510 - Eosinophilic Gastroenteritis: More Common Than we Think and Perhaps Ominous in Women

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Introduction: In recent years, many studies have shown the superiority of split dose bowel prep over conventional prep and the power of underwater colonoscopy (UWC) relative to air/CO2- insufflation colonoscopy (AIC) to enhance ADR. In an effort to optimize detection and removal of precancerous polyps we examined if the relative benefits of UWC and SDP were additive, synergistic or exclusive

Methods: We analyzed our colonoscopy quality database from 2012 to 2017, inclusive of all screening and surveillance colonoscopies that were preceded by a split dose bowel prep. We analyzed the polyp, adenoma and sessile serrated adenoma detection rates (PDR, ADR, SSADR) among patients who also underwent UWC compared to those who did not. UWC were inclusive of both water emersion and water exchange techniques. We also performed sub-group analysis by sex. We used an unpaired t-test for continuous variables and Fisher's exact test to analyze categorical variables.

Results: 3271 colonoscopies met our inclusion criteria, including 1921 SDP+UWC, and 1350 SDP+AIC. We found that SDP+UWC is associated with statistically significant increase in PDR (0.64 vs 0.70, p=0.0003), ADR (0.40 vs 0.45, p=0.005), and SSADR (0.09 vs 0.12, p=0.007) compared to SDP+AIC. However the effect was more robust in males than females. The additional benefits of SDP+UWC were achieved without statically significant differences in insertion time (12.1 vs 12.3 p=0.3), withdrawal time (19.0 vs 19.7, p=0.09), total time (31.0 vs 32.1, p=0.06) and cecal intubation rates (98.7 vs 98.8, p=0.94).

Conclusion: Although frequently challenging, the optimization of colonoscopy and polypectomy is dependent on the clear visualization of the colonic mucosa. We find that the beneficial effects of split dose bowel prep and UWC are additive, and potentially synergistic, to each other and not mutually exclusive in enhancing polyp and adenoma detection. However the addition of UWC to split dose prep appears to be more effective in the male colon for providing an additional benefit in precancerous polyp detection. These findings argue in favor of utilizing multiple high yield techniques to prepare the colon for endoscopy so that during colonoscopy the fluid inserted into the colon appears as “Clear as the Caribbean”


American College of Gastroenterology (ACG) Annual Scientific Meeting, Orlando, FL, October 13-18, 2017