1
|
Yamaguchi D, Shimoda R, Miyahara K, Yukimoto T, Sakata Y, Takamori A, Mizuta Y, Fujimura Y, Inoue S, Tomonaga M, Ogino Y, Eguchi K, Ikeda K, Tanaka Y, Takedomi H, Hidaka H, Akutagawa T, Tsuruoka N, Noda T, Tsunada S, Esaki M. Impact of an artificial intelligence-aided endoscopic diagnosis system on improving endoscopy quality for trainees in colonoscopy: Prospective, randomized, multicenter study. Dig Endosc 2024; 36:40-48. [PMID: 37079002 DOI: 10.1111/den.14573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/19/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE This study was performed to evaluate whether the use of CAD EYE (Fujifilm, Tokyo, Japan) for colonoscopy improves colonoscopy quality in gastroenterology trainees. METHODS The patients in this multicenter randomized controlled trial were divided into Group A (observation using CAD EYE) and Group B (standard observation). Six trainees performed colonoscopies using a back-to-back method in pairs with gastroenterology experts. The primary end-point was the trainees' adenoma detection rate (ADR), and the secondary end-points were the trainees' adenoma miss rate (AMR) and Assessment of Competency in Endoscopy (ACE) tool scores. Each trainee's learning curve was evaluated using a cumulative sum (CUSUM) control chart. RESULTS We analyzed data for 231 patients (Group A, n = 113; Group B, n = 118). The ADR was not significantly different between the two groups. Group A had a significantly lower AMR (25.6% vs. 38.6%, P = 0.033) and number of missed adenomas per patient (0.5 vs. 0.9, P = 0.004) than Group B. Group A also had significantly higher ACE tool scores for pathology identification (2.26 vs. 2.07, P = 0.030) and interpretation and identification of pathology location (2.18 vs. 2.00, P = 0.038). For the CUSUM learning curve, Group A showed a trend toward a lower number of cases of missed multiple adenomas by the six trainees. CONCLUSION CAD EYE did not improve ADR but decreased the AMR and improved the ability to accurately locate and identify colorectal adenomas. CAD EYE can be assumed to be beneficial for improving colonoscopy quality in gastroenterology trainees. TRIAL REGISTRATION University Hospital Medical Information Network Clinical Trials Registry (UMIN000044031).
Collapse
Affiliation(s)
- Daisuke Yamaguchi
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Ryo Shimoda
- Department of Endoscopic Diagnostics and Therapeutics, Saga University Hospital, Saga, Japan
| | - Koichi Miyahara
- Department of Internal Medicine, Karatsu Red Cross Hospital, Saga, Japan
| | - Takahiro Yukimoto
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Yasuhisa Sakata
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Ayako Takamori
- Clinical Research Center, Saga University Hospital, Saga, Japan
| | - Yumi Mizuta
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Yutaro Fujimura
- Department of Internal Medicine, Karatsu Red Cross Hospital, Saga, Japan
| | - Suma Inoue
- Department of Internal Medicine, Karatsu Red Cross Hospital, Saga, Japan
| | - Michito Tomonaga
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Yuya Ogino
- Department of Internal Medicine, Karatsu Red Cross Hospital, Saga, Japan
| | - Kohei Eguchi
- Department of Internal Medicine, Karatsu Red Cross Hospital, Saga, Japan
| | - Kei Ikeda
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Yuichiro Tanaka
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Hironobu Takedomi
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Hidenori Hidaka
- Department of Internal Medicine, Karatsu Red Cross Hospital, Saga, Japan
| | - Takashi Akutagawa
- Department of Endoscopic Diagnostics and Therapeutics, Saga University Hospital, Saga, Japan
| | - Nanae Tsuruoka
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Takahiro Noda
- Department of Internal Medicine, Karatsu Red Cross Hospital, Saga, Japan
| | - Seiji Tsunada
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Motohiro Esaki
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| |
Collapse
|
2
|
Weissman S, Mehta TI, Stein DJ, Tripathi K, Rosenwald N, Kolli S, Aziz M, Feuerstein JD. Comparative Efficacy of Endoscopic Assist Devices on Colonic Adenoma Detection: A Systematic Review With Network Meta-analysis. J Clin Gastroenterol 2022; 56:889-894. [PMID: 35324485 DOI: 10.1097/mcg.0000000000001643] [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: 06/15/2021] [Accepted: 10/18/2021] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIMS Numerous endoscopic assist devices exist, yet data surrounding their comparative efficacy is lacking. We conducted a systematic review with network meta-analysis to determine the comparative efficacy of endoscopic assist devices on colonic adenoma detection. METHODS A systematic search was performed using multiple electronic databases through July 2020, to identify all randomized controlled trials and dual-arm observational studies compared with either other endoscopic assist devices and/or standard colonoscopy. The primary outcome was adenoma detection rate (ADR). Secondary outcomes included polyp detection rate (PDR), serrated adenoma detection rate (SADR), right-sided adenoma detection rate (RADR), and proximal adenoma detection rate (PADR). RESULTS Fifty-seven studies (31,051 patients) met inclusion criteria and were analyzed. Network meta-analysis identified an enhanced ADR among (clear) cap [odds ratio (OR): 2.69, 95% confidence interval (CI): 1.45-4.99], endocuff, (OR: 4.95, 95% CI: 3.15-7.78), and endoring (OR: 3.68, 95% CI: 1.47-9.20)-with no significant difference amongst any particular device. Similar findings for PDR were also seen. Enhanced SADR was identified for endocuff (OR: 9.43) and endoring (OR: 4.06) compared with standard colonoscopy. Enhanced RADR (OR: 5.36) and PADR (OR: 3.78) were only identified for endocuff. Endocuff comparatively demonstrated the greatest ADR, PDR, and SADR, but this was not significant when compared with the other assist devices. Subgroup analysis of randomized controlled trials identified enhanced PDR and ADR for both cap and endocuff. CONCLUSIONS Endoscopic assist devices displayed increased ADR and PDR as compared with standard colonoscopy and thus should be widely adopted. A nonsignificant trend was seen toward higher efficacy for the endocuff device.
Collapse
Affiliation(s)
- Simcha Weissman
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ
| | - Tej I Mehta
- Department of Medicine, Medical College of Wisconsin, Madison, WI
| | | | - Kartikeya Tripathi
- Department of Gastroenterology and Hepatology, University of Massachusetts Medical School-Baystate Campus, Springfield, MA
| | | | - Sindhura Kolli
- Department of Medicine, NYU Langone Medical Center, New York, NY
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH
| | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| |
Collapse
|
3
|
Shahini E, Libânio D, Lo Secco G, Pisani A, Arezzo A. Indications and outcomes of endoscopic resection for non-pedunculated colorectal lesions: A narrative review. World J Gastrointest Endosc 2021; 13:275-295. [PMID: 34512876 PMCID: PMC8394186 DOI: 10.4253/wjge.v13.i8.275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/14/2021] [Accepted: 07/09/2021] [Indexed: 02/06/2023] Open
Abstract
In the last years, endoscopic techniques gained a crucial role in the treatment of colorectal flat lesions. At the same time, the importance of a reliable assessment of such lesions to predict the malignancy and the depth of invasion of the colonic wall emerged. The current unsolved dilemma about the endoscopic excision techniques concerns the necessity of a reliable submucosal invasive cancer assessment system that can stratify the risk of the post-procedural need for surgery. Accordingly, this narrative literature review aims to compare the available diagnostic strategies in predicting malignancy and to give a guide about the best techniques to employ. We performed a literature search using electronic databases (MEDLINE/PubMed, EMBASE, and Cochrane Library). We collected all articles about endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) registering the outcomes. Moreover, we analyzed all meta-analyses comparing EMR vs ESD outcomes for colorectal sessile or non-polypoid lesions of any size, preoperatively estimated as non-invasive. Seven meta-analysis studies, mainly Eastern, were included in the analysis comparing 124 studies and overall 22954 patients who underwent EMR and ESD procedures. Of these, eighty-two were retrospective, twenty-four perspective, nine case-control, and six cohorts, while three were randomized clinical trials. A total of 18118 EMR and 10379 ESD were completed for a whole of 28497 colorectal sessile or non-polypoid lesions > 5-10 mm in size. In conclusion, it is crucial to enhance the preoperative diagnostic workup, especially in deciding the most suitable endoscopic method for radical resection of flat colorectal lesions at risk of underlying malignancy. Additionally, the ESD necessitates further improvement because of the excessively time-consuming as well as the intraprocedural technical hindrances and related complications. We found a higher rate of en bloc resections and R0 for ESD than EMR for non-pedunculated colorectal lesions. Nevertheless, despite the lower local recurrence rates, ESD had greater perforation rates and needed lengthier procedural times. The prevailing risk for additional surgery in ESD rather than EMR for complications or oncologic reasons is still uncertain.
Collapse
Affiliation(s)
- Endrit Shahini
- Department of Gastroenterology and Digestive Endoscopy Unit, National Institute of Research “Saverio De Bellis,” Castellana Grotte (Bari) 70013, Italy
| | - Diogo Libânio
- Department of Gastroenterology, Portuguese Oncology Institute, Porto 4200-072, Portugal
| | - Giacomo Lo Secco
- Department of Surgical Sciences, University of Torino, Turin 10126, Italy
| | - Antonio Pisani
- Department of Gastroenterology and Digestive Endoscopy Unit, National Institute of Research “Saverio De Bellis,” Castellana Grotte (Bari) 70013, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Turin 10126, Italy
| |
Collapse
|
4
|
Spadaccini M, Iannone A, Maselli R, Badalamenti M, Desai M, Chandrasekar VT, Patel HK, Fugazza A, Pellegatta G, Galtieri PA, Lollo G, Carrara S, Anderloni A, Rex DK, Savevski V, Wallace MB, Bhandari P, Roesch T, Gralnek IM, Sharma P, Hassan C, Repici A. Computer-aided detection versus advanced imaging for detection of colorectal neoplasia: a systematic review and network meta-analysis. Lancet Gastroenterol Hepatol 2021; 6:793-802. [PMID: 34363763 DOI: 10.1016/s2468-1253(21)00215-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/31/2021] [Accepted: 06/04/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Computer-aided detection (CADe) techniques based on artificial intelligence algorithms can assist endoscopists in detecting colorectal neoplasia. CADe has been associated with an increased adenoma detection rate, a key quality indicator, but the utility of CADe compared with existing advanced imaging techniques and distal attachment devices is unclear. METHODS For this systematic review and network meta-analysis, we did a comprehensive search of PubMed/Medline, Embase, and Scopus databases from inception to Nov 30, 2020, for randomised controlled trials investigating the effectiveness of the following endoscopic techniques in detecting colorectal neoplasia: CADe, high definition (HD) white-light endoscopy, chromoendoscopy, or add-on devices (ie, systems that increase mucosal visualisation, such as full spectrum endoscopy [FUSE] or G-EYE balloon endoscopy). We collected data on adenoma detection rates, sessile serrated lesion detection rates, the proportion of large adenomas detected per colonoscopy, and withdrawal times. A frequentist framework, random-effects network meta-analysis was done to compare artificial intelligence with chromoendoscopy, increased mucosal visualisation systems, and HD white-light endoscopy (the control group). We estimated odds ratios (ORs) for the adenoma detection rate, sessile serrated lesion detection rate, and proportion of large adenomas detected per colonoscopy, and calculated mean differences for withdrawal time, with 95% CIs. Risk of bias and certainty of evidence were assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. FINDINGS 50 randomised controlled trials, comprising 34 445 participants, were included in our main analysis (six trials of CADe, 18 of chromoendoscopy, and 26 of increased mucosal visualisation systems). HD white-light endoscopy was the control technique in all 50 studies. Compared with the control technique, the adenoma detection rate was 7·4% higher with CADe (OR 1·78 [95% CI 1·44-2·18]), 4·4% higher with chromoendoscopy (1·22 [1·08-1·39]), and 4·1% higher with increased mucosal visualisation systems (1·16 [1·04-1·28]). CADe ranked as the superior technique for adenoma detection (with moderate confidence in hierarchical ranking); cross-comparisons of CADe with other imaging techniques showed a significant increase in the adenoma detection rate with CADe versus increased mucosal visualisation systems (OR 1·54 [95% CI 1·22-1·94]; low certainty of evidence) and with CADe versus chromoendoscopy (1·45 [1·14-1·85]; moderate certainty of evidence). When focusing on large adenomas (≥10 mm) there was a significant increase in the detection of large adenomas only with CADe (OR 1·69 [95% CI 1·10-2·60], moderate certainty of evidence) when compared to HD white-light endoscopy; CADe ranked as the superior strategy for detection of large adenomas. CADe also seemed to be the superior strategy for detection of sessile serrated lesions (with moderate confidence in hierarchical ranking), although no significant increase in the sessile serrated lesion detection rate was shown (OR 1·37 [95% CI 0·65-2·88]). No significant difference in withdrawal time was reported for CADe compared with the other techniques. INTERPRETATION Based on the published literature, detection rates of colorectal neoplasia are higher with CADe than with other techniques such as chromoendoscopy or tools that increase mucosal visualisation, supporting wider incorporation of CADe strategies into community endoscopy services. FUNDING None.
Collapse
Affiliation(s)
- Marco Spadaccini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
| | - Andrea Iannone
- Department of Emergency and Organ Transplantation, Section of Gastroenterology, University of Bari, Bari, Italy
| | - Roberta Maselli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Matteo Badalamenti
- Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Madhav Desai
- Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO, USA
| | | | - Harsh K Patel
- Endoscopy Unit, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Alessandro Fugazza
- Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Gaia Pellegatta
- Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | | | - Gianluca Lollo
- Department of Gastroenterology and Hepatology, Università della Svizzera Italiana, Lugano, Switzerland
| | - Silvia Carrara
- Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Andrea Anderloni
- Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Douglas K Rex
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Victor Savevski
- Artificial Intelligence Research, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Michael B Wallace
- Endoscopy Unit, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Thomas Roesch
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ian M Gralnek
- Institute of Gastroenterology and Liver Diseases, Ha'Emek Medical Center, Afula, Israel
| | - Prateek Sharma
- Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO, USA
| | - Cesare Hassan
- Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| |
Collapse
|
5
|
Adenoma and Advanced Adenoma Detection Rates of Water Exchange, Endocuff, and Cap Colonoscopy: A Network Meta-Analysis with Pooled Data of Randomized Controlled Trials. Dig Dis Sci 2021; 66:1175-1188. [PMID: 32451757 DOI: 10.1007/s10620-020-06324-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/04/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS A network meta-analysis showed that low-cost optimization of existing resources was as effective as distal add-on devices in increasing adenoma detection rate (ADR). We assessed the impacts of water exchange (WE), Endocuff, and cap colonoscopy on ADR and advanced adenoma detection rate (AADR). We hypothesized that WE may be superior at improving ADR and AADR. METHODS The literature was searched for all randomized controlled trials (RCTs) that reported ADR as an outcome and included the keywords colonoscopy, and water exchange, Endocuff, or cap. We performed traditional network meta-analyses with random effect models comparing ADR and AADR of each method using air insufflation (AI) as the control and reported the odds ratios with 95% confidence interval. Performances were ranked based on P-score. RESULTS Twenty-one RCTs met inclusion criteria. Fourteen RCTs also reported AADR. Both WE [1.46 (1.20-1.76)] and Endocuff [1.39 (1.17-1.66)] significantly increase ADR, while cap has no impact on ADR [1.00 (0.82-1.22)]. P-scores for WE (0.88), Endocuff (0.79), cap (0.17), and AI (0.17) suggest WE has the highest ADR. WE [1.38 (1.12-1.70)], but not Endocuff [0.96 (0.76-1.21)] or cap [1.06 (0.85-1.32)], significantly increases AADR. P-scores for WE (0.98), cap (0.50), AI (0.31), and Endocuff (0.21) suggest WE is more effective at increasing AADR. The results did not change after adjusting for age, proportion of males, and withdrawal time. CONCLUSION WE may be the modality of choice to maximally improve ADR and AADR.
Collapse
|
6
|
Zhang Y, Zhang X, Wu Q, Gu C, Wang Z. Artificial Intelligence-Aided Colonoscopy for Polyp Detection: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. J Laparoendosc Adv Surg Tech A 2021; 31:1143-1149. [PMID: 33524298 DOI: 10.1089/lap.2020.0777] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: This study aimed to compare artificial intelligence (AI)-aided colonoscopy with conventional colonoscopy for polyp detection. Methods: A systematic literature search was performed in PubMed and Ovid for randomized clinical trials (RCTs) comparing AI-aided colonoscopy with conventional colonoscopy for polyp detection. The last search was performed on July 22, 2020. The primary outcome was polyp detection rate (PDR) and adenoma detection rate (ADR). Results: Seven RCTs published between 2019 and 2020 with a total of 5427 individuals were included. When compared with conventional colonoscopy, AI-aided colonoscopy significantly improved PDR (P < .001, odds ratio [OR] = 1.95, 95% confidence interval [CI]: 1.75 to 2.19, I2 = 0%) and ADR (P < .001, OR = 1.72, 95% CI: 1.52 to 1.95, I2 = 33%). Besides, polyps in the AI-aided group were significantly smaller in size than those in conventional group (P = .004, weighted mean difference = -0.48, 95% CI: -0.81 to -0.15, I2 = 0%). In addition, AI-aided group detected significantly less proportion of advanced adenoma (P = .03, OR = 0.70, 95% CI: 0.50 to 0.97, I2 = 46%), pedicle polyps (P < .001, OR = 0.64, 95% CI: 0.49 to 0.83, I2 = 0%), and pedicle adenomas (P < .001, OR = 0.60, 95% CI: 0.44 to 0.80, I2 = 0%). Conclusion: AI-aided colonoscopy could significantly increase the PDR and ADR, especially for those with small size. Besides, the shape and pathology recognition of the AI technique should be further improved in the future.
Collapse
Affiliation(s)
- Yuanchuan Zhang
- Department of General Surgery, The Third People's Hospital of Chengdu, Chengdu, China
| | - Xubing Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qingbin Wu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chaoyang Gu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
7
|
Li A, Yang JZ, Yang XX, Feng BC, Zhang MM, Qu JY, Zhou RC, Wang P, Li LX, Zuo XL, Li YQ. Endocuff-assisted colonoscopy versus cap-assisted colonoscopy for adenoma detection rate: A meta-analysis of randomized controlled trials. J Gastroenterol Hepatol 2020; 35:2066-2073. [PMID: 32562282 DOI: 10.1111/jgh.15155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/08/2020] [Accepted: 06/11/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Add-on devices have been widely used in clinical practice. The aim of this meta-analysis was to compare the adenoma detection rate between Endocuff-assisted colonoscopy (EAC) and cap-assisted colonoscopy (CAC). METHODS PubMed, EMBASE, SCOPUS, and Cochrane databases were searched. Outcomes included adenoma detection rate, cecal intubation rate, cecal intubation time, and withdrawal time. Dichotomous data were pooled to obtain the odds ratio or risk ratio. Continuous data were pooled using the mean difference. RESULTS Of the 240 articles reviewed, six randomized controlled trials were included, with a total of 1994 patients. In the meta-analysis, no statistical difference in adenoma detection rate was detected between EAC and CAC (47.0% vs 45.1%; P = 0.33). EAC significantly improved detection rate of diminutive adenomas/polyps compared with CAC (P = 0.01). Cecal intubation was achieved in 96.5% in EAC group and 97.9% in CAC group (P = 0.04). Besides, no statistical difference was found in cecal intubation time (P = 0.86), withdrawal time (P = 0.88), small adenomas/polyps (P = 0.60), or large adenomas/polyps (P = 0.95). CONCLUSION EAC and CAC have their respective merits. EAC significantly improve the detection of diminutive adenomas/polyps. CAC was better in cecal intubation rate.
Collapse
Affiliation(s)
- Ai Li
- Department of Gastroenterology, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China.,Laboratory of Translational Gastroenterology, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China.,Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI tumor, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China
| | - Jing-Ze Yang
- Department of Gastroenterology, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China.,Laboratory of Translational Gastroenterology, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China.,Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI tumor, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China
| | - Xiao-Xiao Yang
- Department of Gastroenterology, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China.,Laboratory of Translational Gastroenterology, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China.,Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI tumor, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China
| | - Bing-Cheng Feng
- Department of Gastroenterology, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China.,Laboratory of Translational Gastroenterology, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China.,Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI tumor, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China
| | - Ming-Ming Zhang
- Department of Gastroenterology, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China.,Laboratory of Translational Gastroenterology, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China.,Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI tumor, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China
| | - Jun-Yan Qu
- Department of Gastroenterology, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China.,Laboratory of Translational Gastroenterology, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China.,Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI tumor, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China
| | - Ru-Chen Zhou
- Department of Gastroenterology, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China.,Laboratory of Translational Gastroenterology, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China.,Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI tumor, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China
| | - Peng Wang
- Department of Gastroenterology, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China.,Laboratory of Translational Gastroenterology, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China.,Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI tumor, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China
| | - Li-Xiang Li
- Department of Gastroenterology, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China.,Laboratory of Translational Gastroenterology, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China.,Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI tumor, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China
| | - Xiu-Li Zuo
- Department of Gastroenterology, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China.,Laboratory of Translational Gastroenterology, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China.,Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI tumor, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China
| | - Yan-Qing Li
- Department of Gastroenterology, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China.,Laboratory of Translational Gastroenterology, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China.,Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI tumor, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan, China
| |
Collapse
|
8
|
Fung BM, Chen FC, Tabibian JH. Clear cap-assisted luminal stenting may improve technical success in gastroduodenal and colonic obstruction. Endosc Int Open 2020; 8:E1429-E1434. [PMID: 33015347 PMCID: PMC7508645 DOI: 10.1055/a-1229-4000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/11/2020] [Indexed: 11/17/2022] Open
Abstract
Background Luminal stenting is safe, effective, and at times the preferred method for relieving gastrointestinal obstruction. However, stent placement is not technically feasible when lesions cannot be traversed with a guidewire, resulting in the need for more invasive methods of palliation and urgent/emergent surgical intervention. In this series, we report our experience with cap-assisted stenting to improve lumen visualization in obstructed segments of the gastrointestinal tract and salvage cases that may have otherwise resulted in technical failure. Methods A clear cap (i. e. distal attachment) was affixed to the scope tip to facilitate visualization and stenting in two cases of gastroduodenal obstruction and three cases of colonic obstruction. Indications for stent placement included malignant obstruction, diverticulitis-associated obstruction, and Crohn's disease-associated stricture. Results In this report, we demonstrate that use of a clear cap facilitated endoscopic stenting in challenging cases of malignant and benign gastroduodenal and colonic obstruction. Conclusions A clear cap for endoscopic stenting can be used in cases in which standard techniques are unsuccessful or those anticipated to be technically difficult at the outset. Cases with tortuous anatomy or particularly tight, friable, or exophytic obstructive lesions may benefit most from this novel technical modification.
Collapse
Affiliation(s)
- Brian M. Fung
- Department of Medicine, Olive View-UCLA Medical Center, Sylmar, California, United States
| | - Formosa C. Chen
- Department of Surgery, Olive View-UCLA Medical Center, Sylmar, California, United States
| | - James H. Tabibian
- Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, California, United States,David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| |
Collapse
|
9
|
Marsano J, Johnson S, Yan S, Alli-Akintade L, Wilson M, Al-Juburi A, Stondell J, Tejaswi S. Comparison of colon adenoma detection rates using cap-assisted and Endocuff-assisted colonoscopy: a randomized controlled trial. Endosc Int Open 2019; 7:E1585-E1591. [PMID: 31788539 PMCID: PMC6877415 DOI: 10.1055/a-0996-7891] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 04/10/2019] [Indexed: 12/13/2022] Open
Abstract
Objectives and study aim Colonoscopy prevents colorectal cancer by removing adenomatous polyps, but missed adenomas lead to interval cancers. Different devices have been used to increase adenoma detection rates (ADR). Two such devices of interest are the transparent cap (Olympus) and Endocuff (ARC Medical). Our study aimed to compare differences in ADR between Endocuff-assisted colonoscopy (EAC), cap-assisted colonoscopy (CAC) and standard colonoscopy (SC). Patients and methods A sample size of 126 subjects was calculated to determine an effect size of 30 %. Patients undergoing screening or surveillance colonoscopy between March 2016 and January 2017 were randomized to SC, CAC or EAC groups. Three experienced endoscopists performed all colonoscopies. Patient demographics, procedure indication, Boston Bowel Prep Score (BBPS), withdrawal time, polyp size, location, histopathology, were analyzed. Results There was no difference in ADR (52 %, 40 % and 54 %) in the SC, CAC and EAC groups respectively ( P = 0.4). Similar findings were also observed for proximal ADR (45 %, 35 %, and 50 %, P = 0.4) and SSA detection rate (16 %, 14 %, and 23 %, P = 0.5). EAC detected higher mean ADR per colonoscopy compared to CAC (1.70 vs 0.76, P = 0.01). However, there was no significant difference in mean ADR per positive colonoscopy (2.08, 1.63, and 2.59, P = 0.21). Conclusion In a randomized controlled trial comparing AC to CAC and SC, neither device conferred additional benefits in ADR among high detectors. When comparing each device, EAC may be better than CAC at detecting more total adenomas.
Collapse
Affiliation(s)
- Joseph Marsano
- Division of Gastroenterology and Hepatology, University of California Davis School of Medicine, Sacramento, California, United States
| | - Sheeva Johnson
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, United States
| | - Stephanie Yan
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, United States
| | - Latifat Alli-Akintade
- Division of Gastroenterology and Hepatology, University of California Davis School of Medicine, Sacramento, California, United States
| | - Machelle Wilson
- Department of Public Health Sciences, Division of Biostatistics, University of California Davis School of Medicine, Sacramento, California, United States
| | - Amar Al-Juburi
- Division of Gastroenterology and Hepatology, University of California Davis School of Medicine, Sacramento, California, United States
| | - Jesse Stondell
- Division of Gastroenterology and Hepatology, University of California Davis School of Medicine, Sacramento, California, United States
| | - Sooraj Tejaswi
- Division of Gastroenterology and Hepatology, University of California Davis School of Medicine, Sacramento, California, United States,Corresponding author Sooraj Tejaswi, MD, MSPH University of California DavisDepartment of Internal MedicineDivision of Gastroenterology and Hepatology4150 V Street, Suite 3500Sacramento, California 95817USA+1- 916-734-7908
| |
Collapse
|
10
|
Facciorusso A, Triantafyllou K, Murad MH, Prokop LJ, Tziatzios G, Muscatiello N, Singh S. Compared Abilities of Endoscopic Techniques to Increase Colon Adenoma Detection Rates: A Network Meta-analysis. Clin Gastroenterol Hepatol 2019; 17:2439-2454.e25. [PMID: 30529731 DOI: 10.1016/j.cgh.2018.11.058] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/22/2018] [Accepted: 11/29/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Adenoma detection rate (ADR) is a quality metric for colorectal cancer screening. We performed a systematic review and network meta-analysis to assess the overall and comparative efficacies of different endoscopic techniques in adenoma detection. METHODS We performed a systematic review of published articles and abstracts, through March 15, 2018, to identify randomized controlled trials of adults undergoing colonoscopy that compared the efficacy of different devices in detection of adenomas. Our final analysis included 74 2-arm trials that comprised 44948 patients. These studies compared efficacies of add-on devices (cap, endocuff, endo-rings, G-EYE), enhanced imaging techniques (chromoendoscopy, narrow-band imaging, flexible spectral imaging color enhancement, blue laser imaging), new scopes (full-spectrum endoscopy, extra-wide-angle-view colonoscopy, dual focus), and low-cost optimizing existing resources (water-aided colonoscopy, second observer, dynamic position change), alone or in combination with high-definition colonoscopy or each other. Primary outcome was increase in ADR. We performed pairwise and network meta-analyses, and appraised quality of evidence using GRADE. RESULTS Low-cost optimizing existing resources (odds ratio [OR], 1.29; 95% CI,1.17-1.43), enhanced imaging techniques (OR,1.21; 95% CI, 1.09-1.35), and add-on devices (OR,1.18; 95% CI, 1.07-1.29) were associated with a moderate increase in ADR compared with high-definition colonoscopy; there was low to moderate confidence in estimates. Use of newer scopes was not associated with significant increases in ADR compared with high-definition colonoscopy (OR, 0.98; 95% CI, 0.79-1.21). In our comparative efficacy analysis, no specific technology for increasing ADR was superior to others. We did not find significant differences between technologies in detection of advanced ADR, polyp detection rate, or mean number of adenomas/patient. CONCLUSIONS In a network meta-analysis of published trials, we found that low-cost optimization of existing resources to be as effective as enhanced endoscopic imaging, or add-on devices, in increasing ADR during high-definition colonoscopy.
Collapse
Affiliation(s)
- Antonio Facciorusso
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy.
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Mohammad Hassan Murad
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Larry J Prokop
- Department of Library Services, Mayo Clinic, Rochester, Minnesota
| | - Georgios Tziatzios
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicola Muscatiello
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Siddharth Singh
- Division of Gastroenterology and Biomedical Informatics, University of California San Diego, La Jolla, California; Division of Biomedical Informatics, University of California San Diego, La Jolla, California
| |
Collapse
|
11
|
Zhan Q, Xiang L, Zhao X, An S, Zhou Y, Xu Y, Li A, Liu S. Determination of withdrawal times in individualized opportunistic screening colonoscopies. Medicine (Baltimore) 2019; 98:e16819. [PMID: 31393413 PMCID: PMC6708899 DOI: 10.1097/md.0000000000016819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 05/22/2019] [Accepted: 07/20/2019] [Indexed: 01/10/2023] Open
Abstract
To investigate effects of bowel preparation, experience level of colonoscopists, and colonoscopy withdrawal time (CWT) on the quality of an individual opportunistic screening colonoscopy, according to adenoma detection rate (ADR).Data were retrospectively analyzed from opportunistic screening colonoscopies (n = 16,951) at 4 hospitals of various care levels in China.The ADR positively correlated with the experience level of the colonoscopist. The individualized CWT varied, depending on the quality of bowel preparation and the number of colonoscopies performed previously by the colonoscopist. In a setting of adequate bowel preparation, the mean CWT decreased with the increased experience of the colonoscopist. With poor and inadequate bowel preparation, no colonoscopist at any level of experience could obtain a satisfactory ADR.For adequately prepared colonoscopies, minimum CWTs have been determined. Repeat colonoscopy is strongly recommended for patients with poor bowel preparation, regardless of the colonoscopist's experience.
Collapse
Affiliation(s)
- Qiang Zhan
- Department of Gastroenterology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu Province
| | - Li Xiang
- Department of Gastroenterology, Longgang District People's Hospital, Shenzhen, Guangdong Province
| | - Xinhua Zhao
- Department of Gastroenterology, Mianyang Central Hospital, Mianyang, Sichuan Province
| | - Shengli An
- Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong Province
| | - Yongbai Zhou
- Department of Gastroenterology, Longgang District Central Hospital of Shenzhen, Shenzhen, Guangdong Province
| | - Yangzhi Xu
- Guangdong Provincial Key Laboratory of Gastroenterology & Department of Gastroenterology, Nanfang Hospital Affiliated to the Southern Medical University, Guangzhou, Guangdong Province, China
| | - Aimin Li
- Guangdong Provincial Key Laboratory of Gastroenterology & Department of Gastroenterology, Nanfang Hospital Affiliated to the Southern Medical University, Guangzhou, Guangdong Province, China
| | - Side Liu
- Guangdong Provincial Key Laboratory of Gastroenterology & Department of Gastroenterology, Nanfang Hospital Affiliated to the Southern Medical University, Guangzhou, Guangdong Province, China
| |
Collapse
|
12
|
Kikuchi D, Kimura R, Nomura K, Tanaka M, Ochiai Y, Iizuka T, Hoteya S. A pilot study of a novel variable-stiffness stylet for efficient colonoscope insertion with <i>ex-vivo</i> colon model. J Anus Rectum Colon 2019; 3:116-120. [PMID: 31583326 PMCID: PMC6774737 DOI: 10.23922/jarc.2018-038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 04/11/2019] [Indexed: 11/30/2022] Open
Abstract
Objectives: The variable-stiffness colonoscope is reportedly useful for making colonoscope insertion easier. However, this function is not associated with all colonoscopes. We developed a variable-stiffness stylet that can be inserted into the endoscope instrumentation channel to change the rigidity of the endoscope. Methods: We developed a stylet with adjustable stiffness and investigated its utility in colonoscope insertion using an ex-vivo model. Four endoscopists performed 24 colonoscope insertions, alternating between using the stylet (Stylet method) and the conventional method. We assessed insertion rate, rate of applying abdominal compression, and insertion time between the two groups. Results: In all procedures, the endoscope was inserted up to the cecum. There were significantly fewer external abdominal compressions with the Stylet method (1/12, 8.3%) compared to the conventional method (6/12, 50%). The insertion time was shorter with the Stylet method (140.9 ± 53.7 s) compared to the conventional method (181.3 ± 64.9 s). Conclusions: Using the variable-stiffness stylet, currently under development, resulted in significantly fewer external abdominal compressions and tended to have shorter insertion time.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Shu Hoteya
- Department of Gastroenterology, Toranomon Hospital
| |
Collapse
|
13
|
van Keulen KE, Soons E, Siersema PD. The Role of Behind Folds Visualizing Techniques and Technologies in Improving Adenoma Detection Rate. ACTA ACUST UNITED AC 2019; 17:394-407. [PMID: 31332633 DOI: 10.1007/s11938-019-00242-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Colorectal cancer is one of the most common malignancies in the Western world and is thought to develop from premalignant polyps. Over the past decade, several behind folds visualizing techniques (BFTs) have become available to improve polyp detection. This systematic review and meta-analysis aims to compare BFTs with conventional colonoscopy (CC). RECENT FINDINGS In the past five years, 14 randomized controlled trials (RCTs) including 8384 patients comparing different BFTs with CC were published. The overall relative risks for adenoma detection rate, polyp detection rate, and adenoma miss rate comparing BFTs with CC were 1.04 (95% confidence interval [CI] 0.98-1.10; P = 0.15), 1.03 (95% CI 0.98-1.09; P = 0.28), and 0.70 (95% CI 0.46-1.05; P = 0.08), respectively. Other quality metrics for colonoscopy were not significantly different between BFT-assisted colonoscopy and CC either. This meta-analysis of RCTs published in the past five years does not show a significant benefit of BFTs on any of the important quality metrics of colonoscopy. The lack of additional effect of BFTs might be due to improved awareness of colonoscopy quality metrics and colonoscopy skills among endoscopists combined with improvements of conventional colonoscope technology.
Collapse
Affiliation(s)
- K E van Keulen
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - E Soons
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - P D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
| |
Collapse
|
14
|
Siau K, Hodson J, Ravindran S, Rutter MD, Iacucci M, Dunckley P. Variability in cecal intubation rate by calculation method: a call for standardization of key performance indicators in endoscopy. Gastrointest Endosc 2019; 89:1026-1036.e2. [PMID: 30659830 DOI: 10.1016/j.gie.2018.12.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 12/29/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The cecal intubation rate (CIR) is a widely accepted key performance indicator (KPI) in colonoscopy but lacks a universal calculation method. We aimed to assess whether differences in CIR calculation methods could have an impact on perceived trainee outcomes. METHODS A systematic review of CIR calculation methods was conducted on major societal guidelines (United Kingdom, European Society of Gastrointestinal Endoscopy [ESGE] and American Society for Gastrointestinal Endoscopy [ASGE]) and trainee-inclusive studies. Trainees awarded colonoscopy certification between June 2011 and 2016 were identified from the United Kingdom e-portfolio and selected as a validation cohort. For each trainee, both the crude and unassisted CIR were calculated for 50 post-certification procedures using definitions from the 3 international guidelines. The resulting CIRs, and the proportions of endoscopists failing to meet the minimum standard of CIR ≥90%, were then compared across these definitions. RESULTS Across the 3 guidelines and 37 eligible studies identified, differences in CIR calculation methodology were demonstrated. These related to adjustment criteria (18 studies) and whether unassisted CIR was stipulated (18 studies). In the validation cohort of 733 trainees (36,650 procedures), the median crude CIR ranged from 96% (ESGE) to 98% (ASGE) (P < .001) and whether unassisted CIR was specified (ESGE, 94%; ASGE, 96%; P < .001). The proportion of trainees failing to achieve CIR ≥90% varied significantly across the different definitions, from 4.9% for the crude ASGE definition to 18.6% for the unassisted ESGE definition (P < .001). CONCLUSIONS CIR calculation methods vary among guidelines and research studies; this has an impact on trainee performance measures. With CIR used as an example, this study highlights the need for standardized definitions and calculations of KPIs in endoscopy.
Collapse
Affiliation(s)
- Keith Siau
- NIHR Biomedical Research Centre, University of Birmingham, Birmingham, United Kingdom; Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, United Kingdom
| | - James Hodson
- Institute of Translational Medicine, Institute of Immunology and Immunotherapy and NIHR Birmingham Biomedical Research Centre, University Hospitals NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom
| | | | - Matthew D Rutter
- Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, United Kingdom; Northern Institute for Cancer Research, Newcastle University, Newcastle, United Kingdom
| | - Marietta Iacucci
- NIHR Biomedical Research Centre, University of Birmingham, Birmingham, United Kingdom; Institute of Translational Medicine, Institute of Immunology and Immunotherapy and NIHR Birmingham Biomedical Research Centre, University Hospitals NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom
| | - Paul Dunckley
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, United Kingdom; Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, United Kingdom
| |
Collapse
|
15
|
Gkolfakis P, Tziatzios G, Spartalis E, Papanikolaou IS, Triantafyllou K. Colonoscopy attachments for the detection of precancerous lesions during colonoscopy: A review of the literature. World J Gastroenterol 2018; 24:4243-4253. [PMID: 30310257 PMCID: PMC6175757 DOI: 10.3748/wjg.v24.i37.4243] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/06/2018] [Accepted: 08/24/2018] [Indexed: 02/06/2023] Open
Abstract
Although colonoscopy has been proven effective in reducing the incidence of colorectal cancer through the detection and removal of precancerous lesions, it remains an imperfect examination, as it can fail in detecting up to almost one fourth of existing adenomas. Among reasons accounting for such failures, is the inability to meticulously visualize the colonic mucosa located either proximal to haustral folds or anatomic curves, including the hepatic and splenic flexures. In order to overcome these limitations, various colonoscope attachments aiming to improve mucosal visualization have been developed. All of them - transparent cap, Endocuff, Endocuff Vision and Endorings - are simply mounted onto the distal tip of the scope. In this review article, we introduce the rationale of their development, present their mode of action and discuss in detail the effect of their implementation in the detection of lesions during colonoscopy.
Collapse
Affiliation(s)
- Paraskevas Gkolfakis
- Hepato-gastroenterology Unit, Second Department of Internal Medicine -Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, ‘‘Attikon” University General Hospital, Athens 12462, Greece
| | - Georgios Tziatzios
- Hepato-gastroenterology Unit, Second Department of Internal Medicine -Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, ‘‘Attikon” University General Hospital, Athens 12462, Greece
| | - Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Athens 12462, Greece
| | - Ioannis S Papanikolaou
- Hepato-gastroenterology Unit, Second Department of Internal Medicine -Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, ‘‘Attikon” University General Hospital, Athens 12462, Greece
| | - Konstantinos Triantafyllou
- Hepato-gastroenterology Unit, Second Department of Internal Medicine -Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, ‘‘Attikon” University General Hospital, Athens 12462, Greece
| |
Collapse
|
16
|
Abstract
PURPOSE OF THE REVIEW Progress towards the goal of high-quality endoscopy across health economies has been founded on high-quality structured training programmes linked to credentialing practice and ongoing performance monitoring. This review appraises the recent literature on training interventions, which may benefit performance and competency acquisition in novice endoscopy trainees. RECENT FINDINGS Increasing data on the learning curves for different endoscopic procedures has highlighted variations in performance amongst trainees. These differences may be dependent on the trainee, trainer and training programme. Evidence of the benefit of knowledge-based training, simulation training, hands-on courses and clinical training is available to inform the planning of ideal training pathway elements. The validation of performance assessment measures and global competency tools now also provides evidence on the effectiveness of training programmes to influence the learning curve. The impact of technological advances and intelligent metrics from national databases is also predicted to drive improvements and efficiencies in training programme design and monitoring of post-training outcomes. Training in endoscopy may be augmented through a series of pre-training and in-training interventions. In conjunction with performance metrics, these evidence-based interventions could be implemented into training pathways to optimise and quality assure training in endoscopy.
Collapse
Affiliation(s)
- Keith Siau
- Department of Gastroenterology, Dudley Group Hospitals NHS Foundation Trust, Dudley, UK. .,Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK.
| | - Neil D Hawkes
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK.,Department of Gastroenterology, Cwm Taf University Health Board, Llantrisant, UK
| | - Paul Dunckley
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK.,Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK
| |
Collapse
|