University of Texas Medical Branch at Galveston Galveston, TX, United States
Minh N. Tran, MD1, Hamza Abdulla, MD2, Sheharyar Merwat, MD3, Sharon Boening, BSN, RN1, Jaison S. John, MD1, Sreeram Parupudi, MD1 1University of Texas Medical Branch at Galveston, Galveston, TX; 2University of Maryland Medical Center, Galveston, TX; 3University of Texas Medical Branch, Galveston, TX
Introduction: Inadequate bowel preparation (IBP) was reported in up to 51% of inpatient colonoscopies leading to repeat procedures increasing the length of stay and cost of care. IBP increases the risk of missed lesions in colorectal cancer (CRC) screening. The Pure-Vu system (Pure-Vu) is a cost-effective FDA-approved oversleeve for pulsed irrigation and evacuation of the effluent allowing completion of colonoscopy. We describe here our experience with the Pure-Vu system in patients with IBP.
Methods: Adult patients ( >=18 years) underwent colonoscopy with IBP needing the assistance of Pure-Vu between August 2019 and May 2021. Boston Bowel Preparation Scale (BBPS) was used to assess the adequacy of cleaning. Patient charts reviewed for procedural details of preparation adequacy, completion of procedure, lesions detected, and interventions performed.
Results: Pure-Vu was used in 40 patients [median age 64 years (20-89)] with IBP to complete the colonoscopy. 35% were inpatients (n=14) while the rest were outpatients (n=26, 65%). The indication for colonoscopy was either diagnostic (n=22, 55%) or CRC screening/surveillance (n=18, 45%). Pure-Vu was used as an adjunct to IBP to allow completion of procedure in 37 patients (92.5%). In 3 patients (7.5%) with active lower gastrointestinal bleeding (LGIB), Pure-Vu was used without bowel preparation to promptly detect the etiology and possibly treat. In patients with IBP, the mean BBPS score improved from 3.1 (range: 0-6) to 8.5 (range 5-9) after intra-procedural cleansing. The cecal intubation rate was 90% (36/40). Overall, clinically relevant findings were noted in 57%. Adenomas were found in 11/18 patients undergoing CRC screening/surveillance (61%). Use of Pure-Vu did not interfere with the performance of endoscopic interventions including biopsy (n=5), cold/hot snare polypectomy (n=15), or EMR (n=2). When used in emergency colonoscopy without bowel preparation, procedures could be completed in all three patients detecting and treating diverticular and post-polypectomy bleeding in one patient each and diagnosing severe right sided ischemic colitis in another. Besides minor mucosal trauma in 2 cases, no major complications were observed with Pure-Vu.
Discussion: In our limited experiences, we found Pure-Vu very useful in patients with IBP, especially in those with prior incomplete procedures. The use of Pure-Vu allowed completion of the procedure and any required interventions. Utility of Pure-Vu without prior bowel preparation in LGIB needs further study.
Figure: Efficacy of PureVu in Inadequate Bowel Preparation (A1, A2) and in a patient with lower GI Bleeding without bowel preparation (B1, B2)
Minh Tran indicated no relevant financial relationships.
Hamza Abdulla indicated no relevant financial relationships.
Sheharyar Merwat indicated no relevant financial relationships.
Sharon Boening indicated no relevant financial relationships.
Jaison John indicated no relevant financial relationships.
Sreeram Parupudi indicated no relevant financial relationships.
Minh N. Tran, MD1, Hamza Abdulla, MD2, Sheharyar Merwat, MD3, Sharon Boening, BSN, RN1, Jaison S. John, MD1, Sreeram Parupudi, MD1. P2228 - Single Center Experience With an Oversleeve-Based Inter-Procedural Colon Cleansing Device, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.