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e110
Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
cm2 (equivalent to: 90 min / lesion with a diameter of 30 mm). The
following variables were evaluated: age; sex; location; morphology;
size (cm2); nodularity; scar; experience; SM fibrosis; histology.
Results:
From 1.2012 to 7.2015, ESD was attempted for 140 lesions
(median size 9 cm2, range 1.2-33; colonic 110 (79%); rectal 30 (21%)
in 140 patients (median age 66, range 44-87; females 57, 41%).
ESD was en bloc in 129 (92%) cases and with a 13 min/cm2 speed
in 82 (59%). Curative resection (R0 with low-LN risk features) was
achieved in 132 (94%). Perforations occurred in 7 (5%) cases in the
colon and have been treated conservatively in 6. Prognostic variables
of a difficult colonic ESD at the multivariate analysis are reported
in the Table; no independent variable was identified for rectal ESD.
Table 1
Rectum (n = 30)
Colon (n = 110)
Easy ESDs, n (%)
15 (50%)
67 (61%)
Unadj OR (95%CI)
Adj OR (95% CI)
Size >7 cm2
3.14 (0.68- 14.50)
3.93 (1.79-8.64)
Scar positive
0.08 (0.01-0.79)
0.09 (0.01-0.81)
Experience >60 procedures
1.38 (0.29-6.60)
4.14 (1.51-11.36)
SM fibrosis positive
0.18 (0.05-0.61)
0.48 (0.27-0.85)
Histology: T1 cancer
2.15 (0.17-26.67)
0.24 (0.06-0.99)
Conclusions:
A difficult ESD has to be expected if the lesion is in
the colon, has a scar of previous biopsies/resection, the operator
has an overall experience <60 procedures. Lesions <7cm2 in size
are resected with a significantly prolonged operative time. Other
features of difficulty not evaluable preoperatively are: SM fibrosis,
and SM-invasive cancer. Western endoscopists should delay ESD for
difficult colonic lesions until an expert level has been achieved.
OC.10.9
DETECTION OF COLONIC ADENOMAS USING DIFFERENT
COLONOSCOPY INSERTION TECHNIQUES
Cadoni S.*
1
, Falt P.
2
, Sanna S.
3
, Argiolas M.
3
, Fanari V.
3
, Gallittu P.
1
,
Liggi M.
1
, Mura D.
1
, Porcedda M.L.
3
, Smajstrla V.
2
, Erriu M.
4
,
Felix W.L.
5
1
Digestive Endoscopy Unit, S. Barbara Hospital, Iglesias (CI), Italy,
2
Digestive Diseases Center, Vìtkovice Hospital,, Ostrava, Czech Republic,
3
Digestive Endoscopy Unit, N. S. di Bonaria Hospital, San Gavino
Monreale (VS), Italy,
4
Department of Surgical Sciences, University of
Cagliari, Cagliari, Italy,
5
Sepulveda Ambulatory Care Center, VAGLAHS
and David Geffen School of Medicine at UCLA, Los Angeles, United
States
Backgroundandaim:
Adenomadetection rate (ADR) is a colonoscopy
quality indicator and low ADR predicts the development of interval
cancers, especially in the right colon (cecum and ascending). Poor
bowel preparation is a notable factor associated with low ADR. We
assessed the impact of different insertion techniques on adenoma
detection in the right colon and entire colon. We test the hypothesis
that the insertion technique that yielded the best bowel preparation
score is associated with the highest right colon and entire colon ADR.
Material and methods:
We pooled and compared data on right
colon and entire colon ADR stratified according to Boston bowel
preparation scale (BBPS) scores. Data were recorded prospectively in
3 similarly designed multicenter randomized controlled trials that
compared insertion pain of water exchange (WE, airless insertion
and constant suction of opaque water), water immersion (WI,
adjunct to insufflation, water infused to facilitate insertion) and
insufflation with air or CO2 (AICD).
Results:
In 1200 (704 males) subjects randomly allocated to WE
(n=395), WI (n=404) or AICD (n=401), demographic and procedural
data were comparable. WE showed significantly higher right colon
and overall BBPS scores (p values range: 0.003 to <0.0005). In the
right colon WE achieved significantly higher ADR <10 mm than WI
and AICD: 11.9% vs 6.9% (p=0.016) and vs 7.2% (p=0.025), respectively;
at BBPS 3 significantly higher ADR than WI and AICD for lesions
of any size (17.6% vs 7.9%, p=0.008; vs 9.0%, p=0.018, respectively)
and for lesions <10 mm (13.3% vs 2.0%, p<0.0005; vs 5.8%, p=0.016,
respectively). Proportions of advanced adenomas of any size at BBPS
3 were: WE 3.3%, WI 1.3%, AICD none (vs WE p=0.045). In the entire
colon, stratifying ADR by excellent bowel cleanliness (BBPS 9-8),
WE revealed significantly higher proportions than the other two
groups: 23.8% vs WI 13.1%, p <0.0005; vs AICD 16.2%, p=0.007. At
BBPS 9-8 WE achieved also the highest overall advanced adenoma
rate (9.6%), vs WI 4.0% p=0.001; vs AICD 5.5% p=0.027. Multivariate
analysis confirmed WE as significant predictor of right colon higher
adenoma detection at BBPS 3, and higher entire colon adenoma
detection at BBPS 9-8. In the remaining colonic segments (hepatic
flexure to rectum) overall ADR was comparable among the three
techniques, also when stratified by excellent colon cleanliness.
Limitations: Secondary outcome analysis, unblinded colonoscopists.
Table 1
Effect of colonoscopy with WE, WI and AICD, and BBPS score on adenoma
detection
P value
WE
WI
AICD WE vs
WE vs
WI vs
N=395 N=404 N=401
WI
AICD AICD
Right colon ADR, n (%)
Any size 59 (14.9) 49 (12.1) 48 (12.0)
0.245
†
0.219
†
1
†
<10 mm 47 (11.9)
28 (6.9)
29 (7.2)
0.016
†
0.025
†
0.862
†
BBPS 3 n = 210 n = 152 n = 156
Any size 37 (17.6)
12 (7.9)
14 (9.0)
0.008
†
0.018
†
0.729
†
<10 mm 28 (13.3)
3 (2.0)
9 (5.8)
<0.0005
†
0.016
†
0.085
†
Right colon advanced
adenoma
††
rate, n (%)
Any size 7 (3.3)
2 (1.3)
0
0.313
0.045
0.243
Entire colon ADR, n (%)
N=395 N=404 N=401
131 (33.2) 117 (29.0) 129 (32.2)
0.199
†
0.764
†
0.322
†
BBPS 9-8 94 (23.8) 53 (13.1) 65 (16.2) <0.0005
†
0.007
†
0.215
†
Entire colon advanced
adenoma
††
rate, n (%)
BBPS 9-8 38 (9.6)
16 (4.0)
22 (5.5)
0.001
†
0.027
†
0.308
†
WE, water exchange; WI, water immersion; AICD, air or CO2 insufflation; ADR,
adenoma detection rate; BBPS, Boston Bowel Preparation Scale (cleanliness scores,
segmental: 3 excellent, 2 good, >1 poor. Cleanliness scores, total: 9-8 excellent,
7-6 good, >6 poor/insufficient);
†
Chi-square; /n, sub-group denominator.
††
Advanced adenomas: diameter ≥10 mm, or high grade dysplasia, or ≥20% villous
component.
Conclusions:
WE is a superior insertion technique for detection
of adenomas, particularly in the right colon and associated with
excellent bowel cleanliness. WE increases also detection of advanced
adenomas at excellent cleanliness, in the right colon (vs AICD) and
in the entire colon (vs WI and AICD).