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Desai M, Ausk K, Brannan D, Chhabra R, Chan W, Chiorean M, Gross SA, Girotra M, Haber G, Hogan RB, Jacob B, Jonnalagadda S, Iles-Shih L, Kumar N, Law J, Lee L, Lin O, Mizrahi M, Pacheco P, Parasa S, Phan J, Reeves V, Sethi A, Snell D, Underwood J, Venu N, Visrodia K, Wong A, Winn J, Wright CH, Sharma P. Use of a Novel Artificial Intelligence System Leads to the Detection of Significantly Higher Number of Adenomas During Screening and Surveillance Colonoscopy: Results From a Large, Prospective, US Multicenter, Randomized Clinical Trial. Am J Gastroenterol 2024; 119:1383-1391. [PMID: 38235741 DOI: 10.14309/ajg.0000000000002664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/14/2023] [Indexed: 01/19/2024]
Abstract
INTRODUCTION Adenoma per colonoscopy (APC) has recently been proposed as a quality measure for colonoscopy. We evaluated the impact of a novel artificial intelligence (AI) system, compared with standard high-definition colonoscopy, for APC measurement. METHODS This was a US-based, multicenter, prospective randomized trial examining a novel AI detection system (EW10-EC02) that enables a real-time colorectal polyp detection enabled with the colonoscope (CAD-EYE). Eligible average-risk subjects (45 years or older) undergoing screening or surveillance colonoscopy were randomized to undergo either CAD-EYE-assisted colonoscopy (CAC) or conventional colonoscopy (CC). Modified intention-to-treat analysis was performed for all patients who completed colonoscopy with the primary outcome of APC. Secondary outcomes included positive predictive value (total number of adenomas divided by total polyps removed) and adenoma detection rate. RESULTS In modified intention-to-treat analysis, of 1,031 subjects (age: 59.1 ± 9.8 years; 49.9% male), 510 underwent CAC vs 523 underwent CC with no significant differences in age, gender, ethnicity, or colonoscopy indication between the 2 groups. CAC led to a significantly higher APC compared with CC: 0.99 ± 1.6 vs 0.85 ± 1.5, P = 0.02, incidence rate ratio 1.17 (1.03-1.33, P = 0.02) with no significant difference in the withdrawal time: 11.28 ± 4.59 minutes vs 10.8 ± 4.81 minutes; P = 0.11 between the 2 groups. Difference in positive predictive value of a polyp being an adenoma among CAC and CC was less than 10% threshold established: 48.6% vs 54%, 95% CI -9.56% to -1.48%. There were no significant differences in adenoma detection rate (46.9% vs 42.8%), advanced adenoma (6.5% vs 6.3%), sessile serrated lesion detection rate (12.9% vs 10.1%), and polyp detection rate (63.9% vs 59.3%) between the 2 groups. There was a higher polyp per colonoscopy with CAC compared with CC: 1.68 ± 2.1 vs 1.33 ± 1.8 (incidence rate ratio 1.27; 1.15-1.4; P < 0.01). DISCUSSION Use of a novel AI detection system showed to a significantly higher number of adenomas per colonoscopy compared with conventional high-definition colonoscopy without any increase in colonoscopy withdrawal time, thus supporting the use of AI-assisted colonoscopy to improve colonoscopy quality ( ClinicalTrials.gov NCT04979962).
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Affiliation(s)
- Madhav Desai
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Karlee Ausk
- Gastroenterology, Swedish Health and Swedish Medical Center, Seattle, Washington, USA
| | - Donald Brannan
- Gastroenterology, Swedish Health and Swedish Medical Center, Seattle, Washington, USA
| | - Rajiv Chhabra
- Department of Gastroenterology, Saint Luke's Hospital of Kansas City, Kansas City, Missouri, USA
| | - Walter Chan
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael Chiorean
- Gastroenterology, Swedish Health and Swedish Medical Center, Seattle, Washington, USA
| | - Seth A Gross
- Gastroenterology, New York University Langone Health, New York, New York, USA
| | - Mohit Girotra
- Gastroenterology, Swedish Health and Swedish Medical Center, Seattle, Washington, USA
| | - Gregory Haber
- Gastroenterology, New York University Langone Health, New York, New York, USA
| | - Reed B Hogan
- GI Associates and Endoscopy Center, Jackson, Mississippi, USA
| | - Bobby Jacob
- Gastroenterology, Largo Medical Center, Largo, Florida, USA
| | - Sreeni Jonnalagadda
- Department of Gastroenterology, Saint Luke's Hospital of Kansas City, Kansas City, Missouri, USA
| | - Lulu Iles-Shih
- Gastroenterology, Swedish Health and Swedish Medical Center, Seattle, Washington, USA
| | - Navin Kumar
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Joanna Law
- Gastroenterology, Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Linda Lee
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Otto Lin
- Gastroenterology, Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Meir Mizrahi
- Gastroenterology, Largo Medical Center, Largo, Florida, USA
| | - Paulo Pacheco
- Gastroenterology, New York University Langone Health, New York, New York, USA
| | - Sravanthi Parasa
- Gastroenterology, Swedish Health and Swedish Medical Center, Seattle, Washington, USA
| | - Jennifer Phan
- Departement of Gastroenterology, Keck Medicine University of Southern California, Los Angeles, California, USA
| | - Vonda Reeves
- GI Associates and Endoscopy Center, Jackson, Mississippi, USA
| | - Amrita Sethi
- Department of Gastroenterology, Columbia University Irving Medical Center, New York, New York, USA
| | - David Snell
- Gastroenterology, New York University Langone Health, New York, New York, USA
| | - James Underwood
- GI Associates and Endoscopy Center, Jackson, Mississippi, USA
| | - Nanda Venu
- Gastroenterology, Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Kavel Visrodia
- Department of Gastroenterology, Columbia University Irving Medical Center, New York, New York, USA
| | - Alina Wong
- Gastroenterology, Swedish Health and Swedish Medical Center, Seattle, Washington, USA
| | - Jessica Winn
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | | | - Prateek Sharma
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
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Tiankanon K, Aniwan S. What are the priority quality indicators for colonoscopy in real-world clinical practice? Dig Endosc 2024; 36:30-39. [PMID: 37422906 DOI: 10.1111/den.14635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/06/2023] [Indexed: 07/11/2023]
Abstract
Colonoscopy is widely used as a colorectal cancer (CRC) screening tool. The effectiveness of a screening colonoscopy is associated with a decreased risk of CRC. However, colonoscopy is an operator-dependent procedure, and endoscopists' quality performance varies widely. This article reviewed the priority metrics and practices that contribute to high-quality screening colonoscopy in real-world clinical practice. With growing evidence, quality indicators have been subject to intense research and associated with reducing postcolonoscopy CRC incidence and mortality. Some quality metrics can reflect an endoscopy unit-based practice (i.e. quality of bowel preparation and withdrawal time). Other quality indicators primarily reflect individuals' skill and knowledge (i.e. cecal intubation rate, adenoma detection rate, and appropriately assigned follow-up colonoscopy interval). Measurement and improvement of priority quality indicators for colonoscopy should be made at both the endoscopist and unit levels. Substantial evidence supports the impact of high-quality colonoscopy in reducing the incidence of postcolonoscopy CRC.
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Affiliation(s)
- Kasenee Tiankanon
- Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Satimai Aniwan
- Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Anderson JC, Rex DK. Performing High-Quality, Safe, Cost-Effective, and Efficient Basic Colonoscopy in 2023: Advice From Two Experts. Am J Gastroenterol 2023; 118:1779-1786. [PMID: 37463252 DOI: 10.14309/ajg.0000000000002407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/05/2023] [Indexed: 07/20/2023]
Abstract
Based on published evidence and our expert experience, we provide recommendations to maximize the efficacy, safety, efficiency, and cost-effectiveness of routine colonoscopy. High-quality colonoscopy begins with colon preparation using a split or same-day dose and preferably a low-volume regimen for optimal patient tolerance and compliance. Successful cecal intubation can be achieved by choosing the correct colonoscope and using techniques to facilitate navigation through challenges such as severe angulations and redundant colons. Safety is a primary goal, and complications such as perforation and splenic rupture can be prevented by avoiding pushing through fixed resistance and avoiding loops in proximal colon. Furthermore, barotrauma can be avoided by converting to water filling only (no gas insufflation) in every patient with a narrowed, angulated sigmoid. Optimal polyp detection relies primarily on compulsive attention to inspection as manifested by adequate inspection time, vigorous probing of the spaces between haustral folds, washing and removing residual debris, and achieving full distention. Achieving minimum recommended adenoma detection rate thresholds (30% in men and 20% in women) is mandatory, and colonoscopists should aspire to adenoma detection rate approaching 50% in screening patients. Distal attachments can improve mucosal exposure and increase detection while shortening withdrawal times. Complete resection of polyps complements polyp detection in preventing colorectal cancer. Cold resection is the preferred method for all polyps < 10 mm. For effective cold resection, an adequate rim of normal tissue should be captured in the snare. Finally, cost-effective high-quality colonoscopy requires the procedure not be overused, as demonstrated by following updated United States Multi Society Task Force on Colorectal Cancer postpolypectomy surveillance recommendations.
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Affiliation(s)
- Joseph C Anderson
- Division of Gastroenterology, Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Division of Gastroenterology, Department of Medicine, White River Junction VAMC, White River Junction, Vermont, USA
- Division of Gastroenterology, Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Douglas K Rex
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Galati JS, Lin K, Gross SA. Recent advances in devices and technologies that might prove revolutionary for colonoscopy procedures. Expert Rev Med Devices 2023; 20:1087-1103. [PMID: 37934873 DOI: 10.1080/17434440.2023.2280773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 11/03/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Colorectal cancer (CRC) is the third most common malignancy and second leading cause of cancer-related mortality in the world. Adenoma detection rate (ADR), a quality indicator for colonoscopy, has gained prominence as it is inversely related to CRC incidence and mortality. As such, recent efforts have focused on developing novel colonoscopy devices and technologies to improve ADR. AREAS COVERED The main objective of this paper is to provide an overview of advancements in the fields of colonoscopy mechanical attachments, artificial intelligence-assisted colonoscopy, and colonoscopy optical enhancements with respect to ADR. We accomplished this by performing a comprehensive search of multiple electronic databases from inception to September 2023. This review is intended to be an introduction to colonoscopy devices and technologies. EXPERT OPINION Numerous mechanical attachments and optical enhancements have been developed that have the potential to improve ADR and AI has gone from being an inaccessible concept to a feasible means for improving ADR. While these advances are exciting and portend a change in what will be considered standard colonoscopy, they continue to require refinement. Future studies should focus on combining modalities to further improve ADR and exploring the use of these technologies in other facets of colonoscopy.
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Affiliation(s)
- Jonathan S Galati
- Department of Internal Medicine, NYU Langone Health, New York, NY, USA
| | - Kevin Lin
- Department of Internal Medicine, NYU Langone Health, New York, NY, USA
| | - Seth A Gross
- Division of Gastroenterology, NYU Langone Health, New York, NY, USA
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Spadaccini M, Schilirò A, Sharma P, Repici A, Hassan C, Voza A. Adenoma detection rate in colonoscopy: how can it be improved? Expert Rev Gastroenterol Hepatol 2023; 17:1089-1099. [PMID: 37869781 DOI: 10.1080/17474124.2023.2273990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 10/18/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION The introduction of widespread colonoscopy screening programs has helped in decreasing the incidence of Colorectal Cancer (CRC). However, 'back-to-back' colonoscopies revealed relevant percentage of missed adenomas. Quality indicators were created to further homogenize detection performances and decrease the incidence of post-colonoscopy CRC. Among them, the Adenoma Detection Rate (ADR), defined as the percentage obtained by dividing the number of endoscopic procedures in which at least one adenoma was resected, by the total number of procedures, was found to be inversely associated with the risks of interval colorectal cancer, advanced-stage interval cancer, and fatal interval cancer. AREAS COVERED In this paper, we performed a comprehensive review of the literature focusing on promising new devices and technologies, which are meant to positively affect the endoscopist performance in detecting adenomas, therefore increasing ADR. EXPERT OPINION Considering the current knowledge, although several devices and technologies have been proposed with this intent, the recent implementation of AI ranked over all of the other strategies and it is likely to become the new standard within few years. However, the combination of different device/technologies need to be investigated in the future aiming at even further increasing of endoscopist detection performances.
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Affiliation(s)
- Marco Spadaccini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Humanitas Clinical and Research Center -IRCCS-, Endoscopy Unit, Rozzano, Italy
| | - Alessandro Schilirò
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | | | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Humanitas Clinical and Research Center -IRCCS-, Endoscopy Unit, Rozzano, Italy
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Humanitas Clinical and Research Center -IRCCS-, Endoscopy Unit, Rozzano, Italy
| | - Antonio Voza
- Humanitas Clinical and Research Center -IRCCS-, Emergency Department, Rozzano, Italy
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Desai M, Rex DK, Bohm ME, Davitkov P, DeWitt JM, Fischer M, Faulx G, Heath R, Imler TD, James-Stevenson TN, Kahi CJ, Kessler WR, Kohli DR, McHenry L, Rai T, Rogers NA, Sagi SV, Sathyamurthy A, Vennalaganti P, Sundaram S, Patel H, Higbee A, Kennedy K, Lahr R, Stojadinovikj G, Campbell C, Dasari C, Parasa S, Faulx A, Sharma P. Impact of withdrawal time on adenoma detection rate: results from a prospective multicenter trial. Gastrointest Endosc 2023; 97:537-543.e2. [PMID: 36228700 DOI: 10.1016/j.gie.2022.09.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/07/2022] [Accepted: 09/23/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Performing a high-quality colonoscopy is critical for optimizing the adenoma detection rate (ADR). Colonoscopy withdrawal time (a surrogate measure) of ≥6 minutes is recommended; however, a threshold of a high-quality withdrawal and its impact on ADR are not known. METHODS We examined withdrawal time (excluding polyp resection and bowel cleaning time) of subjects undergoing screening and/or surveillance colonoscopy in a prospective, multicenter, randomized controlled trial. We examined the relationship of withdrawal time in 1-minute increments on ADR and reported odds ratio (OR) with 95% confidence intervals. Linear regression analysis was performed to assess the maximal inspection time threshold that impacts the ADR. RESULTS A total of 1142 subjects (age, 62.3 ± 8.9 years; 80.5% men) underwent screening (45.9%) or surveillance (53.6%) colonoscopy. The screening group had a median withdrawal time of 9.0 minutes (interquartile range [IQR], 3.3) with an ADR of 49.6%, whereas the surveillance group had a median withdrawal time of 9.3 minutes (IQR, 4.3) with an ADR of 63.9%. ADR correspondingly increased for a withdrawal time of 6 minutes to 13 minutes, beyond which ADR did not increase (50.4% vs 76.6%, P < .01). For every 1-minute increase in withdrawal time, there was 6% higher odds of detecting an additional subject with an adenoma (OR, 1.06; 95% confidence interval, 1.02-1.10; P = .004). CONCLUSIONS Results from this multicenter, randomized controlled trial underscore the importance of a high-quality examination and efforts required to achieve this with an incremental yield in ADR based on withdrawal time. (Clinical trial registration number: NCT03952611.).
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Affiliation(s)
- Madhav Desai
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA; Division of Gastroenterology, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Douglas K Rex
- Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Matthew E Bohm
- Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Perica Davitkov
- Department of Gastroenterology and Hepatology, Louis Stokes VA Medical Center, Cleveland, Ohio, USA
| | - John M DeWitt
- Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Monika Fischer
- Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Ryan Heath
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Timothy D Imler
- Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Toyia N James-Stevenson
- Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Charles J Kahi
- Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - William R Kessler
- Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Divyanshoo R Kohli
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Lee McHenry
- Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tarun Rai
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Nicholas A Rogers
- Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sashidhar V Sagi
- Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Anjana Sathyamurthy
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Prashanth Vennalaganti
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Suneha Sundaram
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Harsh Patel
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - April Higbee
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Kevin Kennedy
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Rachel Lahr
- Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Gjorgie Stojadinovikj
- Department of Gastroenterology and Hepatology, Louis Stokes VA Medical Center, Cleveland, Ohio, USA
| | - Carlissa Campbell
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Chandra Dasari
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Sravanthi Parasa
- Department of Gastroenterology, Swedish Medical Center, Seattle, Washington, USA
| | - Ashley Faulx
- Department of Gastroenterology and Hepatology, Louis Stokes VA Medical Center, Cleveland, Ohio, USA
| | - Prateek Sharma
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA; Division of Gastroenterology, University of Kansas School of Medicine, Kansas City, Kansas, USA
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Zimmermann-Fraedrich K, Sehner S, Rösch T, Aschenbeck J, Schröder A, Schubert S, Liceni T, Aminalai A, Spitz W, Möhler U, Heller F, Berndt R, Bartel-Kowalski C, Niemax K, Burmeister W, Schachschal G. Second-generation distal attachment cuff for adenoma detection in screening colonoscopy: a randomized multicenter study. Gastrointest Endosc 2023; 97:112-120. [PMID: 36030888 DOI: 10.1016/j.gie.2022.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 08/10/2022] [Accepted: 08/19/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Randomized studies have demonstrated that a distal attachment cap with rubber side arms, the Endocuff Vision (ECV; Olympus America, Center Valley, Pa, USA), increased colonoscopic adenoma detection rate (ADR) in various mixed patient collectives. This is the first study to evaluate its use in a primary colonoscopic screening program. METHODS Patients over age 55 years undergoing screening colonoscopy in 9 German private offices in Berlin and Hamburg were randomized to either the study group using ECV or the control group using high-definition colonoscopies (standard of care). The main outcome parameter was ADR, whereas secondary outcomes were detection rates of all adenomas per colonoscopy (APCs), of adenoma subgroups, and of hyperplastic polyps. RESULTS Of 1416 patients (mean age, 61.1 years; 51.8% women), with a median of 41 examinations per examiner (n = 23; interquartile range, 12-81), 700 were examined with ECV and 716 without. Adjusting for the effects of the colonoscopies, ADR was 39.5% (95% confidence interval [CI], 32.6%-46.3%) in the ECV group versus 32.2% (95% CI, 25.9%-38.6%) in the control group, which resulted in an increase of 7.2% (95% CI, 2.3%-12.2%; P = .004). The increase in ADR was mainly because of small polyps, with adjusted ADRs for adenomas <10 mm of 33.3% (95% CI, 26.5%-40.2%) for study patients versus 24.0% (95% CI, 18.2%-29.8%) for control patients (P < .001). APC was also significantly increased (.57 ECV vs .51 control subjects, P = .045). CONCLUSIONS A distal attachment cap with side arms significantly increased the ADR in patients undergoing primary colonoscopic screening. Because of the correlation of ADR and interval cancer, its use should be encouraged, especially in this setting. (Clinical trial registration number: NCT03442738.).
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Affiliation(s)
| | - Susanne Sehner
- Institute for Medical Biometry and Epidemiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | - Guido Schachschal
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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