Comparison of Colon Adenoma Detection Rate Using Two Distal Colonoscope Attachments
|ClinicalTrials.gov Identifier: NCT02665741|
Recruitment Status : Completed
First Posted : January 28, 2016
Last Update Posted : May 30, 2017
|Condition or disease||Intervention/treatment||Phase|
|Colon Cancer Screening Colon Polyps Colon Adenomas Water Exchange Colonoscopy||Device: Olympus transparent cap Device: Medivators Endocuff Device: Control||Not Applicable|
Although mortality from colon cancer is decreasing, it remains the second leading cause of cancer related death in the United States. There are multiple factors contributing to this decrease, such as increased awareness, improving screening techniques, etc.
Of the available modalities approved for colon cancer screening in the United States, colonoscopy is considered the gold standard. Colonoscopy has the advantage of being both diagnostic and therapeutic, allowing the removal of pre-cancerous polyps, before the polyps can transform into cancer. Colonic polyps can occur at any location from the rectum to the cecum. Colonoscopy has been shown to be more effective in decreasing incidence of cancer in the left colon but remains limited in the detection of right sided polyps /lesions 2. This difference based on location is thought to be due to several reasons. Typically the right side of the colon is less clean than the left side during colonoscopy, thereby impairing visualization of polyps. This problem has been overcome by incorporating a "split bowel preparation", which has not become standard of care. However, the problem of not being able to visualize polyps behind folds seen in the colon persists despite improvements in the quality of cleansing of the colon. Various endoscopic technologies have been introduced with the goal of assisting with the manipulation of such colonic folds, and thereby reducing chances of missing polyps behind fold. Two such colonoscope assisted devices including the distal transparent cap and the Endocuff endoscopic overtube.
The Endocuff overtube is a small device with flexible arms arranged in 2 rows. Each row has 8 short, soft arms projecting away from the device. These arms are used to peel back the colonic folds without causing physical damage to enable visualization behind colonic folds. The use of Endocuff overtube has shown promising results in terms of cecal intubation rate and time as well as adenoma detection rates 3.
The transparent cap attachment is a clear plastic device that fits at the end of the colonoscope and extends a short distance past the tip of the colonoscope. It aids in the manipulation of folds and in maintaining a suitable distance from the mucosa, with the goal of improving visualization. Although some studies comparing cap fitted colonoscopy to standard (non- attachment) colonoscopies have shown improved adenoma detection 4, others have shown no significant benefit 5.
Although, these devices have been compared with conventional colonoscopies (i.e without any distal attachment), to the investigator's knowledge, there are currently no studies that have compared these two distal colonoscope attachment devices head-to-head, and none has specifically evaluated effects on detection of right sided adenomas. Also, here at UCDavis, these devices are being used specifically in diagnostic colonoscopies for removal of large polyps and the choice of which specific device is used dependends on level of comfort of the advanced endoscopist. The endoscopists participating in the investigators' study do not currently use these devices as part of their routine colonoscopies, thus it is important to provide head to head comparison of these devices to help guide management practice.
Therefore, the investigators' goal is to compare the Endocuff overtube assisted, transparent cap fitted, and non-cap fitted ( standard) colonoscopy in patients presenting to UC Davis Medical Center for screening colonoscopies.
In addition, 2 of the 3 investigators will employ the water exchange method during for all arms of the trial, while the other investigator will employ the conventional air method of colonoscopy.
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||126 participants|
|Intervention Model:||Parallel Assignment|
|Official Title:||Comparison of Colon Adenoma Detection Rate Using Two Distal Colonoscope Attachments|
|Study Start Date :||January 2016|
|Actual Primary Completion Date :||February 2017|
|Actual Study Completion Date :||February 2017|
No distal colonoscope attachment will be used in this arm
No distal colonoscope attachments
Experimental: Olympus transparent cap
The Olympus transparent cap will be attached to the distal end of colonoscope prior to starting the procedure
Device: Olympus transparent cap
distal colonscope attachment
Experimental: Medivators Endocuff
The Medivators Endocuff will be attached to the distal end of colonoscope prior to starting the procedure
Device: Medivators Endocuff
distal colonscope attachment
- Adenoma detection rate [ Time Frame: 1 year ]The investigators will compare adenoma detection rate at completion of study across the 4 arms
- Proximal adenoma detection rate [ Time Frame: 1 year ]The investigators will compare proximal adenoma detection rate at completion of study across the 4 arms
- Polyp detection rate [ Time Frame: 1 year ]The investigators will compare polyp detection rate at completion of study across the 4 arms
- Cecal intubation rate [ Time Frame: 1 year ]The investigators will compare cecal intubation rate at completion of study across the 4 arms
- Withdrawal time [ Time Frame: 1 year ]The investigators will compare colonoscopy withdrawal time rate at completion of study across the 4 arms
- Major complications (perforation, bleeding requiring transfusion) [ Time Frame: 1 year ]The investigators will compare major complications at completion of study across the 4 arms
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02665741
|United States, California|
|University of California, Davis|
|Sacramento, California, United States, 95817|