Water Exchange (WE) and Quality Improvement - Enhanced Advanced Adenoma Detection: A Pooled Data Analysis of 6 Randomized Controlled Trials

Felix W. Leung, Malcolm Koo, Hui Jia, Joseph W. Leung, Sergio Cadoni, Premysl Falt, Yu Hsi Hsieh, Chi Tan Hu, Yanglin Pan, Franco Radaelli

Research output: Contribution to journalReview article

Abstract

Introduction: Advanced adenomas (≥10 mm in diameter, >25% villous, or high-grade dysplasia), a marker of colorectal cancer risk, are used to stratify patients for closer surveillance. Modern accessories, endoscopes, and age-adjusted evaluation have variable impacts on the advanced adenoma detection rate (AADR). In 1 randomized controlled trial (RCT) comparing air insufflation (AI) with water exchange (WE), the right colon AADR was significantly increased by WE. Four network meta-analyses reported that WE significantly increased overall adenoma detection rate (ADR), but the impact on AADR was not addressed. Aim: The aim of this study was to test the hypothesis that WE significantly increased AADR compared with AI. Method: Six Clinicaltrial.gov-registered RCTs were reported by a group of WE investigators. Data including AADR (primary outcome) and overall ADR (secondary outcome) were pooled. Results: A total of 5407 patients were randomized to AI (2699) and WE (2708). Compared with AI, WE significantly increased AADR (5.7% vs. 8.3%, P=0.001) and overall ADR (20.9% vs. 27.4%, P=0.001). Conclusions: In contrast to published reports, which showed variable impacts on AADR, WE was consistent in increasing AADR in 6 reported RCTs. The pooled data confirm that the impact of WE in increasing AADR was significant. The significantly enhanced overall ADR indicated that WE provided a higher quality outcome than AI. The significant improvement in AADR confirmed WE to be clinically relevant and has finally arrived as a timely addition to colorectal cancer prevention programs.

Original languageEnglish (US)
Article number0000131
JournalJournal of Clinical Gastroenterology
DOIs
StateAccepted/In press - Jan 1 2019

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Water Quality
Quality Improvement
Adenoma
Randomized Controlled Trials
Water
Insufflation
Air
Colorectal Neoplasms
Endoscopes

Keywords

  • advanced adenoma detection rate
  • air insufflation
  • overall adenoma detection rate
  • water exchange

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Water Exchange (WE) and Quality Improvement - Enhanced Advanced Adenoma Detection : A Pooled Data Analysis of 6 Randomized Controlled Trials. / Leung, Felix W.; Koo, Malcolm; Jia, Hui; Leung, Joseph W.; Cadoni, Sergio; Falt, Premysl; Hsieh, Yu Hsi; Hu, Chi Tan; Pan, Yanglin; Radaelli, Franco.

In: Journal of Clinical Gastroenterology, 01.01.2019.

Research output: Contribution to journalReview article

Leung, Felix W. ; Koo, Malcolm ; Jia, Hui ; Leung, Joseph W. ; Cadoni, Sergio ; Falt, Premysl ; Hsieh, Yu Hsi ; Hu, Chi Tan ; Pan, Yanglin ; Radaelli, Franco. / Water Exchange (WE) and Quality Improvement - Enhanced Advanced Adenoma Detection : A Pooled Data Analysis of 6 Randomized Controlled Trials. In: Journal of Clinical Gastroenterology. 2019.
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title = "Water Exchange (WE) and Quality Improvement - Enhanced Advanced Adenoma Detection: A Pooled Data Analysis of 6 Randomized Controlled Trials",
abstract = "Introduction: Advanced adenomas (≥10 mm in diameter, >25{\%} villous, or high-grade dysplasia), a marker of colorectal cancer risk, are used to stratify patients for closer surveillance. Modern accessories, endoscopes, and age-adjusted evaluation have variable impacts on the advanced adenoma detection rate (AADR). In 1 randomized controlled trial (RCT) comparing air insufflation (AI) with water exchange (WE), the right colon AADR was significantly increased by WE. Four network meta-analyses reported that WE significantly increased overall adenoma detection rate (ADR), but the impact on AADR was not addressed. Aim: The aim of this study was to test the hypothesis that WE significantly increased AADR compared with AI. Method: Six Clinicaltrial.gov-registered RCTs were reported by a group of WE investigators. Data including AADR (primary outcome) and overall ADR (secondary outcome) were pooled. Results: A total of 5407 patients were randomized to AI (2699) and WE (2708). Compared with AI, WE significantly increased AADR (5.7{\%} vs. 8.3{\%}, P=0.001) and overall ADR (20.9{\%} vs. 27.4{\%}, P=0.001). Conclusions: In contrast to published reports, which showed variable impacts on AADR, WE was consistent in increasing AADR in 6 reported RCTs. The pooled data confirm that the impact of WE in increasing AADR was significant. The significantly enhanced overall ADR indicated that WE provided a higher quality outcome than AI. The significant improvement in AADR confirmed WE to be clinically relevant and has finally arrived as a timely addition to colorectal cancer prevention programs.",
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author = "Leung, {Felix W.} and Malcolm Koo and Hui Jia and Leung, {Joseph W.} and Sergio Cadoni and Premysl Falt and Hsieh, {Yu Hsi} and Hu, {Chi Tan} and Yanglin Pan and Franco Radaelli",
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T1 - Water Exchange (WE) and Quality Improvement - Enhanced Advanced Adenoma Detection

T2 - A Pooled Data Analysis of 6 Randomized Controlled Trials

AU - Leung, Felix W.

AU - Koo, Malcolm

AU - Jia, Hui

AU - Leung, Joseph W.

AU - Cadoni, Sergio

AU - Falt, Premysl

AU - Hsieh, Yu Hsi

AU - Hu, Chi Tan

AU - Pan, Yanglin

AU - Radaelli, Franco

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: Advanced adenomas (≥10 mm in diameter, >25% villous, or high-grade dysplasia), a marker of colorectal cancer risk, are used to stratify patients for closer surveillance. Modern accessories, endoscopes, and age-adjusted evaluation have variable impacts on the advanced adenoma detection rate (AADR). In 1 randomized controlled trial (RCT) comparing air insufflation (AI) with water exchange (WE), the right colon AADR was significantly increased by WE. Four network meta-analyses reported that WE significantly increased overall adenoma detection rate (ADR), but the impact on AADR was not addressed. Aim: The aim of this study was to test the hypothesis that WE significantly increased AADR compared with AI. Method: Six Clinicaltrial.gov-registered RCTs were reported by a group of WE investigators. Data including AADR (primary outcome) and overall ADR (secondary outcome) were pooled. Results: A total of 5407 patients were randomized to AI (2699) and WE (2708). Compared with AI, WE significantly increased AADR (5.7% vs. 8.3%, P=0.001) and overall ADR (20.9% vs. 27.4%, P=0.001). Conclusions: In contrast to published reports, which showed variable impacts on AADR, WE was consistent in increasing AADR in 6 reported RCTs. The pooled data confirm that the impact of WE in increasing AADR was significant. The significantly enhanced overall ADR indicated that WE provided a higher quality outcome than AI. The significant improvement in AADR confirmed WE to be clinically relevant and has finally arrived as a timely addition to colorectal cancer prevention programs.

AB - Introduction: Advanced adenomas (≥10 mm in diameter, >25% villous, or high-grade dysplasia), a marker of colorectal cancer risk, are used to stratify patients for closer surveillance. Modern accessories, endoscopes, and age-adjusted evaluation have variable impacts on the advanced adenoma detection rate (AADR). In 1 randomized controlled trial (RCT) comparing air insufflation (AI) with water exchange (WE), the right colon AADR was significantly increased by WE. Four network meta-analyses reported that WE significantly increased overall adenoma detection rate (ADR), but the impact on AADR was not addressed. Aim: The aim of this study was to test the hypothesis that WE significantly increased AADR compared with AI. Method: Six Clinicaltrial.gov-registered RCTs were reported by a group of WE investigators. Data including AADR (primary outcome) and overall ADR (secondary outcome) were pooled. Results: A total of 5407 patients were randomized to AI (2699) and WE (2708). Compared with AI, WE significantly increased AADR (5.7% vs. 8.3%, P=0.001) and overall ADR (20.9% vs. 27.4%, P=0.001). Conclusions: In contrast to published reports, which showed variable impacts on AADR, WE was consistent in increasing AADR in 6 reported RCTs. The pooled data confirm that the impact of WE in increasing AADR was significant. The significantly enhanced overall ADR indicated that WE provided a higher quality outcome than AI. The significant improvement in AADR confirmed WE to be clinically relevant and has finally arrived as a timely addition to colorectal cancer prevention programs.

KW - advanced adenoma detection rate

KW - air insufflation

KW - overall adenoma detection rate

KW - water exchange

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U2 - 10.1097/MCG.0000000000001311

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M3 - Review article

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