Withdrawal Time and Use of Wide-angle Endoscope to Increase the Adenoma Detection Rate of Screening Colonoscopy

Study Overview
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Brief Summary
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Colonoscopy outcome is strictly related to the adenoma detection rate (ADR). An endoscopy withdrawal time >6min has been suggested to increase the ADR since it allows for thorough evaluation of the several hidden areas of the colon. The FUSE, full spectrum endoscopy system, has been demonstrated to reduce the rate of missed lesions due to its wide-angle view. In the present study the authors evaluate the impact of WT on ADR for High Definition Standard Endoscopes with just a single imager to the FUSE endoscope.

Detailed Description
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Introduction Colonoscopy outcome is strictly related to the adenoma detection rate. An endoscopy withdrawal time >6min has been suggested to increase the adenoma detection rate since it allows for accurate evaluation of the several hidden areas of the colon. The FUSE endoscope has been demonstrated also to reduce the rate of missed lesions due to its wide angle view. Aim of the study to evaluate the impact on the adenoma detection rate either of the use of a FUSE endoscope or of interventions directed at optimizing withdrawal time. to assess the impact of different factors in influencing the withdrawal time Methods A prospective non-randomized observational single-center study involving consecutive outpatients, aged 18-85 yr, undergoing colonoscopy with different indications. Previous abdominal colon resection, obstruction, inadequate preparation and incomplete examination were exclusion criteria. In a 3-month period 4 expert endoscopists will performed 500 colonoscopies either with standard endoscope or with FUSE without a dedicated withdrawal time protocol. Colonoscopy withdrawal times will be measured without the endoscopists' knowledge of being monitored. During a subsequent 3-month period the same endoscopists will perform further 500 colonoscopies with standard and FUSE scopes using dedicated inspection techniques and a minimum 6-minute withdrawal time. In this second phase withdrawal times will be again measured, but endoscopists will be aware of being monitored. The following parameters will be recorded: Demographic and general characteristics Indications to colonoscopy Colonoscopy findings Quality of preparation: Boston scale Time to reach the coecum Withdrawal time The adenoma detection rate and the mean adenomas per patients will be calculated.

Official Title
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Effect of a Longer Withdrawal Time or of the Use of a Wide-angle Endoscope on the Adenoma Detection Rate of Screening Colonoscopy

Conditions
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ColoRectal Cancer, Colon Polyp

Intervention / Treatment
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* Procedure: Colonoscopy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Indication for colonoscopy, age 18-85 Exclusion Criteria: Previous abdominal colon resection, colon obstruction, inadequate preparation and incomplete examination

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 85 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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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Standard scope-short time<br>Standard colonoscopy with unmonitored withdrawal time | Procedure: Colonoscopy<br>* Colonoscopy performed in adult consecutive patients for different indications<br>|
| FUSE scope-short time<br>Wide-angle colonoscopy with unmonitored withdrawal time | Procedure: Colonoscopy<br>* Colonoscopy performed in adult consecutive patients for different indications<br>|
| Standard scope-long time<br>Standard colonoscopy with monitored withdrawal time | Procedure: Colonoscopy<br>* Colonoscopy performed in adult consecutive patients for different indications<br>|
| FUSE scope-long time<br>Wide-angle colonoscopy with monitored withdrawal time | Procedure: Colonoscopy<br>* Colonoscopy performed in adult consecutive patients for different indications<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Adenoma detection rate | The rate of patient with at least one adenoma detected at colonoscopy | Up to 10 days from the end of endoscopy | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Factors affecting the withdrawal time | Analysis of the factors (quality of preparation, indications for colonoscopy) likely to influence the withdrawal time | Up to 10 days from the end of endoscopy | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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colorectal cancer, Colon polyp, Colonoscopy, Adenoma detection rate