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Unsedated ColonoscopyNCT03160859

Prospective RCT Of Water Exchange (WE) vs. WE Plus Cap-Assisted Colonoscopy

A study testing Study method in people with Unsedated Colonoscopy and Water Exchange Colonoscopy, run by VA Office of Research and Development at 3 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This is a study to compare two different, but normally, used methods of colonoscopy in patients undergoing colonoscopy without sedation. There will be two arms in this study: WE (water exchange) control, and WE (water exchange) plus cap (placed at tip of the colonoscope). Read more about this study

Who is it for?
Ages 50 to 80 yearsHealthy volunteers can take part
What is being tested?
Study method
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
280 participants
Where
3 sitesUnited States
Study dates
8 Jun 2018to 28 Oct 2022
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 50 to 80 years
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Informed/educated (about pros and cons of the unsedated option) Veterans undergoing:
  • diagnostic
  • surveillance (follow up of polyps)
  • screening (first-time) colonoscopy at participating sites
  • choosing scheduled unsedated colonoscopy for any reason (lack of escort, personal preference)

Who cannot join

  • decline to be randomized
  • unable to give consent or respond to questionnaires
  • history of colon surgery
  • active inflammatory bowel disease
  • lower gastrointestinal bleeding (except for occult blood or FIT positive in the context of colon cancer screening)
  • therapeutic colonoscopy (e.g., hemostasis, removal of large polyp)
Show all 31Show fewer
  • proctosigmoidoscopy
  • bidirectional endoscopy
  • inadequate consumption of bowel preparation
  • known history of severe diverticulosis or diverticulitis
  • history of abdominal surgery previously requiring sedation for colonoscopy
  • current narcotic/anxiolytic medication use
  • prior unsuccessful experience with unsedated colonoscopy
  • emergent colonoscopy
  • evidence of colonic obstruction based on pre-colonoscopy clinical evaluation
  • current participation in other studies
  • medical condition that could increase the risk associated with colonoscopy
  • active cardiac
  • or pulmonary disease
  • or other serious disease
  • medical condition that would preclude a benefit from colonoscopic screening
  • cancer
  • or any terminal illness
  • prosthetic heart valve
  • anticoagulant therapy
  • nonmedical problems
  • psychiatric disorders
  • excessive use of alcohol
  • need for special precautions in performing colonoscopy
  • antibiotic prophylaxis
  • request of on demand sedation

Trial locations and contacts

3 sites in 1 country.

United States3 sites
  • VA Palo Alto Health Care System, Palo Alto, CA

    Palo Alto, California, 94304-1290

  • VA Northern California Health Care System, Mather, CA

    Sacramento, California, 95655

  • VA Greater Los Angeles Healthcare System, Sepulveda, CA

    Sepulveda, California, 91343

Other trials in United States

About this study

Official title: Prospective RCT of Water Exchange (WE) vs. WE Plus Cap-Assisted Colonoscopy

This is a study to compare two different, but normally, used methods of colonoscopy in patients undergoing colonoscopy without sedation. There will be two arms in this study: WE (water exchange) control, and WE (water exchange) plus cap (placed at tip of the colonoscope). The patient will prepare himself/herself for the colonoscopy as per normal instructions and he/she will be given the information for the study at that time so that he/she can make a decision to participate in the study. The control method will use water instead of air during insertion of the colonoscope. The study method will use a cap that will fit onto the end of the colonoscope plus water during insertion of the colonoscope. This study will assess if the study method is less painful than the control method.

Read the detailed description

This will be a multi-VA site, unblinded investigators, prospective randomized control trial (RCT). Randomization (WE, WE + cap) will be based on computer generated random numbers placed inside opaque sealed envelopes. The envelope (in pre-arranged order set up by statistics consultant) will be opened to reveal the code when the colonoscopist is ready to insert the endoscope to begin the examination. This will be a comparison of two arms (WE, WE + cap) to see which one is less painful.

Patients who are willing to participate will sign an informed consent before starting the colonoscopy procedure. Separate parallel randomization will be set up at each site, stratified type of colonoscopy (screening, surveillance, diagnostic). All subjects will have scheduled unsedated colonoscopy as a result of lack of escort or personal preference for no sedation. Randomization will be set up by statistics consultant.

Control Method: One arm of the study will include unsedated colonoscopy with water exchange (WE) as the control method. Residual air in the colon will be removed and water will be infused to guide insertion through an airless lumen. Infused water will be removed by suction, along with residual fecal debris, predominantly during insertion.

Study method: The other arm will include unsedated colonoscopy with water exchange (WE) and the addition of a cap, fitted to the colonoscope per manufacturer instruction.

Being tested
Control, Study method
Keywords
unsedated colonoscopy, water exchange colonoscopy, cap, colonoscopy pain
Medical subject headings
Anterior polar cataract 2

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • ControlOther

    Also called Water exchange method

    Unsedated colonoscopy with water exchange (WE) where the residual air in the colon will be removed and water will be infused to guide insertion through an airless lumen. Infused water is removed predominantly during insertion.

  • Study methodDevice

    Also called Water exchange method plus cap

    Unsedated colonoscopy with water exchange (WE + cap) and the addition of a cap fitted to the colonoscope.

Study groups in NCT03160859
Study groupRoleWhat they receive
Control MethodOtherOne arm of the study will include unsedated colonoscopy with water exchange (WE) as the control method. Residual air in the colon will be removed and water will be infused to guide insertion through an airless lumen. Infused water will be removed predominantly during insertion.
Receives: Other: Control
Study MethodOtherThe other arm will include unsedated colonoscopy with water exchange (WE) and the addition of a simple commercially available accessory to the colonoscopy device: a cap (Disposable Distal Attachment, Olympus Medical Systems Corp., Tokyo, Japan) fitted to the colonoscope per manufacturer instruction. Residual air in the colon will be removed and water will be infused to guide insertion through an airless lumen. Infused water will be removed predominantly during insertion.
Receives: Device: Study method

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Real Time Maximum Insertion Pain

    Pain during insertion reported to the unblinded assisting nurse, visual analogue scale, VAS: 0=none, 10=most severe. The highest pain score will be tabulated for analysis. Timing of data collection will be at the discretion of the nurse to minimize bias by colonoscopist behavior.

    Measured: Insertion pain was measured during the duration of the colonoscopy procedure, which lasted on average for about 1 hour

Secondary outcomes (3)
  1. Proportion of Patients With No Insertion Pain

    Proportion of patients who report no pain during insertion of the colonoscope.

    Measured: Pain was measured during the duration of the colonoscopy procedure, which lasted on average for about 1 hour

  2. Insertion Time

    Time to cecum (clock display on monitor), faster insertion is a quality marker

    Measured: Insertion time in minutes was measured during the duration of the colonoscopy procedure, which lasted on average for about 1 hour

  3. Right Colon Adenoma Detection Rate (ADR)

    Right colon Adenoma Detection Rate (ADR) is the proportion of patients with at least one adenoma in the part of the colon between the cecum and the hepatic flexure.

    Measured: Adenoma Detection Rate (ADR) was measured during the duration of the colonoscopy procedure, which lasted on average for about 1 hour

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted19 May 2017
  2. Study start8 Jun 2018
  3. Primary completion28 Oct 2022
  4. Study completion28 Oct 2022

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Supportive care
Allocation
Randomised
Intervention model
Parallel groups
Model description
This will be a multi-VA site, prospective RCT to compare different methods with 2 arms to determine which is less painful: water alone or water plus cap. Randomization will be based on computer generated random numbers placed inside opaque sealed envelopes. The envelope will be opened to reveal the code when the colonoscopist is ready to insert the endoscope to begin the examination. Patients who are willing to participate will sign an informed consent before starting the colonoscopy procedure. Separate parallel randomization will be set up at each site. Control Method: Involves unsedated colonoscopy with water exchange. Residual air will be removed and water will be infused to guide insertion through an airless lumen. Infused water will be removed by suction, along with residual fecal debris, predominantly during insertion. Study method: Involves unsedated colonoscopy with water exchange and the addition of a commercially available accessory fitted onto the colonoscope.
Masking
Single blind
Who is masked
Participant
Enrolment
280 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03160859
Sponsor's protocol ID
GAST-015-16S
Status last verified
Nov 2023
First submitted
12 May 2017
Last updated
12 Dec 2023
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
No

Publications

  • Wolff WI, Shinya H. Polypectomy via the fiberoptic colonoscope. Removal of neoplasms beyond reach of the sigmoidoscope. N Engl J Med. 1973 Feb 15;288(7):329-32. doi: 10.1056/NEJM197302152880701. No abstract available.

    PubMed 4682941
  • Leung FW. The case of unsedated screening colonoscopy in the United States. Gastrointest Endosc. 2009 Jun;69(7):1354-6. doi: 10.1016/j.gie.2008.12.234. Epub 2009 Feb 27. No abstract available.

    PubMed 19249764
  • Leung FW, Aljebreen AM, Brocchi E, Chang EB, Liao WC, Mizukami T, Schapiro M, Triantafyllou K. Sedation-risk-free colonoscopy for minimizing the burden of colorectal cancer screening. World J Gastrointest Endosc. 2010 Mar 16;2(3):81-9. doi: 10.4253/wjge.v2.i3.81.

    PubMed 21160707
  • Leung FW. Is there a place for sedationless colonoscopy? J Interv Gastroenterol. 2011 Jan;1(1):19-22. doi: 10.4161/jig.1.1.14592.

    PubMed 21686108
  • Cataldo PA. Colonoscopy without sedation. Dis Colon Rectum. 1996 Mar;39(3):257-61. doi: 10.1007/BF02049463.

    PubMed 8603544
  • Hoffman MS, Butler TW, Shaver T. Colonoscopy without sedation. J Clin Gastroenterol. 1998 Jun;26(4):279-82. doi: 10.1097/00004836-199806000-00013.

    PubMed 9649011
  • Rex DK, Imperiale TF, Portish V. Patients willing to try colonoscopy without sedation: associated clinical factors and results of a randomized controlled trial. Gastrointest Endosc. 1999 May;49(5):554-9. doi: 10.1016/s0016-5107(99)70381-0.

    PubMed 10228251
  • Subramanian S, Liangpunsakul S, Rex DK. Preprocedure patient values regarding sedation for colonoscopy. J Clin Gastroenterol. 2005 Jul;39(6):516-9. doi: 10.1097/01.mcg.0000165667.79530.44.

    PubMed 15942439
  • Early DS, Saifuddin T, Johnson JC, King PD, Marshall JB. Patient attitudes toward undergoing colonoscopy without sedation. Am J Gastroenterol. 1999 Jul;94(7):1862-5. doi: 10.1111/j.1572-0241.1999.01219.x.

    PubMed 10406249
  • Leung FW. Patients' perspective - written testimonials from physician-patients and oral accounts presented by patients in person. J Interv Gastroenterol. 2011 Jan;1(1):45-46. doi: 10.4161/jig.1.1.14605. No abstract available.

    PubMed 21686115
  • Jonas DE, Russell LB, Sandler RS, Chou J, Pignone M. Patient time requirements for screening colonoscopy. Am J Gastroenterol. 2007 Nov;102(11):2401-10. doi: 10.1111/j.1572-0241.2007.01387.x. Epub 2007 Jun 29.

    PubMed 17608779
  • Leung FW. Unsedated colonoscopy introduced to ensure access is acceptable to a subgroup of veterans. Dig Dis Sci. 2008 Oct;53(10):2719-22. doi: 10.1007/s10620-007-0192-8. Epub 2008 Feb 15.

    PubMed 18274901
  • Felix W. Leung, Hartley Cohen, Stanley K. Dea, Dennis M. Jensen, Thomas O. Kovacs, Gordon V. Ohning, Joseph R. Pisegna, Alireza Sedarat, Alan Sheinbaum, Timothy C. Simmons, Rebecca Slomovic, Brennan M. Spiegel, Mitchell J. Spirt, James Sul and Rabindra R. Watson. Scheduled unsedated colonoscopy - a novel tool for managing no shows due to lack of escorts required for conscious sedation. Gastrointestinal Endoscopy, 2014-05-01, Volume 79, Issue 5, Pages AB178-AB179

  • Terruzzi V, Meucci G, Radaelli F, Terreni N, Minoli G. Routine versus "on demand" sedation and analgesia for colonoscopy: a prospective randomized controlled trial. Gastrointest Endosc. 2001 Aug;54(2):169-74. doi: 10.1067/mge.2001.113923.

    PubMed 11474385
  • Leung FW, Harker JO, Jackson G, Okamoto KE, Behbahani OM, Jamgotchian NJ, Aharonian HS, Guth PH, Mann SK, Leung JW. A proof-of-principle, prospective, randomized, controlled trial demonstrating improved outcomes in scheduled unsedated colonoscopy by the water method. Gastrointest Endosc. 2010 Oct;72(4):693-700. doi: 10.1016/j.gie.2010.05.020. Epub 2010 Jul 8.

    PubMed 20619405

Questions about this trial

What is this clinical trial studying?

A study testing Study method in people with Unsedated Colonoscopy and Water Exchange Colonoscopy, run by VA Office of Research and Development at 3 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 31 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 12 Dec 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 12 Dec 2023). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Real Time Maximum Insertion Pain (time frame: Insertion pain was measured during the duration of the colonoscopy procedure, which lasted on average for about 1 hour). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03160859, which also lists 26 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Dec 2023.

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