Which should go first during same-day upper and lower gastrointestinal endoscopy? A randomized prospective study...

Area of Science:

• Gastroenterology
• Endoscopic Procedures

Background:

• Same-day bidirectional endoscopy, combining esophagogastroduodenoscopy (EGD) and colonoscopy, is a common clinical practice.
• The optimal procedural sequence for maximizing colonoscopy performance and quality remains undetermined.

Purpose of the Study:

• To compare colonoscopy performance and quality based on whether colonoscopy precedes or follows EGD in same-day procedures.

Main Methods:

• A prospective randomized trial involving 1,103 patients allocated to either EGD-colonoscopy or colonoscopy-EGD sequences.
• Key colonoscopy metrics including cecal intubation success, insertion time, and adenoma detection rate were assessed.
• Subjective patient discomfort was evaluated using questionnaires in a subset of patients.

Main Results:

• No significant differences were observed in colonoscopy completion rates, difficult cecal intubation rates, or adenoma detection rates between the two sequences.
• Factors such as female gender, age 55+, poor bowel preparation, and prior abdominal surgery were associated with increased difficulty in cecal intubation.
• Patients in the colonoscopy-EGD group reported higher subjective discomfort during EGD.

Conclusions:

• The procedural sequence of EGD and colonoscopy does not influence colonoscopy performance or quality.
• Patient-specific factors significantly impact the success of colonoscopy.
• An EGD-first sequence may lead to a more comfortable patient experience during the EGD component.