Hoffman A, Murthy S, Pompetzki L, Rey JW, Goetz M, Tresch A, Galle PR, Kiesslich R. Intraprocedural bowel cleansing with the JetPrep cleansing system improves adenoma detection. World J Gastroenterol 2015; 21(26): 8184-8194 [PMID: 26185393 DOI: 10.3748/wjg.v21.i26.8184]
Corresponding Author of This Article
Arthur Hoffman, MD, PhD, Department of Internal Medicine II, HSK Hospital, Teaching Hospital of the University Medicine of Mainz, 65199 Wiesbaden, Germany. ahoff66286@aol.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Randomized Controlled Trial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jul 14, 2015; 21(26): 8184-8194 Published online Jul 14, 2015. doi: 10.3748/wjg.v21.i26.8184
Table 1 Inclusion and Exclusion criteria
Inclusion criteria
All patients ≥ 50 yr of age who reported for a screening or surveillance colonoscopy and had a history of removed adenomas were included in the study.
Exclusion criteria
Patients who were unable to sign the informed consent form
Patients who had undergone previous (partial) resection of the large bowel, except for appendectomy
Patients with known or pre-existing colorectal carcinoma
Patients with chronic inflammatory bowel disease
Patients with known FAP or HNPCC syndromes in the family
Patients with a Quick score < 50%, pTT > 50 s, or thrombocytes < 50000/μL who had received no specific measures for the improvement of their coagulation (FFP, TK) before the examination
Patients suffering from a severe underlying disease (ASA > II°)
Patients who were determined to have a cleanliness score of 3 on the Boston Bowel Preparation Scale for the proximal portion of the colon during the examination
Patients in whom a complete colonoscopy could not be performed in the first or second step of the investigation
Patients in whom the first step of the investigation took ≥ 45 min
Table 2 Bowel preparation scale
0 = Unprepared colon segment. Due to solid stool that cannot be cleared, the mucosa cannot be observed
1 = Some portions of the mucosa of the colon segment can be observed, but other areas are covered by residual staining consisting of residual stool or opaque fluid
2 = Minor amount of residual staining. No stool fragments or small quantities of opaque fluid, but the mucosal surface of the colon segment can be observed well
3 = The entire mucosa of the colon segment can be observed well and has no residual staining
Table 3 Secondary endpoint analysis
Miss rate for the entire colon
Polyp miss rates and detection rates for the entire colon and the right side of the colon
Colon cleanliness after JetPrep and standard cleaning (based on the Boston Bowel Preparation Scale)
Rate of adverse events resulting from the use of JetPrep
Table 4 Patient characteristics
Original cohort of patients
n = 73
Dropouts
9/73 (12.3%)
Number of included patients
64/73 (87.7%)
Group stratification
Group A (first standard), n = 30
Group B (first JetPrep), n = 34
Age (yr)
63.53 ± 8.03
Sex
M: 34; F: 30
Risk of developing CRC
High: n = 22; Low: n = 42
BBPS (baseline values) per protocol (n = 64)
4.84 ± 1.81
BBPS (baseline values) of original patient cohort1 (n = 71)
Table 7 Overview of detection rates and miss rates
Group A
Group B
P value
Polyps, total found
First step: 35
First step: 68
< 0.001
Second step: 36
Second step: 24
Miss rates for polyps, total
50.70%
26.10%
Polyps on the right side
First step: 13
First step: 39
< 0.001
Second step: 20
Second step: 14
Miss rate for polyps
60.6%
26.4%
Adenomas, SSA total
First step: 17
First step: 42
0.035
Second step: 13
Second step: 13
Miss rate for adenomas, SSA total
43.3%
23.7%
Adenomas, SSA on the right side
First step: 7
First step: 27
0.043
Second step: 9
Second step: 11
Miss rate for adenomas, SSA on the right side
56.3%
29.0%
Adenomas total
First step: 13
First step: 32
0.101
Second step: 11
Second step: 12
Miss rate for adenomas, total
45.8%
27.3%
Adenomas on the right side
First step: 3
First step: 17
0.064
Second step: 7
Second step: 10
Miss rate for adenomas on the right side
70.0%
37.0%
SSA
First step: 4
First step: 10
0.243
Second step: 2
Second step: 1
Miss rate for SSA
33.3%
9.1%
Citation: Hoffman A, Murthy S, Pompetzki L, Rey JW, Goetz M, Tresch A, Galle PR, Kiesslich R. Intraprocedural bowel cleansing with the JetPrep cleansing system improves adenoma detection. World J Gastroenterol 2015; 21(26): 8184-8194