title: Intraprocedural bowel cleansing with the JetPrep cleansing system improves adenoma detection.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  JetPrep is recommended for use during colonoscopy because a better prepared bowel enables a better adenoma detection, particularly in the proximal colon.
authors.affiliation: Arthur Hoffman, Johannes Wilhelm Rey, Martin Goetz, Peter Robert Galle, Ralf Kiesslich, First Department of Medicine, Johannes Gutenberg University of Mainz, 65199 Wiesbaden, Germany.
authors.forename: Arthur
authors.initials: A
authors.lastname: Hoffman
authors.affiliation: Arthur Hoffman, Johannes Wilhelm Rey, Martin Goetz, Peter Robert Galle, Ralf Kiesslich, First Department of Medicine, Johannes Gutenberg University of Mainz, 65199 Wiesbaden, Germany.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Murthy
authors.affiliation: Arthur Hoffman, Johannes Wilhelm Rey, Martin Goetz, Peter Robert Galle, Ralf Kiesslich, First Department of Medicine, Johannes Gutenberg University of Mainz, 65199 Wiesbaden, Germany.
authors.forename: Lena
authors.initials: L
authors.lastname: Pompetzki
authors.affiliation: Arthur Hoffman, Johannes Wilhelm Rey, Martin Goetz, Peter Robert Galle, Ralf Kiesslich, First Department of Medicine, Johannes Gutenberg University of Mainz, 65199 Wiesbaden, Germany.
authors.forename: Johannes Wilhelm
authors.initials: JW
authors.lastname: Rey
authors.affiliation: Arthur Hoffman, Johannes Wilhelm Rey, Martin Goetz, Peter Robert Galle, Ralf Kiesslich, First Department of Medicine, Johannes Gutenberg University of Mainz, 65199 Wiesbaden, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Goetz
authors.affiliation: Arthur Hoffman, Johannes Wilhelm Rey, Martin Goetz, Peter Robert Galle, Ralf Kiesslich, First Department of Medicine, Johannes Gutenberg University of Mainz, 65199 Wiesbaden, Germany.
authors.forename: Achim
authors.initials: A
authors.lastname: Tresch
authors.affiliation: Arthur Hoffman, Johannes Wilhelm Rey, Martin Goetz, Peter Robert Galle, Ralf Kiesslich, First Department of Medicine, Johannes Gutenberg University of Mainz, 65199 Wiesbaden, Germany.
authors.forename: Peter Robert
authors.initials: PR
authors.lastname: Galle
authors.affiliation: Arthur Hoffman, Johannes Wilhelm Rey, Martin Goetz, Peter Robert Galle, Ralf Kiesslich, First Department of Medicine, Johannes Gutenberg University of Mainz, 65199 Wiesbaden, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Kiesslich
mesh_terms: D000236:Adenoma / Q000235:genetics / Q000473:pathology*; D018256:Adenomatous Polyps / Q000235:genetics / Q000473:pathology*; D000368:Aged; D003111:Colonic Polyps / Q000235:genetics / Q000473:pathology*; D003113:Colonoscopy / Q000009:adverse effects; D015179:Colorectal Neoplasms / Q000235:genetics / Q000473:pathology*; D018592:Cross-Over Studies; D003951:Diagnostic Errors / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D007507:Therapeutic Irrigation / Q000009:adverse effects / Q000295:instrumentation*
keywords: Adenoma detection rate; Adenoma miss rate; Boston Bowel Preparation Scale; Colon preparation; Flat adenoma; Interval cancer; Right sided colon