Pediatric vs Adult Colonoscopes' Effectiveness in Obese Patients: The PACE Randomized Clinical Trial

Area of Science:

• Gastroenterology
• Medical Devices
• Clinical Trials

Background:

• Obesity is a significant risk factor for colorectal neoplasia.
• Optimizing colonoscopy for obese patients is crucial due to higher risks.
• Limited comparative data exists for colonoscope selection in obese individuals.

Purpose of the Study:

• To compare the efficacy of slim (pediatric) versus adult colonoscopes in obese patients.
• To determine if slim colonoscopes offer equivalent or superior performance for colonoscopy in individuals with a body mass index (BMI) of ≥30 kg/m2.
• To provide data guiding colonoscope choice for enhanced colonoscopy in obese populations.

Main Methods:

• A randomized equivalence clinical trial included 245 obese patients (BMI ≥30 kg/m2).
• Participants were randomized 1:1 to receive either a slim or adult colonoscope.
• The primary outcome measured was successful cecal intubation within 10 minutes without scope exchange.

Main Results:

• Equivalence was demonstrated, with the primary endpoint achieved in 94.3% of the slim colonoscope group and 92.6% of the adult colonoscope group.
• Both adjusted and unadjusted analyses confirmed equivalence within the predefined margin.
• Secondary outcomes, including insertion time and adenoma detection rate, were similar between groups.

Conclusions:

• Slim and adult colonoscopes are equivalent for non-difficult colonoscopies in obese patients.
• A trend towards improved performance was observed with the slim colonoscope.
• Expert endoscopists can effectively use both colonoscope types in this patient demographic.