Randomized Controlled Trial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2015; 21(26): 8184-8194
Published online Jul 14, 2015. doi: 10.3748/wjg.v21.i26.8184
Intraprocedural bowel cleansing with the JetPrep cleansing system improves adenoma detection
Arthur Hoffman, Sanjay Murthy, Lena Pompetzki, Johannes Wilhelm Rey, Martin Goetz, Achim Tresch, Peter Robert Galle, Ralf Kiesslich
Arthur Hoffman, Johannes Wilhelm Rey, Martin Goetz, Peter Robert Galle, Ralf Kiesslich, First Department of Medicine, Johannes Gutenberg University of Mainz, 65199 Wiesbaden, Germany
Arthur Hoffman, Johannes Wilhelm Rey, Department of Internal Medicine II, HSK Hospital, Teaching Hospital of the University Medicine of Mainz, 55131 Mainz, Germany
Sanjay Murthy, The Ottawa Hospital and University of Ottawa, Ottawa, ON K1H 8L6, Canada
Lena Pompetzki, Department of Urology, Health and Care Center Ruesselsheim, 65428 Ruesselsheim, Germany
Martin Goetz, First Department of Medicine, University of Tuebingen, 72076 Tuebingen, Germany
Achim Tresch, Max Planck Institute, 50931 Cologne, Germany
Author contributions: Hoffman A designed and performed the research, wrote the manuscript, and contributed to data analysis, interpretation, and provision of study material and patients; Murthy S performed the research and collected and/or assembled the data; Pompetzki L analyzed, collected and/or assembled the data; Tresch A and Rey JW analyzed and interpreted the data; Goetz M analyzed the data; Galle PR and Kiesslich R performed the research and gave administrative support.
Institutional review board statement: The study was reviewed and approved by the Ethical Review Committee of the University of Mainz.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at ahoff66286@aol.com.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Arthur Hoffman, MD, PhD, Department of Internal Medicine II, HSK Hospital, Teaching Hospital of the University Medicine of Mainz, 65199 Wiesbaden, Germany. ahoff66286@aol.com
Telephone: +49-611-432420 Fax: +49-611-432418
Received: December 1, 2014
Peer-review started: December 1, 2014
First decision: February 10, 2015
Revised: March 18, 2015
Accepted: April 3, 2015
Article in press: April 3, 2015
Published online: July 14, 2015
Processing time: 225 Days and 6.8 Hours
Abstract

AIM: To investigate the impact of JetPrep cleansing on adenoma detection rates.

METHODS: In this prospective, randomized, crossover trial, patients were blindly randomized to an intervention arm or a control arm. In accordance with the risk profile for the development of colorectal carcinoma, the study participants were divided into high-risk and low-risk groups. Individuals with just one criterion (age > 70 years, adenoma in medical history, and first-degree relative with colorectal cancer) were regarded as high-risk patients. Bowel preparation was performed in a standardized manner one day before the procedure. Participants in the intervention arm underwent an initial colonoscopy with standard bowel cleansing using a 250-mL syringe followed by a second colonoscopy that included irrigation by the use of the JetPrep cleansing system. The reverse sequence was used in the control arm. The study participants were divided into a high-risk group and a low-risk group according to their respective risk profiles for the development of colorectal carcinoma.

RESULTS: A total of 64 patients (34 men and 30 women) were included in the study; 22 were included in the high-risk group. After randomization, 30 patients were assigned to the control group (group A) and 34 to the intervention group (group B). The average Boston Bowel Preparation Scale score was 5.15 ± 2.04. The withdrawal time needed for the first step was significantly longer in group A using the JetPrep system (9.41 ± 3.34 min) compared to group B (7.5 ± 1.92 min). A total of 163 polyps were discovered in 64 study participants who underwent both investigation steps. In group A, 49.4% of the polyps were detected during the step of standard bowel cleansing while the miss rate constituted 50.7%. Group B underwent cleansing with the JetPrep system during the first examination step, and as many as 73.9% of polyps were identified during this step. Thus, the miss rate in group B was a mere 26.1% (P < 0.001). When considering only the right side of the colon, the miss rate in group A during the first examination was 60.6%, in contrast to a miss rate of 26.4% in group B (P < 0.001).

CONCLUSION: JetPrep is recommended for use during colonoscopy because a better prepared bowel enables a better adenoma detection, particularly in the proximal colon.

Keywords: Colon preparation; Adenoma detection rate; Adenoma miss rate; Interval cancer; Boston Bowel Preparation Scale; Right sided colon; Flat adenoma

Core tip: Stool tends to hinder visibility during colonoscopy, and its presence therefore increases the risk that lesions will be overlooked. The JetPrep system is an irrigation system that was designed for intraprocedural colon cleansing. The aim of this randomized, prospective study was to investigate the impact of JetPrep cleansing on detection rates of adenomas. The JetPrep system enabled better cleansing of the colon, which increased the detection of polyps throughout the entire colon and especially on its right side (P < 0.001). Based on the results of this study, the JetPrep flushing device may be broadly recommended for use during screening colonoscopy to improve bowel preparation and to increase polyp detection rates.