Working…
COVID-19 is an emerging, rapidly evolving situation.
Get the latest public health information from CDC: https://www.coronavirus.gov.

Get the latest research information from NIH: https://www.nih.gov/coronavirus.
ClinicalTrials.gov
ClinicalTrials.gov Menu

Evaluation of the Impact of Water Method During Insertion Phase of Flexible Sigmoidoscopy in Training (FSW)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT03208283
Recruitment Status : Active, not recruiting
First Posted : July 5, 2017
Last Update Posted : January 23, 2020
Sponsor:
Information provided by (Responsible Party):
Raymond Shing Yan Tang, Chinese University of Hong Kong

Brief Summary:

Colonoscopy is a sedated procedure traditionally performed using air insufflation during the insertion phase of the procedure. Recently, the use of water method (eg, water infusion or water exchange techniques) during the insertion phase of colonoscopy has been reported to increase the proportion of patients in whom complete unsedated colonoscopy could be achieved, reduce patient recovery time burdens, decrease abdominal discomfort during and after colonoscopy, enhance cecal intubation, and increase willingness to repeat an unsedated colonoscopy. However, there has been no study on the use of water method during the training of primary care doctors or nurse endoscopists in flexible sigmoidoscopy for colorectal cancer screening.

In unsedated endoscopic procedure such as FS, endoscope insertion techniques that can potentially reduce patient discomfort and increase the rate of achieving an adequate depth of scope insertion are desirable. Our current study aims to evaluate the impact of water method during insertion phase of FS in the training of primary care doctors or nurse endoscopists for colorectal cancer screening.


Condition or disease Intervention/treatment Phase
Colorectal Cancer Screening Diagnostic Test: Water method group Diagnostic Test: Air insufflation group Not Applicable

Detailed Description:

It is estimated that there are about 1.2 million patients with colorectal cancer (CRC) worldwide, with a rising trend in CRC incidence and mortality globally. In Hong Kong, colorectal cancer ranks first in cancer incidence and second in cancer mortality.

CRC is one of the most preventable cancers because its development in general follows an adenoma-carcinoma sequence. Adenomas are considered precursor lesions for CRC. Recent guidelines from USA, Europe and Asia Pacific region recommend CRC screening for average-risk asymptomatic individuals starting at age 50. Modalities such as guaiac-based fecal occult blood tests (gFOBT), fecal immunochemical tests (FIT), flexible sigmoidoscopy, and colonoscopy are among the acceptable options for CRC screening. Studies have shown that early detection and removal of colorectal adenoma by screening flexible sigmoidoscopy (FS) and screening colonoscopy with polypectomy reduce CRC incidence and mortality.

Approximately two-thirds of CRC are located in the sigmoid colon and rectum, which can be diagnosed by FS. In countries where colonoscopy may not be widely available or a prolonged waiting time exists, FS becomes an attractive option for CRC screening.

When compared to colonoscopy, FS has the advantages of being an unsedated procedure, requiring less stringent bowel prep, and being less technically demanding. While flexible sigmoidoscopy have traditionally been performed by gastroenterologists or surgeons, studies have demonstrated that adequately trained primary care doctors and nurse endoscopists can perform screening flexible sigmoidoscopy as safely and effectively as gastroenterologists or surgeons. The American Society for Gastrointestinal Endoscopy (ASGE), the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), and the The Society of Gastrointestinal Nurses and Associates (SGNA) recommend 25 supervised procedures for training in FS. Hawes R et al reported that at least 30 supervised procedures were needed before 85% - 90% of the procedures were graded as competent in doctors without prior experience on rigid sigmoidoscopy. In another report, at least 50 supervised procedures have been suggested for FS training of clinicians without prior endoscopic skills.

From a technical standpoint, colonoscopy is a sedated procedure traditionally performed using air insufflation during the insertion phase of the procedure. Recently, the use of water method (eg, water infusion or water exchange techniques) during the insertion phase of colonoscopy has been reported to increase the proportion of patients in whom complete unsedated colonoscopy could be achieved, reduce patient recovery time burdens, decrease abdominal discomfort during and after colonoscopy, enhance cecal intubation, and increase willingness to repeat an unsedated colonoscopy. However, there has been no study on the use of water method during the training of primary care doctors or nurse endoscopists in flexible sigmoidoscopy for colorectal cancer screening.

In unsedated endoscopic procedure such as FS, endoscope insertion techniques that can potentially reduce patient discomfort and increase the rate of achieving an adequate depth of scope insertion are desirable. Our current study aims to evaluate the impact of water method during insertion phase of FS in the training of primary care doctors or nurse endoscopists for colorectal cancer screening.

Layout table for study information
Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 400 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Participant)
Primary Purpose: Diagnostic
Official Title: Evaluation of the Impact of Water Metsertion Phase of Flexible Sigmoidoscopy in the Training of Primary Care Doctors or Nurse Endoscopists for Colorectal Cancer Screening: A Randomized Controlled Study (FSW Study)
Actual Study Start Date : October 28, 2014
Estimated Primary Completion Date : December 2020
Estimated Study Completion Date : December 2020

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Active Comparator: Air insufflation group
During the insertion phase of the initial 30 FS procedures, air insufflation will be used to allow passage of endoscope to ≥ 50cm above anal verge (including rectum, sigmoid colon and part of descending colon), or to the limit of patient tolerance of an unsedated procedure. Trainees will be allowed 10 minutes for the insertion phase. The unassisted portion of the examination would be terminated if reasonable progress is not being attained, excessive patient discomfort observed, or the supervising endoscopist believes that patient safety may be compromised. During the withdrawal phase, air insufflation will be used in standard fashion for examination of the colonic mucosa.
Diagnostic Test: Air insufflation group
During the insertion phase of the initial 30 FS procedures, air insufflation will be used to allow passage of endoscope to at least 50cm above anal verge (including rectum, sigmoid colon and part of descending colon), or to the limit of patient tolerance of an unsedated procedure. Trainees will be allowed 10 minutes for the insertion phase. The unassisted portion of the examination would be terminated if reasonable progress is not being attained, excessive patient discomfort observed, or the supervising endoscopist believes that patient safety may be compromised. During the withdrawal phase, air insufflation will be used in standard fashion for examination of the colonic mucosa.
Other Name: Air insufflation

Active Comparator: Water method group
During the insertion phase of the initial 30 FS procedures, sterile water will be infused by a standard endoscopy water pump into the distal colon to allow passage of endoscope to ≥ 50cm above anal verge (including rectum, sigmoid colon and part of descending colon), or to the limit of patient tolerance of an unsedated procedure. Air insufflation will not be used during the insertion phase. Trainees will be allowed 10 minutes for the insertion phase. The unassisted portion of the examination would be terminated if reasonable progress is not being attained, excessive patient discomfort observed, or the supervising endoscopist believes that patient safety may be compromised. During the withdrawal phase, air insufflation will be used in standard fashion for examination of the colonic mucosa.
Diagnostic Test: Water method group
During the insertion phase of the initial 30 FS procedures, sterile water will be infused by a standard endoscopy water pump into the distal colon to allow passage of endoscope to ≥ 50cm above anal verge (including rectum, sigmoid colon and part of descending colon), or to the limit of patient tolerance of an unsedated procedure. Air insufflation will not be used during the insertion phase. Trainees will be allowed 10 minutes for the insertion phase. The unassisted portion of the examination would be terminated if reasonable progress is not being attained, excessive patient discomfort observed, or the supervising endoscopist believes that patient safety may be compromised. During the withdrawal phase, air insufflation will be used in standard fashion for examination of the colonic mucosa.
Other Name: Water Immersion




Primary Outcome Measures :
  1. Independently performed flexible sigmoidoscopy completion rate by each trainee [ Time Frame: 12 weeks ]
    The percentage of unassisted FS procedure completed within the allowed 10 minutes in the initial 30 FS procedures for each trainee endoscopist

  2. The mean independently performed flexible sigmoidoscopy completion rate in each study group [ Time Frame: 12 weeks ]
    2) The mean percentage of unassisted FS procedure completed within the allowed 10 minutes in the initial 30 FS procedures by all trainee endoscopists in the air insufflation group, and the water method group, respectively


Secondary Outcome Measures :
  1. Polyp detection rate [ Time Frame: 12 weeks ]
    Number and type of polyp detected during flexible sigmoidoscopy

  2. Insertion distance [ Time Frame: 12 weeks ]
    Mean unassisted scope insertion distance within the allowed 10 minutes and the total insertion distance in the initial 30 FS procedures

  3. Procedural time [ Time Frame: 12 weeks ]
    Mean insertion time, withdrawal time, and total procedure time in the initial 30 FS in each study group

  4. Patients' satisfaction [ Time Frame: 12 weeks ]
    This will be assessed by validated patient satisfaction questionnaire for gastrointestinal endoscopy (modified GHAA-9)



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


Layout table for eligibility information
Ages Eligible for Study:   50 Years to 70 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • Consecutive asymptomatic patients suitable for CRC screening by FS
  • Age 50 - 70 years
  • Written informed consent available

Exclusion Criteria:

  • Contraindications for endoscopy due to comorbidities
  • Unable to provide written informed consent
  • Personal history of polyposis syndrome, personal history of CRC, personal history of inflammatory bowel disease
  • Coagulopathy (INR>1.5) or thrombocytopenia (platelets <50,000)
  • Pregnant patients

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03208283


Locations
Layout table for location information
Hong Kong
Centre for Digestive Health, Institute of Digestive Disease, Chinese University of Hong Kong
Hong Kong, Hong Kong
Sponsors and Collaborators
Chinese University of Hong Kong
Investigators
Layout table for investigator information
Principal Investigator: Shing Yan Raymond Tang Chinese University of Hong Kong
Layout table for additonal information
Responsible Party: Raymond Shing Yan Tang, Associate Director of S.H. Ho Centre for Digestive Health, Institute of Digestive Disease, the Chinese University of Hong Kong, Chinese University of Hong Kong
ClinicalTrials.gov Identifier: NCT03208283    
Other Study ID Numbers: FSW
First Posted: July 5, 2017    Key Record Dates
Last Update Posted: January 23, 2020
Last Verified: January 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Layout table for additional information
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
Additional relevant MeSH terms:
Layout table for MeSH terms
Colorectal Neoplasms
Intestinal Neoplasms
Gastrointestinal Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Neoplasms
Digestive System Diseases
Gastrointestinal Diseases
Colonic Diseases
Intestinal Diseases
Rectal Diseases