A247 L-MENTHOL DURING COLONOSCOPY FOR ADENOMA DETECTION IN AN INTERMEDIATE RISK PATIENT POPULATION: A DOUBLE-BLIND, RANDOMIZED CONTROLLED TRIAL
Bibliographic record
Abstract
Adenoma detection rate (ADR) is defined as the proportion of screening colonoscopies performed by a physician that detect at least one histologically-confirmed colorectal adenoma or adenocarcinoma. Colonoscopy is considered the gold standard for detection and removal of polyps. However, despite advances in technology, there is still a significant number of missed polyps during colonoscopy. L-Menthol (peppermint oil) has been shown to induce spasmolytic effects in human colon circular smooth muscle, it could potentially improve the visual field for the endoscopist. The aim of our study was to determine the effectiveness and safety of topical L-menthol preparation in adenoma detection and effect on colonic peristalsis. This was a randomized, double-blind, controlled trial conducted at the University of Alberta. Patients undergoing screening colonoscopy were consecutively recruited from the Stop Colorectal Cancer through Prevention and Education program. Patients were randomized to L-Menthol solution or the control solution (liquid simethicone) administered as spray at the cecum. Peristalsis was recorded at baseline, then at 1 and 5 minutes and graded as none, mild, moderate or severe, based on a validated classification. The endoscopists and patients were blinded. During the procedure, insertion and withdrawal times were recorded, as were the quality of bowel preparation, total sedation, changes to patient position, abdominal pressure and the use of carbon dioxide. The location, size, removal technique and type of polyp detected were documented. All specimens retrieved were sent for histopathology. After the procedure, patients were contacted and questioned about adverse effects. A total of 122 patients enrolled in our study, 61 patients were randomized to receive L-Menthol. There were no significant differences in patient characteristics between the two groups. The overall ADR was 63.1%. There were no significant differences in the amount of sedation, position change, or withdrawal time. The primary end-point of ADR was 57.4% in the L-menthol group and 68.9% in placebo (p=0.260). The proportion of patients with no peristalsis at 5 minutes was 44.3% in the L-menthol group and 21.3% in the control group (p=0.002). There were no significant differences in peristalsis at baseline and after 1 minute. No significant differences were found regarding bloating or abdominal pain between the two groups. No major side effects were reported in the two groups. Topical L-menthol was associated with decreased peristalsis during colonoscopy after 5 minutes. L-Menthol did not increase the ADR in intermediate-risk patients, however, further studies on other patient populations should be considered. None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".