title: Adenoma detection with blue-water infusion colonoscopy: a randomized trial.
abstract: Background and aimsColonoscopy is currently the reference method to detect colorectal neoplasia, yet some adenomas remain undetected. The water infusion technique and dying with indigo carmine has shown interesting results for reducing this miss rate. The aim of this study was to compare the adenoma detection rate (adenoma and adenocarcinoma; ADR) and the mean number of adenomas per patient (MAP) for blue-water infusion colonoscopy (BWIC) versus standard colonoscopy.MethodsWe performed a multicenter, randomized controlled trial in eight units, including patients with a validated indication for colonoscopy (symptoms, familial or personal history, fecal occult blood test positive). Consenting patients were randomized 1:1 to BWIC or standard colonoscopy. All colonoscopies were performed by experienced colonoscopists. All colonoscopy quality indicators were prospectively recorded.ResultsAmong the 1065 patients included, colonoscopies were performed completely for 983 patients (514 men; mean age 59.1). The ADR was not significantly different between the groups; 40.4 % in the BWIC group versus 37.5 % in the standard colonoscopy group (odds ratio [OR] 1.13; 95 % confidence interval [CI] 0.87 - 1.48;P= 0.35). MAP was significantly greater in the BWIC group (0.79) than in the standard colonoscopy group (0.64;P= 0.005). For advanced adenomas, the results were 50 (10.2 %) and 36 (7.3 %), respectively (P= 0.10). The cecal intubation rate was not different but the time to cecal intubation was significantly longer in BWIC group (9.9 versus 6.2 minutes;P< 0.001).ConclusionDespite the higher MAP with BWIC, the routine use of BWIC does not translate to a higher ADR. Whether increased detection ultimately results in a lower rate of interval carcinoma is not yet known.
  
  
  BACKGROUND
  EudraCT 2012-A00548 - 35; NCT01937429.
authors.affiliation: Hepatogastroenterology Department, Hôpital Edouard Herriot, Hospices Civils de Lyon, France.|Lyon 1 University Claude Bernard, Lyon, France.
authors.forename: Adriane
authors.initials: A
authors.lastname: Lesne
authors.affiliation: Hepatogastroenterology Department, University Hospital d'Estaing, Clermont-Ferrand, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Rouquette
authors.affiliation: Hospices Civils de Lyon, pôle Information médicale Evaluation Recherche, and Université de Lyon, EA 7425 Health Services and Performance Research (HESPER), Lyon, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Touzet
authors.affiliation: Hepatogastroenterology Department, Nord Ouest Hospital, Villefranche-sur-Saône, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Petit-Laurent
authors.affiliation: Hepatogastroenterology Department, University Hospital Croix Rousse, Lyon, France.
authors.forename: Gwenaelle
authors.initials: G
authors.lastname: Tourlonias
authors.affiliation: Hepatogastroenterology Department, University Hospital Saint-Etienne, Saint-Priest en Jarez, France.|Hepatogastroenterology Department, St Joseph St Luc Hospital, Lyon, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: Pasquion
authors.affiliation: Hepatogastroenterology Department, Hôpital Edouard Herriot, Hospices Civils de Lyon, France.|Hepatogastroenterology Department, University Hospital Croix Rousse, Lyon, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Rivory
authors.affiliation: Hepatogastroenterology Department, Hôpital Edouard Herriot, Hospices Civils de Lyon, France.
authors.forename: Guillermo
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authors.lastname: Aguero Garcete
authors.affiliation: Hepatogastroenterology Department, University Hospital d'Estaing, Clermont-Ferrand, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Scanzi
authors.affiliation: Hepatogastroenterology Department, Nord Ouest Hospital, Villefranche-sur-Saône, France.
authors.forename: Sylvaine
authors.initials: S
authors.lastname: Chalumeau
authors.affiliation: Hepatogastroenterology Department, Hôpital Edouard Herriot, Hospices Civils de Lyon, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Chambon-Augoyard
authors.affiliation: Hepatogastroenterology Department, University Hospital Lyon Sud, Pierre-Bénite, France.
authors.forename: Driffa
authors.initials: D
authors.lastname: Moussata
authors.affiliation: Hepatogastroenterology Department, Nord Ouest Hospital, Villefranche-sur-Saône, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Leger-Nguyen
authors.affiliation: Hepatogastroenterology Department, Public Hospital Bourgoin-Jallieu, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Degeorges
authors.affiliation: Hepatogastroenterology Department, University Hospital Lyon Sud, Pierre-Bénite, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Chauvenet
authors.affiliation: Hepatogastroenterology Department, Public Hospital Bourgoin-Jallieu, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Fontanges
authors.affiliation: Hepatogastroenterology Department, University Hospital Croix Rousse, Lyon, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Baubet
authors.affiliation: Hepatogastroenterology Department, Public Hospital Bourgoin-Jallieu, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Brulet
authors.affiliation: Hepatogastroenterology Department, University Hospital Croix Rousse, Lyon, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Billioud
authors.affiliation: Hepatogastroenterology Department, Hôpital Edouard Herriot, Hospices Civils de Lyon, France.
authors.forename: Elsa
authors.initials: E
authors.lastname: Thimonier
authors.affiliation: Hepatogastroenterology Department, University Hospital Lyon Sud, Pierre-Bénite, France.
authors.forename: Karine
authors.initials: K
authors.lastname: Stroeymeyt-Martin
authors.affiliation: Hepatogastroenterology Department, Nord Ouest Hospital, Villefranche-sur-Saône, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Hamel
authors.affiliation: Hepatogastroenterology Department, Hôpital Edouard Herriot, Hospices Civils de Lyon, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Graillot
authors.affiliation: Hepatogastroenterology Department, Public Hospital Bourgoin-Jallieu, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Cruiziat
authors.affiliation: Hepatogastroenterology Department, Nord Ouest Hospital, Villefranche-sur-Saône, France.
authors.forename: Olivia
authors.initials: O
authors.lastname: Scalone
authors.affiliation: Hepatogastroenterology Department, Hôpital Edouard Herriot, Hospices Civils de Lyon, France.
authors.forename: Marc
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authors.lastname: O'Brien
authors.affiliation: Hepatogastroenterology Department, St Joseph St Luc Hospital, Lyon, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Péré-Vergé
authors.affiliation: Hepatogastroenterology Department, University Hospital Croix Rousse, Lyon, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Souquet
authors.affiliation: Hepatogastroenterology Department, University Hospital Saint-Etienne, Saint-Priest en Jarez, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Phelip
authors.affiliation: Hepatogastroenterology Department, University Hospital d'Estaing, Clermont-Ferrand, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Poincloux
authors.affiliation: Hospices Civils de Lyon, pôle Information médicale Evaluation Recherche, and Université de Lyon, EA 7425 Health Services and Performance Research (HESPER), Lyon, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Poupon-Bourdy
authors.affiliation: Hospices Civils de Lyon, pôle Information médicale Evaluation Recherche, and Université de Lyon, EA 7425 Health Services and Performance Research (HESPER), Lyon, France.
authors.forename: Angélique
authors.initials: A
authors.lastname: Denis
authors.affiliation: Hospices Civils de Lyon, pôle Information médicale Evaluation Recherche, and Université de Lyon, EA 7425 Health Services and Performance Research (HESPER), Lyon, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Magaud
authors.affiliation: Hepatogastroenterology Department, Hôpital Edouard Herriot, Hospices Civils de Lyon, France.|Lyon 1 University Claude Bernard, Lyon, France.|INSERM U1032, LabTau, Lyon, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Ponchon
authors.affiliation: Hepatogastroenterology Department, Hôpital Edouard Herriot, Hospices Civils de Lyon, France.|Lyon 1 University Claude Bernard, Lyon, France.|INSERM U1032, LabTau, Lyon, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Pioche
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging*; D000236:Adenoma / Q000000981:diagnostic imaging*; D000368:Aged; D002432:Cecum; D003113:Colonoscopy / Q000379:methods*; D003116:Color; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D014867:Water
chemical_list: D014867:Water