Comparison of Procedural Sequences in Same-day Painless Bidirectional Endoscopy With Colonoscopic Water Exchange Method

Study Overview
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Brief Summary
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This prospective randomized controlled trial is to compare evaluate the optimal procedure sequence among patients undergoing water exchange colonoscopy.

Detailed Description
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Same-day esophagogastroduodenoscopy (EGD) and colonoscopy (bidirectional endoscopy; BDE) are commonly performed to evaluate for gastrointestinal conditions, such as active gastrointestinal bleeding, iron deficiency anemia, positive fecal occult blood tests and abdominal pain. EGD-colonoscopy sequence seems to be the reasonable choice for BDE using air or CO2. With the use of water exchange method, endoscopists have to remove the dirty fecal material and air bubble during insertion. Gas insufflated during EGD may get into the colon and make subsequent water exchange colonoscopy more difficult. The aim of this prospective randomized controlled trial is to compare evaluate the optimal procedure sequence among patients undergoing water exchange colonoscopy.

Official Title
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Division of Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan

Conditions
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Colon Disease, Bidirectional Endoscopy

Intervention / Treatment
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* Behavioral: colonoscopy first
* Behavioral: EGD first


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients underwent fully sedated bidirectional endoscopy in the physical check-up department Exclusion Criteria: Patients who < 18 years old, > 80 years old Without standard colon preparation Allergy to meperidine or propofol With a history of partial colectomy Refusal to provide written informed consent American Society of Anesthesiology (ASA) risk Class 3 or higher

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: A total of 200 patients were allocated into one of two groups by computerized randomization. Patients in the group A (colonoscopy first group) received colonoscopy followed by EGD and those in the group B (EGD first group) received EGD followed by colonoscopy.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: colonoscopy first group<br>Patients received water-exchange colonoscopy first and followed by esophagogastroduodenoscopy | Behavioral: colonoscopy first<br>* Received water exchange colonoscopy followed by EGD<br>|
| Active Comparator: EGD first group<br>Patients received esophagogastroduodenoscopy first and followed by water-exchange colonoscopy | Behavioral: EGD first<br>* Received EGD followed by water exchange colonoscopy<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| cecal insertion time | Cecal insertion time was defined as the time from insertion into the rectum to the time when the colonoscope tip passed to a point proximal to the ileocecal valve so that the base of cecum was visible. | 30 minutes | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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water exchange, colonoscopy, cecal insertion time, bidirectional endoscopy