BACKGROUND & AIMS:Sufficient bowel preparation is crucial for successful screening and surveillance colonoscopy. However, rates of inadequate preparation are still high. We investigated the effects of reinforced patient education using a smartphone application software (APP) for colonoscopy preparation in participants in a CRC screening program. METHODS:We performed a prospective, endoscopist-blinded study of 500 patients undergoing split-dose bowel preparation for CRC screening or surveillance colonoscopies at multiple centers in Germany, from November 2017 through January 2019. Participants (n [ 500) were given oral and written instructions during their initial appointment and then randomly assigned (1:1) to groups that received reinforced education starting 3 days before the colonoscopy (APP group) or no further education (controls). The primary outcome was quality of bowel preparation according to the Boston bowel preparation scale. Secondary outcomes included polyp and adenoma detection rates, compliance with low-fiber diet, split-dose laxative intake, perceived discomfort from the preparation procedure. RESULTS:The mean Boston bowel preparation scale score was significantly higher in the APP-group (7.6 -0.1) than in the control group (6.7 -0.1) (P < .0001). The percentage of patients with insufficient bowel preparation was significantly lower in the APP group (8%) than in the control group (17%) (P [ .0023). The adenoma detection rate was significantly higher in the APP group (35% vs 27% in controls) (P [ .0324). Use of the APP was accompanied by a lower level of non-compliance with correct laxative intake (P [.0080) and diet instructions (P [ .0089). The APP group reported a lower level of discomfort during preparation (P < .0001). CONCLUSIONS:In a randomized trial, reinforcing patient education with a smartphone application optimized bowel preparation in the 3 days before colonoscopy, increasing bowel cleanliness, adenoma detection, and compliance in patients undergoing CRC screening or surveillance. ClinicalTrials. gov no: NCT03290157
Adequate polyp detection is crucial to colonoscopy; however, detection can be impaired. In particular, flat polyps located behind folds or near the colonic flexures appear to be a problem. We present a cheap and easily adjustable 3D-printed tool to enhance the view of a standard colonoscope using additional commercially available sideoptics. A cap adjustable to a standard endoscope was printed by a 3 D printer and had two microcameras fixed to offer two additional views. Fourteen endoscopists performed one standard and one sideoptic-enhanced colonoscopy in a randomized order. Flat lesions were simulated in an endoscopy training model. Time for withdrawal was measured, along with the number of flat lesions detected. Withdrawal time did not differ significantly between standard and sideoptic-enhanced colonoscopy (329 vs. 389 seconds). The median number of detected flat lesions per endoscopic examination was significantly higher using the sideoptic tool (8 vs. 6.5; = 0.001). A 3D-printed sideoptic-enhanced cap including two microcameras may be a cheap, easy, and feasible add-on to improve adenoma detection rates in routine colonoscopy.
Background: The use of anti-foaming agent and mucolytics before esophagogastroduodenoscopy (EGD) as premedication may show a better mucosal visibility and improve the quality of endoscopy. Aim: To detect whether the combination of Simethicone with N-Acetyl Cysteine (NAC) as premedication before EGD improves mucosal visualization. Methods: The study population included 768 participants. They were randomized into four arms (Group A: Simethicone + N-Acetyl cysteine, Group B: Simethicone alone, Group C: N-Acetyl cysteine (NAC) alone and Group D: Placebo) using sealed envelopes. The participants were given 90 ml of solution (15ml emulsion + 75 ml of water). The participants and the endoscopist were blinded. After 20 minutes of consuming the solution, EGD done and multiple images from oesophagus, stomach and duodenum were obtained. The Total mucosal visibility score (TMVS), total duration of procedure and total number of lesions detected were calculated. Results: The study population included 57% males and the mean age was 44.18 years. Each group was randomized with 192 participants. TMVS was lowest in group-A with a score of 8.31 (P<0.05) than the other groups (B, C & D-9.93, 11.46 & 12.06 respectively). The score of mucous/bubbles obscuring the vision was significantly lower in group A with 78.16% of its participants compared to the other groups (B, C & D-67.7%, 50.52% and 38.85% respectively). The time duration to complete the procedure was also significantly less in group A compared to other groups. Eighty one percent of the participants in group A did not require flushing to clear the mucous/bubbles, which was the highest compared to other groups. Conclusion: Simethicone with NAC premedication had a better TMVS, reduced mucous/bubbles obscuring the vision, reduced total duration of procedure during the procedure. Hence, the usage of premedication with anti-foaming agents and mucolytics may improve the quality of EGD.
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