Intraprocedural bowel cleansing with the JetPrep cleansing system improves adenoma detection

Table 1 Inclusion and Exclusion criteria

Inclusion criteria

All patients ≥ 50 yr of age who reported for a screening or surveillance colonoscopy and had a history of removed adenomas were included in the study.

Exclusion criteria

Patients who were unable to sign the informed consent form

Patients who had undergone previous (partial) resection of the large bowel, except for appendectomy

Patients with known or pre-existing colorectal carcinoma

Patients with chronic inflammatory bowel disease

Patients with known FAP or HNPCC syndromes in the family

Patients with a Quick score < 50%, pTT > 50 s, or thrombocytes < 50000/μL who had received no specific measures for the improvement of their coagulation (FFP, TK) before the examination

Patients suffering from a severe underlying disease (ASA > II°)

Patients who were determined to have a cleanliness score of 3 on the Boston Bowel Preparation Scale for the proximal portion of the colon during the examination

Patients in whom a complete colonoscopy could not be performed in the first or second step of the investigation

Patients in whom the first step of the investigation took ≥ 45 min

Table 2 Bowel preparation scale

0 = Unprepared colon segment. Due to solid stool that cannot be cleared, the mucosa cannot be observed

1 = Some portions of the mucosa of the colon segment can be observed, but other areas are covered by residual staining consisting of residual stool or opaque fluid

2 = Minor amount of residual staining. No stool fragments or small quantities of opaque fluid, but the mucosal surface of the colon segment can be observed well

3 = The entire mucosa of the colon segment can be observed well and has no residual staining

For the purposes of this scale the bowel is divided into 3 portions, including the ascending colon, the transverse colon, and the descending colon. Each region is assigned a value from 0 to 3. The segment scores are summed to yield a total BBPS score ranging from 0 to 9. The minimum BBPS score was 0 and indicated either the poorest quality of bowel preparation or an unprepared colon while a perfectly clean colon without any residual liquid was scored 9 (47).

Table 3 Secondary endpoint analysis

Miss rate for the entire colon

Polyp miss rates and detection rates for the entire colon and the right side of the colon

Colon cleanliness after JetPrep and standard cleaning (based on the Boston Bowel Preparation Scale)

Rate of adverse events resulting from the use of JetPrep

Table 4 Patient characteristics

Original cohort of patients	n = 73
Dropouts	9/73 (12.3%)
Number of included patients	64/73 (87.7%)
Group stratification	Group A (first standard), n = 30
	Group B (first JetPrep), n = 34
Age (yr)	63.53 ± 8.03
Sex	M: 34; F: 30
Risk of developing CRC	High: n = 22; Low: n = 42
BBPS (baseline values) per protocol (n = 64)	4.84 ± 1.81
BBPS (baseline values) of original patient cohort1 (n = 71)	5.15 ± 2.04

¹A complete colonoscopy could not be performed in 2 patients. CRC: Colorectal cancer; BBPS: Boston Bowel Preparation Scale.

Table 5 Investigation-specific characteristics

	Group A	Group B	P value
	(first step: standard cleansing)	(first step: JetPrep)
Propofol (mg)	366.33 ± 123.83	421.1 ± 151.05	0.1161
Investigator			0.2232
Kiesslich R	n = 22	n = 20
Murthy S	n = 8	n = 14
Withdrawal time (min)
First step	7.5 ± 1.92	9.41 ± 3.34	0.0093
Second step	8.22 ± 2.25	7.60 ± 1.71	0.2241
Total	15.72 ± 4.00	17.0 ± 4.70	0.2153
Withdrawal time with JetPrep (min)	8.22 ± 2.25	9.41 ± 3.34	0.1883
Total duration (min)	36.23 ± 20.31	42.0 ± 18.91	0.0733
Intervention time (s)
First step	218.77 ± 530.21	317.47 ± 638.62	0.2893
Second step	122.47 ± 188.31	162.94 ± 361.21	0.3763
BBPS basic value	4.9 ± 1.9	4.79 ± 1.79	0.8182

¹Independent t-test;

²χ² test;

³Mann-Whitney U-test. BBPS: Boston Bowel Preparation Scale.

Table 6 Comparison of water consumption

	Group A	Group B	P value
	(first step: standard cleansing)	(first step: JetPrep)
Water consumption (mL)
First examination	308.70 ± 159.3	900 ± 588.18	< 0.0012
Second examination	658.70 ± 272.47	1141.81 ± 102.67	< 0.0011
Total water consumption (mL)	967.39 ± 341.99	1014.81 ± 660.54	0.5592

¹Independent t-test;

²Mann-Whitney U-test.

Table 7 Overview of detection rates and miss rates

	Group A	Group B	P value
Polyps, total found	First step: 35	First step: 68	< 0.001
	Second step: 36	Second step: 24
Miss rates for polyps, total	50.70%	26.10%
Polyps on the right side	First step: 13	First step: 39	< 0.001
	Second step: 20	Second step: 14
Miss rate for polyps	60.6%	26.4%
Adenomas, SSA total	First step: 17	First step: 42	0.035
	Second step: 13	Second step: 13
Miss rate for adenomas, SSA total	43.3%	23.7%
Adenomas, SSA on the right side	First step: 7	First step: 27	0.043
	Second step: 9	Second step: 11
Miss rate for adenomas, SSA on the right side	56.3%	29.0%
Adenomas total	First step: 13	First step: 32	0.101
	Second step: 11	Second step: 12
Miss rate for adenomas, total	45.8%	27.3%
Adenomas on the right side	First step: 3	First step: 17	0.064
	Second step: 7	Second step: 10
Miss rate for adenomas on the right side	70.0%	37.0%
SSA	First step: 4	First step: 10	0.243
	Second step: 2	Second step: 1
Miss rate for SSA	33.3%	9.1%

SSA: Sessile serrated adenomas.