessile serrated adenoma/polyp (SSA/P) of any size, in each group. | 9 months |
| Flat neoplasms located in proximal colon | Low-grade adenoma, adenoma with villous components, high-grade adenoma, noninvasive carcinoma, and invasive carcinoma in proximal colon | 9 months |
| Adverse events | the rate of bleeding and perforation during colonoscopy procedure and abdominal pain, diarrhea, hematochezia and change of defecation habit Within one week. | 9 months |
| Department of Holistic Integrative Medicine, Shenzhen Hospital of Southern Medical University | Recruiting | Shenzhen | Guangdong | 510000 | China |
|
| Department of Gastroenterology, Huaihe Hospital of Henan University | Recruiting | Kaifeng | Henan | 475000 | China |
|
| Department of Gastroenterology, Shaanxi Second People's Hospital | Recruiting | Xi'an | Shaanxi | 710005 | China |
|
| Jia H, Pan Y, Guo X, Zhao L, Wang X, Zhang L, Dong T, Luo H, Ge Z, Liu J, Hao J, Yao P, Zhang Y, Ren H, Zhou W, Guo Y, Zhang W, Chen X, Sun D, Yang X, Kang X, Liu N, Liu Z, Leung F, Wu K, Fan D. Water Exchange Method Significantly Improves Adenoma Detection Rate: A Multicenter, Randomized Controlled Trial. Am J Gastroenterol. 2017 Apr;112(4):568-576. doi: 10.1038/ajg.2016.501. Epub 2016 Dec 6. |
| 30738046 | Result | Zhao S, Wang S, Pan P, Xia T, Chang X, Yang X, Guo L, Meng Q, Yang F, Qian W, Xu Z, Wang Y, Wang Z, Gu L, Wang R, Jia F, Yao J, Li Z, Bai Y. Magnitude, Risk Factors, and Factors Associated With Adenoma Miss Rate of Tandem Colonoscopy: A Systematic Review and Meta-analysis. Gastroenterology. 2019 May;156(6):1661-1674.e11. doi: 10.1053/j.gastro.2019.01.260. Epub 2019 Feb 6. |
| 28365356 | Result | Desai M, Sanchez-Yague A, Choudhary A, Pervez A, Gupta N, Vennalaganti P, Vennelaganti S, Fugazza A, Repici A, Hassan C, Sharma P. Impact of cap-assisted colonoscopy on detection of proximal colon adenomas: systematic review and meta-analysis. Gastrointest Endosc. 2017 Aug;86(2):274-281.e3. doi: 10.1016/j.gie.2017.03.1524. Epub 2017 Mar 29. |