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Optimization for Sequencing and Analysis of Degraded FFPE-RNA Samples

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Optimal sequences of same-visit bidirectional endoscopy: Systematic review and meta-analysis.

Passisd Laoveeravat^1,2, Subhanudh Thavaraputta¹, Sakolwan Suchartlikitwong¹

¹Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA.

Digestive Endoscopy : Official Journal of the Japan Gastroenterological Endoscopy Society

|August 2, 2019

Summary

Performing esophagogastroduodenoscopy (EGD) before colonoscopy (E-C) results in less sedation and patient discomfort compared to the reverse order (C-E). Both sequences show similar polyp and adenoma detection rates.

Keywords:

bidirectional endoscopy colonoscopy discomfort optimal sequence upper endoscopy

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Area of Science:

Gastroenterology
Endoscopy
Clinical Research

Background:

Same-visit colonoscopy and esophagogastroduodenoscopy (EGD) are increasingly common procedures.
Conflicting evidence exists regarding the optimal sequence for combined EGD and colonoscopy.

Purpose of the Study:

To compare the performance, safety, and patient discomfort between EGD followed by colonoscopy (E-C) and colonoscopy followed by EGD (C-E).

Main Methods:

A meta-analysis of six randomized controlled trials was conducted.
Outcomes assessed included procedural performance (cecal intubation time, adenoma/polyp detection rates), patient and endoscopist discomfort scores, and sedation use.

Main Results:

The E-C sequence demonstrated significantly lower use of fentanyl and propofol compared to the C-E sequence.
Patients and endoscopists reported significantly lower discomfort scores in the E-C group.
No significant differences were observed in cecal intubation time, adenoma detection rate, or polyp detection rate between the two sequences.

Conclusions:

The E-C sequence is associated with reduced sedation requirements and improved patient and endoscopist comfort.
The E-C sequence is recommended as the optimal order for combined EGD and colonoscopy due to better patient experience without compromising diagnostic yield.