INWARD
Research type
Research Study
Full title
Does careful Inspection of colonic mucosa during iNsertion and WithdrAwal of bowel scope improve Rate of adenoma Detection (INWARD)
IRAS ID
216452
Contact name
Brian P Saunders
Contact email
Sponsor organisation
London North West Healthcare NHs Trust
Duration of Study in the UK
1 years, 1 months, 11 days
Research summary
Successful implementation of colorectal screening programmes and improvement in colonoscopic technology have resulted in significant decrease in colorectal cancer incidence and mortality. Effectiveness of colonoscopy largely depends on detection and removal of adenomas before they become cancerous. Despite the vast improvement in colonoscopy training and technology, it remains as an imperfect tool. It has been reported that the adenoma miss rate during colonoscopy varies between 6-27% in clinical practice. Adenoma Detection Rate (ADR) is a surrogate marker of efficient colonoscopy. Researchers continue to explore various methods and technologies to improve adenoma detection such as frequent position changes, routine use of antispasmodics and devices to improve the mucosal visibility.
However, all the techniques are focused on the withdrawal stage of the examination. Colonic examination is tradionally performed with rapid passage of colonoscope to the caecum and a careful examination of mucosa is carried out during the withdrawal phase. Polyps are removed during the withdrawal phase. It is well known from expert opinion that some polyps are detected during the insertion rather than withdrawal especially in sigmoid and transverse colon. This could be due to different anatomical configuration of colon during insertion and withdrawal.
Therefore, it may expose different portions of colonic mucosal surface on insertion and withdrawal.Flexible sigmoidoscopy Bowel cancer screening programme (Bowel Scope) has been successfully implemented since May 2013. Initial reports suggest ADR within Bowel Scope screening varies considerably.
Therefore, we propose a simple technique to improve ADR in Bowel Scope Screening.We hypothesised that careful inspection and polypectomy during both phases would be complementary and it would increase ADR by complete visualisation of recto sigmoid mucosa during Bowel Scope.
The study will be done at St Mark's Hospital in patients referred for a bowel scope. We are aiming to recruit patients for about 12 months.
REC name
London - Brighton & Sussex Research Ethics Committee
REC reference
16/LO/2131
Date of REC Opinion
24 Jan 2017
REC opinion
Further Information Favourable Opinion