Optimal Laxatives for Oral Colonoscopy Bowel Preparation: from High-volume to Novel Low-volume Solutions.
[Optimal Laxatives for Oral Colonoscopy Bowel Preparation: from High-volume to Novel Low-volume Solutions]. Korean J Gastroenterol. 2020 Feb 25;75(2):65-73 Authors: Na SY, Moon W Abstract Optimal bowel preparation is essential for a more accurate, comfortable, and safe colonoscopy. The majority of postcolonoscopy colorectal cancers can be explained by procedural factors, mainly missed polyps or inadequate examination. Therefore the most important goal of optimal bowel preparation is to reduce the incidence of colorectal cancer. Although adequate preparation should be achieved in 85-90% or more of all colonoscopy as a quality indicator, unfortunately 20-30% shows inadequate preparation. Laxatives for oral colonoscopy bowel preparation can be classified into polyethylene glycol (PEG)-electrolyte lavage solution, osmotic laxatives, stimulant laxatives, and divided into high-volume solution (≥3 L) and low-volume solution (
Incomplete resection of colorectal neoplasia decreases the efficacy of colonoscopy and contributes to post-colonoscopy colorectal cancer. Conventional endoscopic resection (CR) of polyps, performed in a gas-distended colon, is the current standard, but incomplete resection rates (IRR) of approximately 3-25% for non-diminutive (>5mm) non-pedunculated lesions are reported. Underwater endoscopic resection (UR), a novel technique utilizing advantages of water-aided colonoscopy, may help reduce IRR.
Colonoscopy screening is proven to reduce mortality rates for colorectal cancer, which relies on early detection and removal of colonic polyps. Methods to improve polyp or adenoma detection have constantly been sought. AmplifEYE is a FDA-approved device with a row of flexible detection arms attached to the tip of colonoscope which can separate colonic folds during scope withdrawal and can improve polyp detection. Clinical data on this relatively new device especially in Chinese patients is lacking.
Adenoma detection rate (ADR) in colon cancer screening is most important for cancer prophylaxis. Recent studies suggest a benefit of endoscopic devices attached to the distal tip of the colonoscope for improving the ADR. This work is the first three arm randomized controlled trial comparing standard colonoscopy with Endocuff and Cap.
The reduced incidence and mortality from colorectal cancer over the past 30 years is largely attributable colonoscopy and polypectomy. However, success of colonoscopy depends on finding and removing all precancerous polyps. Clear visualization of the colonic mucosa is a prerequisite and depends on preparation quality. Multiple studies have shown that splitting the dose of bowel prep prior to colonoscopy significantly improves prep quality. Additional studies have shown that prep quality improves polyp and adenoma detection rates (PDR and ADR).
Colonoscopy with polypectomy is associated with a reduction in colorectal cancer risk. Incomplete polyp removal occurs in a significant proportion of patients undergoing polypectomy. Suboptimal polypectomy technique can result in costly referral to surgery or even interval cancer. Although complete polyp resection is integral to cancer prevention, polypectomy competency is rarely reported and quality metrics for this skill are lacking. We aimed to assess polypectomy competency and measure its correlation with established colonoscopy quality metrics, including adenoma detection rate (ADR) and withdrawal time (WT).
Colonoscopy, the gold standard for the detection of colorectal cancer, fails to detect 22-28% of polyps, resulting in interval cancer. The aim of this study was to compare a new, full-spectrum endoscope (Fuse, EndoChoiceTM, Alpharetta, GA) to standard forward-viewing colonoscopy in the detection of colorectal neoplasms.
Stool DNA testing has evolved into a highly accurate and well-validated test for the screen-detection of colorectal neoplasia. An optimized multi-target stool DNA test (MT-sDNA) achieves the same high point-sensitivities as reported with colonoscopy for early-stage colorectal cancer (CRC) and significantly higher sensitivity than by fecal immunochemical blood testing (FIT) for detection of both cancer and advanced precancer. Thus, MT-sDNA sets a new high criterion standard for the noninvasive screen-detection of colorectal neoplasia. With clinical application, MT-sDNA has potential to meaningfully address current gaps in o...
This study aimed to develop quantitative HRME image analysis algorithms based on pathological and architectural features. In addition, it aimed to evaluate the automated classification algorithms performance to accurately categorize neoplastic (tubular adenoma, tubulovillous adenoma and cancer) and non-neoplastic (normal, hyperplastic) mucosa in the colon.
Small colonic polyps are commonly encountered at colonoscopy and are usually removed due to the risk of progression to colorectal cancer. Cold snare polypectomy is used to remove these lesions without diathermy. In essence, the polyp is transected by a snare, along with a rim of surrounding normal mucosa. This theoretically allows complete polyp removal without the potential complications of electrocautery, particularly delayed bleeding and perforation. However, the adequacy of cold snare polypectomy (in terms of completeness of resection) has not been studied in a real world setting.
Adenoma detection rate (ADR) is one of the most important quality indicators of screening colonoscopy. For ADR calculation, one polyp in each patient is enough to count as positive even that such patient actually has more than one polyp. Adenoma miss rate (AMR) may be an important reason to develop an interval colon cancer. In back-to-back colonoscopy, it has been reported that a colonoscopist with high ADR still missed certain number of adenoma. Therefore a better quality indicator is needed to predict AMR.