Right-sided Retroflexion With Standard Adult Versus Pediatric Colonoscopes

Study Overview
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Brief Summary
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Screening colonoscopy has been shown to be less effective in preventing colorectal cancer in the proximal colon compared to the distal colon. Possible reasons for this include bowel preparation often being worse in the proximal colon as well as flat depressed lesions being more common in the proximal colon. Retroflexion is commonly regarded as standard practice in the rectum, but retroflexion in the proximal colon is not currently routinely performed due to concerns of perforation and possibly because of the increased time required. Proximal colon retroflexion has been shown to be safe and effective without any complications, but data regarding ability to retroflex with certain types of colonoscopes is limited. Endoscopists interchangeably use standard adult colonoscopes or pediatric colonoscopes. Studies have not been performed to comparatively evaluate the success rates of standard adult and pediatric colonoscopes and whether either type of instrument confers a greater polyp detection rate.

Official Title
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Right-sided Retroflexion With Standard Adult Versus Pediatric Colonoscopes

Conditions
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Colonic Neoplasms

Intervention / Treatment
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* Procedure: Retroflexion with the adult colonoscope.
* Procedure: Retroflexion with the pediatric colonoscope.


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients over the age 18 undergoing screening or surveillance colonoscopy Exclusion Criteria: Age less than 18 Pregnant History of ulcerative colitis or Crohn's disease History of polyposis syndromes History of colon resection Colonoscopy being performed for diagnostic purposes (ie. bleeding, abdominal pain, alternating bowel habits)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

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
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Adult colonoscope<br>Use of the adult colonoscope. | Procedure: Retroflexion with the adult colonoscope.<br> <br> |
| Active Comparator: Pediatric colonoscope<br>Use of the pediatric colonoscope. | Procedure: Retroflexion with the pediatric colonoscope.<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of cases in which right-sided retroflexion is successful with the adult and pediatric colonoscopes. |  | After 50% and 100% of patient enrollment is complete. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Adenoma detection rate in forward and retroflexed views. |  | After 50% and 100% of patient enrollment is complete. | 
| Reasons for failure of retroflexion. | This will be assessed as a yes/no variable. In addition, the specific reasons that the endoscopist could not retroflex the colonoscope in the right colon will assessed, such as the colonoscope not being able to be advanced to the cecum, small diameter of the right colon, too much resistance encountered when attempting retroflexion that the endoscopist does not feel comfortable with, etc. | After 50% and 100% of patient enrollment is complete. |