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Ghosh NK, Kumar A. Ultra-minimally invasive endoscopic techniques and colorectal diseases: Current status and its future. Artif Intell Gastrointest Endosc 2024; 5:91424. [DOI: 10.37126/aige.v5.i2.91424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 04/12/2024] [Accepted: 05/06/2024] [Indexed: 05/11/2024] Open
Abstract
Colorectal diseases are increasing due to altered lifestyle, genetic, and environmental factors. Colonoscopy plays an important role in diagnosis. Advances in colonoscope (ultrathin scope, magnetic scope, capsule) and technological gadgets (Balloon assisted scope, third eye retroscope, NaviAid G-EYE, dye-based chromoendoscopy, virtual chromoendoscopy, narrow band imaging, i-SCAN, etc.) have made colonoscopy more comfortable and efficient. Now in-vivo microscopy can be performed using confocal laser endomicroscopy, optical coherence tomography, spectroscopy, etc. Besides developments in diagnostic colonoscopy, therapeutic colonoscopy has improved to manage lower gastrointestinal tract bleeding, obstruction, perforations, resection polyps, and early colorectal cancers. The introduction of combined endo-laparoscopic surgery and robotic endoscopic surgery has made these interventions feasible. The role of artificial intelligence in the diagnosis and management of colorectal diseases is also increasing day by day. Hence, this article is to review cutting-edge developments in endoscopic principles for the management of colorectal diseases.
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Affiliation(s)
- Nalini Kanta Ghosh
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
| | - Ashok Kumar
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
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Sherif Naguib M, Khairy A, Shehab H, Abosheaishaa H, Meguid Kassem A. The impact of EndoCuff-assisted colonoscopy on the polyp detection rate: A cross-over randomized back-to-back study. Arab J Gastroenterol 2024; 25:102-108. [PMID: 38418285 DOI: 10.1016/j.ajg.2023.11.007] [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: 08/16/2023] [Revised: 10/29/2023] [Accepted: 11/28/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND AND STUDY AIMS Colorectal cancer (CRC) is one of the most common cancers worldwide, and most CRCs develop from polyps with malignant potential. We aimed to study the difference in polyp detection rate between EndoCuff-assisted colonoscopies (EAC) and standard colonoscopy (SC). PATIENTS AND METHODS This study was conducted at Cairo University Hospitals on patients referred for screening or diagnostic colonoscopy from July 2018 to August 2020. All included patients underwent back-to-back standard colonoscopy (SC) and ENDOCUFF VISION-assisted colonoscopies (EAC). RESULTS 214 patients were included in this study. In comparison between EAC and SC, EAC increased the polyp detection rate (69 (32.24 %) vs. 57(26.64 %) (p < 0.05), EAC increased the detection of diminutive polyps ≤ 5 mm (104 vs. 81) (p < 0.05), and small polyps 6-9 mm (12 vs. 10) while there was no difference in large polyps ≥ 10 mm. EAC increased the adenoma detection rate (ADR) (37 (17.2 %) vs. 32(14.9 %) (p < 0.05). The findings detected by EAC shortened the interval of surveillance determined by SC findings. EndoCuff caused six mucosal erosions (2.8 %) in patients. CONCLUSION EAC increases the number of detected colonic polyps, primarily small polyps on the left and right sides of the colon.
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Affiliation(s)
- Mohammed Sherif Naguib
- Gastrointestinal Endoscopy and Liver Unit, Faculty of Medicine Cairo University, Cairo, Egypt
| | - Ahmed Khairy
- Gastrointestinal Endoscopy and Liver Unit, Faculty of Medicine Cairo University, Cairo, Egypt; Gastroenterology Division, Endemic Medicine Department, Cairo University, Cairo, Egypt
| | - Hany Shehab
- Gastrointestinal Endoscopy and Liver Unit, Faculty of Medicine Cairo University, Cairo, Egypt; Gastroenterology Division, Endemic Medicine Department, Cairo University, Cairo, Egypt
| | - Hazem Abosheaishaa
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, NYC Health + Hospitals Queens, NY, USA.
| | - Abdel Meguid Kassem
- Gastrointestinal Endoscopy and Liver Unit, Faculty of Medicine Cairo University, Cairo, Egypt; Gastroenterology Division, Endemic Medicine Department, Cairo University, Cairo, Egypt
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Chatterjee D, Mou SI, Sultana T, Hosen MI, Faruk MO. Identification and validation of prognostic signature genes of bladder cancer by integrating methylation and transcriptomic analysis. Sci Rep 2024; 14:368. [PMID: 38172584 PMCID: PMC10764961 DOI: 10.1038/s41598-023-50740-x] [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: 11/05/2023] [Accepted: 12/24/2023] [Indexed: 01/05/2024] Open
Abstract
Being a frequent malignant tumor of the genitourinary system, Bladder Urothelial Carcinoma (BLCA) has a poor prognosis. This study focused on identifying and validating prognostic biomarkers utilizing methylation, transcriptomics, and clinical data from The Cancer Genome Atlas Bladder Urothelial Carcinoma (TCGA BLCA) cohort. The impact of altered differentially methylated hallmark pathway genes was subjected to clustering analysis to observe changes in the transcriptional landscape on BLCA patients and identify two subtypes of patients from the TCGA BLCA population where Subtype 2 was associated with the worst prognosis with a p-value of 0.00032. Differential expression and enrichment analysis showed that subtype 2 was enriched in immune-responsive and cancer-progressive pathways, whereas subtype 1 was enriched in biosynthetic pathways. Following, regression and network analyses revealed Epidermal Growth Factor Receptor (EGFR), Fos-related antigen 1 (FOSL1), Nuclear Factor Erythroid 2 (NFE2), ADP-ribosylation factor-like protein 4D (ARL4D), SH3 domain containing ring finger 2 (SH3RF2), and Cadherin 3 (CDH3) genes to be the most significant prognostic gene markers. These genes were used to construct a risk model that separated the BLCA patients into high and low-risk groups. The risk model was also validated in an external dataset by performing survival analysis between high and low-risk groups with a p-value < 0.001 and the result showed the high group was significantly associated with poor prognosis compared to the low group. Single-cell analyses revealed the elevated level of these genes in the tumor microenvironment and associated with immune response. High-grade patients also tend to have a high expression of these genes compared to low-grade patients. In conclusion, this research developed a six-gene signature that is pertinent to the prediction of overall survival (OS) and might contribute to the advancement of precision medicine in the management of bladder cancer.
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Affiliation(s)
- Dipankor Chatterjee
- Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Sadia Islam Mou
- Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Tamanna Sultana
- Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Md Ismail Hosen
- Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Md Omar Faruk
- Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, 1000, Bangladesh.
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Pattarajierapan S, Tipmanee P, Supasiri T, Wisedopas N, Khomvilai S. Texture and color enhancement imaging (TXI) plus endocuff vision versus TXI alone for colorectal adenoma detection: a randomized controlled trial. Surg Endosc 2023; 37:8340-8348. [PMID: 37697119 DOI: 10.1007/s00464-023-10396-0] [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: 06/28/2023] [Accepted: 08/13/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND AND AIMS Increasing the adenoma detection rate (ADR) helps reduce the risk of post-colonoscopy colorectal cancer. Texture and Color Enhancement Imaging (TXI) improves ADR by enhancing the brightness and contrast of endoscopic images. Endocuff Vision (ECV) is a mucosal exposure device that helps flatten the colonic folds. The benefit of combining TXI with ECV has not been studied previously. Thus, we aimed to compare the ADR between using TXI combined with ECV and TXI alone. METHODS We conducted a prospective randomized controlled trial recruiting patients aged ≥ 40 years who underwent colonoscopy for colorectal cancer screening or gastrointestinal symptoms. The participants were randomized in a 1:1 ratio into the TXI with ECV (TXI + ECV) and the TXI groups. Experienced endoscopists with ≥ 40% ADR performed all colonoscopies. The primary outcome was ADR. RESULTS We had 189 and 192 patients in the TXI + ECV and TXI groups, respectively. The baseline characteristics of both groups were comparable. The ADR was significantly higher in the TXI + ECV group than in the TXI group (65.6% vs. 52.1%, P = 0.007). Adenoma per colonoscopy (APC) was significantly greater in the TXI + ECV group than in the TXI group (1.6 vs. 1.2, P = 0.021), prominently proximal (1.0 vs. 0.7, P = 0.031), non-pedunculated (1.4 vs. 1.1, P = 0.035), and diminutive (1.3 vs. 1, P = 0.045) adenomas. Serrated lesion detection rate, insertion time, and withdrawal time did not differ between the groups. CONCLUSION Adding ECV to TXI significantly improves ADR and APC compared to using TXI alone. TRIAL REGISTRATION Thai Clinical Trials Registry TCTR20220507004.
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Affiliation(s)
- Sukit Pattarajierapan
- Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
- King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Phadungkiat Tipmanee
- Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
| | - Thanan Supasiri
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Naruemon Wisedopas
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Supakij Khomvilai
- Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand.
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Karsenti D, Tharsis G, Perrot B, Cattan P, Percie du Sert A, Venezia F, Zrihen E, Gillet A, Lab JP, Tordjman G, Cavicchi M. Effect of real-time computer-aided detection of colorectal adenoma in routine colonoscopy (COLO-GENIUS): a single-centre randomised controlled trial. Lancet Gastroenterol Hepatol 2023; 8:726-734. [PMID: 37269872 DOI: 10.1016/s2468-1253(23)00104-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Artificial intelligence systems have been developed to improve polyp detection. We aimed to evaluate the effect of real-time computer-aided detection (CADe) on the adenoma detection rate (ADR) in routine colonoscopy. METHODS This single-centre randomised controlled trial (COLO-GENIUS) was done at the Digestive Endoscopy Unit, Pôle Digestif Paris-Bercy, Clinique Paris-Bercy, Charenton-le-Pont, France. All consecutive individuals aged 18 years or older who were scheduled for a total colonoscopy and had an American Society of Anesthesiologists score of 1-3 were screened for inclusion. After the caecum was reached and the colonic preparation was appropriate, eligible participants were randomly assigned (1:1; computer-generated random numbers list) to either standard colonoscopy or CADe-assisted colonoscopy (GI Genius 2.0.2; Medtronic). Participants and cytopathologists were masked to study assignment, whereas endoscopists were not. The primary outcome was ADR, which was assessed in the modified intention-to-treat population (all randomly assigned participants except those with misplaced consent forms). Safety was analysed in all included patients. According to statistical calculations, 20 endoscopists from the Clinique Paris-Bercy had to include approximately 2100 participants with 1:1 randomisation. The trial is complete and registered with ClinicalTrials.gov, NCT04440865. FINDINGS Between May 1, 2021, and May 1, 2022, 2592 participants were assessed for eligibility, of whom 2039 were randomly assigned to standard colonoscopy (n=1026) or CADe-assisted colonoscopy (n=1013). 14 participants in the standard group and ten participants in the CADe group were then excluded due to misplaced consent forms, leaving 2015 participants (979 [48·6%] men and 1036 [51·4%] women) in the modified intention-to-treat analysis. ADR was 33·7% (341 of 1012 colonoscopies) in the standard group and 37·5% (376 of 1003 colonoscopies) in the CADe group (estimated mean absolute difference 4·1 percentage points [95% CI 0·0-8·1]; p=0·051). One bleeding event without deglobulisation occurred in the CADe group after a large (>2 cm) polyp resection and resolved after a haemostasis clip was placed during a second colonoscopy. INTERPRETATION Our findings support the benefits of CADe, even in a non-academic centre. Systematic use of CADe in routine colonoscopy should be considered. FUNDING None.
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Affiliation(s)
- David Karsenti
- Digestive Endoscopy Unit, Pôle Digestif Paris-Bercy, Clinique Paris-Bercy, Charenton-le-Pont, France.
| | - Gaëlle Tharsis
- Digestive Endoscopy Unit, Pôle Digestif Paris-Bercy, Clinique Paris-Bercy, Charenton-le-Pont, France
| | - Bastien Perrot
- UMR 1246 SPHERE, INSERM, Nantes University and Tours University, Nantes, France
| | - Philippe Cattan
- Digestive Endoscopy Unit, Pôle Digestif Paris-Bercy, Clinique Paris-Bercy, Charenton-le-Pont, France
| | - Alice Percie du Sert
- Digestive Endoscopy Unit, Pôle Digestif Paris-Bercy, Clinique Paris-Bercy, Charenton-le-Pont, France
| | - Franck Venezia
- Digestive Endoscopy Unit, Pôle Digestif Paris-Bercy, Clinique Paris-Bercy, Charenton-le-Pont, France
| | - Elie Zrihen
- Digestive Endoscopy Unit, Pôle Digestif Paris-Bercy, Clinique Paris-Bercy, Charenton-le-Pont, France
| | - Agnès Gillet
- Digestive Endoscopy Unit, Pôle Digestif Paris-Bercy, Clinique Paris-Bercy, Charenton-le-Pont, France
| | | | - Gilles Tordjman
- Digestive Endoscopy Unit, Pôle Digestif Paris-Bercy, Clinique Paris-Bercy, Charenton-le-Pont, France
| | - Maryan Cavicchi
- Digestive Endoscopy Unit, Pôle Digestif Paris-Bercy, Clinique Paris-Bercy, Charenton-le-Pont, France
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Palma R, Andrisani G, Fanello G, Lauro A, Panetta C, Eberspacher C, Di Matteo FM, Vaccari S, Zorzetti N, D’Andrea V, Pontone S. Endocuff Vision-Assisted Resection for Difficult Colonic Lesions-Preliminary Results of a Multicenter, Prospective Randomized Pilot Study. J Clin Med 2023; 12:4980. [PMID: 37568382 PMCID: PMC10420096 DOI: 10.3390/jcm12154980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Background-Screening programs for colorectal cancer are implemented due to their ability to reduce mortality. The Endocuff Vision is a new endoscopic device that significantly improves the adenoma detection rate. The primary outcome was to assess the efficacy of ECV in improving stability and reducing operation time during difficult colon polypectomies in a multicenter randomized prospective study. Methods-In a randomized multicenter pilot study, two groups of patients who underwent difficult polypectomies with and without the assistance of Endocuff Vision were compared. Demographics and clinical characteristics of patients were obtained, and polyps' size, morphology, site, and access (SMSA); polypectomy time; and endoscope stability were evaluated. Results-From October 2016 to April 2020, 32 patients were enrolled. In total, 12 patients underwent Endocuff Vision polypectomy, and 20 patients underwent standard polypectomy by using a computer-generated random number table. No statistical differences were found in clinical characteristics, SMSA, and polypectomy time. The most interesting findings were the positive correlations between shaking and SMSA (r = 0.55, p = 0.005) and shaking and polypectomy time (r = 0.745, p < 0.0001). Conclusion-Endocuff Vision seems to be adequately stable during difficult endoscopic resection procedures. The new parameter proposed that shaking is strongly correlated to the stability of the endoscope, the difficulty of the resection (SMSA), and the polypectomy time.
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Affiliation(s)
- Rossella Palma
- Department of Surgery, “Sapienza” University of Rome, 00161 Rome, Italy; (R.P.); (A.L.); (C.P.); (C.E.); (S.V.); (N.Z.); (V.D.)
| | - Gianluca Andrisani
- Digestive Endoscopy Unit, Campus Bio-Medico, University of Rome, 00185 Rome, Italy; (G.A.); (F.M.D.M.)
| | - Gianfranco Fanello
- UOC Gastroenterologia ed Endoscopia Digestiva, Azienda Ospedaliera “San Giovanni-Addolorata”, 00184 Rome, Italy;
| | - Augusto Lauro
- Department of Surgery, “Sapienza” University of Rome, 00161 Rome, Italy; (R.P.); (A.L.); (C.P.); (C.E.); (S.V.); (N.Z.); (V.D.)
| | - Cristina Panetta
- Department of Surgery, “Sapienza” University of Rome, 00161 Rome, Italy; (R.P.); (A.L.); (C.P.); (C.E.); (S.V.); (N.Z.); (V.D.)
| | - Chiara Eberspacher
- Department of Surgery, “Sapienza” University of Rome, 00161 Rome, Italy; (R.P.); (A.L.); (C.P.); (C.E.); (S.V.); (N.Z.); (V.D.)
| | - Francesco Maria Di Matteo
- Digestive Endoscopy Unit, Campus Bio-Medico, University of Rome, 00185 Rome, Italy; (G.A.); (F.M.D.M.)
| | - Samuele Vaccari
- Department of Surgery, “Sapienza” University of Rome, 00161 Rome, Italy; (R.P.); (A.L.); (C.P.); (C.E.); (S.V.); (N.Z.); (V.D.)
| | - Noemi Zorzetti
- Department of Surgery, “Sapienza” University of Rome, 00161 Rome, Italy; (R.P.); (A.L.); (C.P.); (C.E.); (S.V.); (N.Z.); (V.D.)
| | - Vito D’Andrea
- Department of Surgery, “Sapienza” University of Rome, 00161 Rome, Italy; (R.P.); (A.L.); (C.P.); (C.E.); (S.V.); (N.Z.); (V.D.)
| | - Stefano Pontone
- Department of Surgery, “Sapienza” University of Rome, 00161 Rome, Italy; (R.P.); (A.L.); (C.P.); (C.E.); (S.V.); (N.Z.); (V.D.)
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Shahsavari D, Waqar M, Thoguluva Chandrasekar V. Image enhanced colonoscopy: updates and prospects-a review. Transl Gastroenterol Hepatol 2023; 8:26. [PMID: 37601740 PMCID: PMC10432234 DOI: 10.21037/tgh-23-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Colonoscopy has been proven to be a successful approach in both identifying and preventing colorectal cancer. The incorporation of advanced imaging technologies, such as image-enhanced endoscopy (IEE), plays a vital role in real-time diagnosis. The advancements in endoscopic imaging technology have been continuous, from replacing fiber optics with charge-coupled devices to the introduction of chromoendoscopy in the 1970s. Recent technological advancements include "push-button" technologies like autofluorescence imaging (AFI), narrowed-spectrum endoscopy, and confocal laser endomicroscopy (CLE). Dye-based chromoendoscopy (DCE) is falling out of favor due to the longer time required for application and removal of the dye and the difficulty of identifying lesions in certain situations. Narrow band imaging (NBI) is a technology that filters the light used for illumination leading to improved contrast and better visibility of structures on the mucosal surface and has shown a consistently higher adenoma detection rate (ADR) compared to white light endoscopy. CLE has high sensitivity and specificity for polyp detection and characterization, and several classifications have been developed for accurate identification of normal, regenerative, and dysplastic epithelium. Other IEE technologies, such as blue laser imaging (BLI), linked-color imaging (LCI), i-SCAN, and AFI, have also shown promise in improving ADR and characterizing polyps. New technologies, such as Optivista, red dichromatic imaging (RDI), texture and color enhancement imaging (TXI), and computer-aided detection (CAD) using artificial intelligence (AI), are being developed to improve polyp detection and pathology prediction prior to widespread use in clinical practice.
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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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Chang TL, Lewis B, Deutsch N, Nulsen B. Changes in Adenoma Detection Rate From Full-Spectrum Endoscopy to Standard Forward-Viewing Endoscopy. J Clin Gastroenterol 2023; 57:404-409. [PMID: 35470297 PMCID: PMC9983745 DOI: 10.1097/mcg.0000000000001706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/04/2022] [Indexed: 12/10/2022]
Abstract
GOALS The aim was to investigate the adenoma detection rate (ADR) of endoscopists who have used full-spectrum endoscopy (Fuse) for 3 years and revert back to traditional forward-viewing endoscopes (R-TFV) at an ambulatory surgical center. BACKGROUND Traditional forward viewing (TFV) endoscopes have 1 camera and provide an angle of view of 140 to 170 degrees, whereas Fuse provides a 330 degrees view through the addition of 2 side cameras. It has previously been reported that Fuse increased the ADR by 5.4% when compared with previous rates using TFV. Fuse is no longer commercially available. The ADR of endoscopists who revert back to TFV is unknown. STUDY We conducted a retrospective analysis of data examining the ADR from average risk screening colonoscopies at a 5-room ambulatory surgical center where endoscopists transitioned from TFV to Fuse in April 2014 and then reverted back to TFV in 2016. The primary outcome was ADR. Secondary outcomes were ADR for advanced and right-sided adenomas. RESULTS A total of 6110 procedures were reviewed. The ADR was 23.70% for TFV, 29.02% for Fuse and 28.88% for R-TFV. The ADR for advanced adenomas was 3.8% for TFV, 6.0% for Fuse and 7.3% for R-TFV. The ADR for right-sided adenomas was 13.0% for TFV, 16.7% for Fuse and 16.0% for R-TFV. The results for all 3 categories showed a statistical difference between TFV and Fuse as well as between TFV and R-TFV. There were no statistical differences between the ADR of Fuse compared with R-TFV. CONCLUSIONS During R-TFV, endoscopists are able to maintain their increased ability to detect adenomas. This would suggest that there was a change in behavior in endoscopists using Fuse that was durable.
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Thayalasekaran S, Bhattacharyya R, Chedgy F, Basford P, Subramaniam S, Kandiah K, Thursby-Pelham F, Brown J, Alkandari A, Ellis R, Coda S, Goggin P, Amos M, Fogg C, Longcroft-Wheaton G, Bhandari P. Randomized controlled trial of EndoRings assisted colonoscopy versus standard colonoscopy. Dig Endosc 2023; 35:354-360. [PMID: 36085410 DOI: 10.1111/den.14432] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 09/06/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The EndoRings device is a distal attachment consisting of two layers of circular flexible rings that evert mucosal folds. The aim of this study was to investigate whether EndoRing assisted colonoscopy (ER) improves polyp and adenoma detection compared to standard colonoscopy (SC). METHODS Multicenter, parallel group, randomized controlled trial. RESULTS Total of 556 patients randomized to ER (n = 275) or SC (n = 281). Colonoscopy completed in 532/556 (96%) cases. EndoRings removed in 74/275 (27%) patients. Total number of polyps in ER limb 582 vs. 515 in SC limb, P = 0.04. Total number of adenomas in ER limb 361 vs. 343 for SC limb, P = 0.49. A statistically significant difference in the mean number of polyps per patient in both the intention to treat (1.84 SC vs. 2.10 ER, P = 0.027) and per protocol (PP) (1.84 SC vs. 2.25 ER, P = 0.004). CONCLUSIONS Our study shows promise for the EndoRings device to improve polyp detection.
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Affiliation(s)
| | | | - Fergus Chedgy
- Department of Gastroenterology, Royal Sussex County Hospital, Brighton and Hove, UK
| | - Peter Basford
- Western Sussex Hospitals NHS Foundation Trust, Worthing, UK
| | | | - Kesavan Kandiah
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | | | - James Brown
- Pharmacy and Biomedical Sciences, Portsmouth University, Portsmouth, UK
| | - Asma Alkandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Richard Ellis
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Sergio Coda
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Patrick Goggin
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Mark Amos
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Carole Fogg
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Gaius Longcroft-Wheaton
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK.,Pharmacy and Biomedical Sciences, Portsmouth University, Portsmouth, UK
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK.,Pharmacy and Biomedical Sciences, Portsmouth University, Portsmouth, UK
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Hassan C, Piovani D, Spadaccini M, Parigi T, Khalaf K, Facciorusso A, Fugazza A, Rösch T, Bretthauer M, Mori Y, Sharma P, Rex DK, Bonovas S, Repici A. Variability in adenoma detection rate in control groups of randomized colonoscopy trials: a systematic review and meta-analysis. Gastrointest Endosc 2023; 97:212-225.e7. [PMID: 36243103 DOI: 10.1016/j.gie.2022.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/26/2022] [Accepted: 10/04/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND AIMS Adenoma detection rate (ADR) is still the main surrogate outcome parameter of screening colonoscopy, but most studies include mixed indications, and basic ADR is quite variable. We therefore looked at the control groups in randomized ADR trials using advanced imaging or mechanical methods to find out whether indications or other factors influence ADR levels. METHODS Patients in the control groups of randomized controlled trials (RCTs) on ADR increase using various methods were collected based on a systematic review; this control group had to use high-definition white-light endoscopy performed between 2008 and 2021. Random-effects meta-analysis was used to pool ADR in control groups and its 95% confidence interval (CI) according to clinical (indication and demographic), study setting (tandem/parallel, number of centers, sample size), and technical (type of intervention, withdrawal time) parameters. Interstudy heterogeneity was reported with the I2 statistic. Multivariable mixed-effects meta-regression was performed for potentially relevant variables. RESULTS From 80 studies, 25,304 patients in the respective control groups were included. ADR in control arms varied between 8.2% and 68.1% with a high degree of heterogeneity (I2 = 95.1%; random-effect pooled value, 37.5%; 95% CI, 34.6‒40.5). There was no difference in ADR levels between primary colonoscopy screening (12 RCTs, 15%) and mixed indications including screening/surveillance and diagnostic colonoscopy; however, fecal immunochemical testing as an indication for colonoscopy was an independent predictor of ADR (odds ratio [OR], 1.6; 95% CI, 1.1-2.4). Other well-known parameters were confirmed by our analysis such as age (OR, 1.038; 95% CI, 1.004-1.074), sex (male sex: OR, 1.02; 95% CI, 1.01-1.03), and withdrawal time (OR, 1.1; 95% CI, 1.0-1.1). The type of intervention (imaging vs mechanical) had no influence, but methodologic factors did: More recent year of publication and smaller sample size were associated with higher ADR. CONCLUSIONS A high level of variability was found in the level of ADR in the control groups of RCTs. With regards to indications, only fecal immunochemical test-based colonoscopy studies influenced basic ADR, and primary colonoscopy screening appeared to be similar to other indications. Standardization for variables related to clinical, methodologic, and technical parameters is required to achieve generalizability and reproducibility.
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Affiliation(s)
- Cesare Hassan
- Department of Biomedical Sciences, Pieve Emanuele, Humanitas University, Rozzano, Italy; Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Daniele Piovani
- Department of Biomedical Sciences, Pieve Emanuele, Humanitas University, Rozzano, Italy; Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Marco Spadaccini
- Department of Biomedical Sciences, Pieve Emanuele, Humanitas University, Rozzano, Italy; Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Tommaso Parigi
- Department of Biomedical Sciences, Pieve Emanuele, Humanitas University, Rozzano, Italy; Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Kareem Khalaf
- Department of Biomedical Sciences, Pieve Emanuele, Humanitas University, Rozzano, Italy
| | - Antonio Facciorusso
- Department of Medical Sciences, Section of Gastroenterology, University of Foggia, Foggia, Italy
| | - Alessandro Fugazza
- Department of Biomedical Sciences, Pieve Emanuele, Humanitas University, Rozzano, Italy
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Bretthauer
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Yuichi Mori
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway; Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Prateek Sharma
- Department of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Douglas K Rex
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Pieve Emanuele, Humanitas University, Rozzano, Italy; Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Alessandro Repici
- Department of Biomedical Sciences, Pieve Emanuele, Humanitas University, Rozzano, Italy; Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
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12
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Endocuff-assisted versus standard colonoscopy for improving adenoma detection rate: meta-analysis of randomized controlled trials. Tech Coloproctol 2023; 27:91-101. [PMID: 35915293 DOI: 10.1007/s10151-022-02642-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 05/18/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND The effect of Endocuff-assisted colonoscopy compared with standard colonoscopy is conflicting in terms of the adenoma detection rate. The aim of this meta-analysis was to compare the efficacy of Endocuff-assisted colonoscopy for adenoma detection. METHODS PubMed, Embase, Google Scholar and Cochrane Library were searched up to the end of June 8, 2021. All randomized controlled trials (RCTs) comparing Endocuff-assisted colonoscopy with standard colonoscopy were included. Dichotomous data were pooled to obtain the relative risk with a 95% CI, whereas continuous data were pooled using a mean difference with 95% CI. RESULTS A total of 23 RCTs involving 17,999 patients were included. Compared with standard colonoscopy, use of the Endocuff was associated with a significant improvement in the adenoma detection rate (RR = 1.16, 95% CI 1.08-1.24), polyp detection rate (RR = 1.17, 95% CI 1.09-1.25), sessile serrated lesion detection rate (RR = 1.23, 95% CI 1.05-1.43), left-side lesion detection rate (RR = 1.24, 95% CI 1.08-1.43), and mean number of adenomas per patient (MD = 0.17, 95% CI 0.08-0.26). There were no significant differences between the and groups in detection of advanced adenomas, mean number of polyps per patient, right-side lesion detection rate, cecal intubation rate, cecal intubation time and withdrawal time. CONCLUSIONS The pooled evidence suggests a significant improvement in the adenoma detection rate, and polyp detection rate using the Endocuff. On the other hand, no significant effect on the detection of advanced adenomas and mean number of polyps per patient was noted.
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13
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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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14
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Walls M, Houwen BBSL, Rice S, Seager A, Dekker E, Sharp L, Rees CJ. The effect of the endoscopic device Endocuff™/Endocuff vision™ on quality standards in colonoscopy: A systematic review and meta-analysis of randomized trials. Colorectal Dis 2022; 25:573-585. [PMID: 36471638 DOI: 10.1111/codi.16444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/07/2022] [Accepted: 11/20/2022] [Indexed: 12/30/2022]
Abstract
AIM The adenoma detection rate (ADR) is an important quality measure, with a high ADR reflecting high-quality colonoscopy. This systematic review and meta-analysis aimed to assess the effects of Endocuff™/Endocuff Vision™-assisted colonoscopy (EAC) versus standard colonoscopy (SC) on ADR and other clinical, patient and resource-use outcomes. METHOD MEDLINE, EMBASE, Web of Science, Scopus and the Cochrane Central Register of Controlled Trials were searched for full papers reporting randomized studies comparing EAC with SC. The primary outcome was ADR. Secondary outcomes comprised key polyp/adenoma detection, procedure-related, patient-related and health economic measures. Random effects meta-analyses provided pooled estimates of outcomes [risk ratio (RR) or mean difference (MD), with 95% confidence intervals (CI)]. RESULTS Twelve parallel-group randomized controlled trials (RCTs) and three crossover RCTs with data on 9140 patients were included. EAC significantly increased the ADR (RR 1.18, 95% CI 1.09-1.29), mean adenomas per procedure (MAP) (MD 0.19, 95% CI 0.06-0.33), polyp detection rate (PDR) (RR 1.20, 95% CI 1.10-1.30) and mean polyps per procedure (MPP) (MD 0.39, 95% CI 0.14-0.63) versus SC. EAC significantly increased segmental PDR versus SC in the sigmoid (RR 2.02, 95% CI 1.64-2.49), transverse (RR 1.63, 95% CI 1.09-2.42), ascending (RR 1.74, 95% CI 1.26-2.41) and caecal segments (RR 1.91, 95% CI 1.29-2.82). Procedure-related variables did not differ between arms. There were insufficient data for meta-analysis of health economic or patient-centred outcomes. CONCLUSIONS EAC increased ADR, MAP, PDR and MPP versus SC without detrimental effects on procedure measures. Cost-effectiveness and patient experience data are lacking and would be valuable to inform practice recommendations.
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Affiliation(s)
- Martin Walls
- South Tyneside District Hospital, South Shields, Tyne and Wear, UK.,Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle-upon-Tyne, Tyne and Wear, UK
| | - Britt B S L Houwen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Stephen Rice
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle-upon-Tyne, Tyne and Wear, UK
| | - Alexander Seager
- South Tyneside District Hospital, South Shields, Tyne and Wear, UK.,Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle-upon-Tyne, Tyne and Wear, UK
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle-upon-Tyne, Tyne and Wear, UK
| | - Colin J Rees
- South Tyneside District Hospital, South Shields, Tyne and Wear, UK.,Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle-upon-Tyne, Tyne and Wear, UK
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15
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Desai PN, Patel CN, Kabrawala M, Nanadwani S, Mehta R, Prajapati R, Patel N, Sethia M. Distal Endoscopic Attachments. JOURNAL OF DIGESTIVE ENDOSCOPY 2022. [DOI: 10.1055/s-0042-1755336] [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] [Indexed: 12/23/2022] Open
Abstract
AbstractEndoscopy is an evolving science and the last two decades has seen it expand exponentially at a pace unapparelled in the past. With the advancement in new procedures like image-enhanced endoscopy, magnifying endoscopy, third space endoscopy, and highly advanced endoscopic ultrasound procedures, endoscopic accessories are also evolving to cater the unmet needs. Endoscopic cap or distal attachment cap is a simple but very important accessory in the endoscopists' armamentarium which has changed the path of endoscopic procedures. It has so far been used commonly mostly for variceal ligation and endoscopic mucosal resections for colorectal polyps. But the horizon of its use has expanded in the recent years for difficult clinical scenarios like providing stability to the endoscope, overcoming blind spots during screening colonoscopies, maintaining clear field of vision during endotherapy of gastrointestinal bleeding, and during magnification endoscopy for lesion characterizations and so on. These caps are of different shapes, sizes, colors, and material depending on manufacturers and their implications while performing varied endoscopies. This review summarizes the clinical utilities of the cap in diagnostic as well as therapeutic endoscopy and its expanding indications of use.
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Affiliation(s)
- Pankaj N. Desai
- Department of Endoscopy and Endosonography, SIDS Hospital & Research Centre, Surat, Gujarat, India
| | - Chintan N. Patel
- Department of Endoscopy and Endosonography, SIDS Hospital & Research Centre, Surat, Gujarat, India
| | - Mayank Kabrawala
- Department of Gastroenterology, SIDS Hospital & Research Centre, Surat, Gujarat, India
| | - Subhash Nanadwani
- Department of Gastroenterology, SIDS Hospital & Research Centre, Surat, Gujarat, India
| | - Rajiv Mehta
- Department of Gastroenterology, SIDS Hospital & Research Centre, Surat, Gujarat, India
| | - Ritesh Prajapati
- Department of Gastroenterology, SIDS Hospital & Research Centre, Surat, Gujarat, India
| | - Nisharg Patel
- Department of Gastroenterology, SIDS Hospital & Research Centre, Surat, Gujarat, India
| | - Mohit Sethia
- Department of Gastroenterology, SIDS Hospital & Research Centre, Surat, Gujarat, India
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16
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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.
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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
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17
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Hong SW, Hong HS, Kim K, Oh K, Lee JY, Park JH, Hwang SW, Park SH, Yang DH, Ye BD, Myung SJ, Yang SK, Byeon JS. Improved adenoma detection by a novel distal attachment device-assisted colonoscopy: a prospective randomized controlled trial. Gastrointest Endosc 2022; 96:543-552.e1. [PMID: 35500658 DOI: 10.1016/j.gie.2022.04.1307] [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: 09/26/2021] [Accepted: 04/21/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS WingCap (A&A Medical Supply LLC, Seongnam, South Korea) is a novel distal attachment device for colonoscopy that combines a cap and an existing mucosal exposure device, such as Endocuff Vision (Arc Medical Design Ltd, Leeds, UK) and AmplifEYE (Medivators Inc, Minneapolis, Minn, USA). We aimed to investigate whether WingCap-assisted colonoscopy can improve the adenoma detection rate (ADR) and adenoma per colonoscopy (APC) and simultaneously shorten cecal intubation time compared with standard colonoscopy. METHODS We conducted a single-center, prospective, randomized controlled trial for outpatients aged ≥18 years undergoing colonoscopy. The primary outcome was ADR differences with the assistance of WingCap. Secondary outcomes were APC and other colonoscopy quality indicators, such as cecal intubation and withdrawal times. RESULTS In total, 537 patients were randomized for WingCap-assisted or standard colonoscopy. Their mean age was 59.3 years, and 48.5% were men. ADR was significantly higher in the WingCap group than in the control group (37.2% vs 26.6%, P = .012). APC was greater with WingCap than with standard colonoscopy (.72 ± 1.34 vs .45 ± 0.97, P = .008), prominently for nonpedunculated (.65 ± 1.25 vs .42 ± .95, P = .015) and diminutive (.42 ± .94 vs .20 ± .64, P = .002) adenomas. With WingCap, ADR and APC significantly increased for beginner endoscopists, whereas a modest increase was seen for experienced endoscopists. There were no differences in cecal intubation and withdrawal times between the 2 arms. No serious adverse event was associated with the use of WingCap. CONCLUSIONS WingCap-assisted colonoscopy was tolerable and efficacious for improving ADR and APC compared with standard colonoscopy, especially for nonpedunculated and diminutive adenomas and for beginner endoscopists. (Clinical trial registration number: KCT0005214.).
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Affiliation(s)
- Seung Wook Hong
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea; Digestive Diseases Research Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hee Seung Hong
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Kyuwon Kim
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Kyunghwan Oh
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jae Yong Lee
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jin Hwa Park
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Sung Wook Hwang
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Sang Hyoung Park
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Dong-Hoon Yang
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Byong Duk Ye
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea; Digestive Diseases Research Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Jae Myung
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea; Digestive Diseases Research Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Suk-Kyun Yang
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea; Digestive Diseases Research Center, University of Ulsan College of Medicine, Seoul, South Korea
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18
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Miyaguchi K, Tsuzuki Y, Hirooka N, Shiomi R, Ohgo H, Nakamoto H, Imaeda H. Endo-wing versus transparent hood-assisted colonoscopy for colorectal adenoma detection: A randomized controlled trial. J Gastroenterol Hepatol 2022; 37:766-772. [PMID: 35174541 DOI: 10.1111/jgh.15805] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/15/2022] [Accepted: 02/13/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM This study aimed to compare the mean number of adenomas in patients undergoing Endo-wing-assisted colonoscopy (EAC) and transparent hood-assisted colonoscopy (TAC). METHODS Patients undergoing colonoscopy for positive fecal immunochemical tests, colon polyp surveillance, and evaluation of abdominal symptoms at a single institution were randomly assigned to the EAC or TAC group. The mean number of adenomas per patient, adenoma detection rate, cecal intubation time, withdrawal time, mean number of adenomas per location, and adenoma size were compared. RESULTS Overall, 800 patients were enrolled. The EAC and TAC groups comprised 372 and 393 patients, respectively. The groups did not significantly differ with respect to cecal intubation and withdrawal times. The mean number of adenomas per patient was significantly higher in the EAC group (1.13 vs 0.90, P = 0.04), particularly in the sigmoid colon (0.54 [201/372] vs 0.38 [149/393], P = 0.04). The adenoma detection rates were 48.1% and 45.0% in the EAC and TAC groups, respectively, albeit without significant difference between the two groups (P = 0.393). The total number of sessile-type adenomas (0.73 [270/372] vs 0.47 [183/393], P < 0.0001) and small polyps (≤ 5 mm) (0.53 [198/372] vs 0.41 [159/393], P = 0.016) was significantly higher in the EAC group. CONCLUSION Endo-wing-assisted colonoscopy is significantly superior to TAC in terms of the mean number of adenomas per patient.
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Affiliation(s)
- Kazuya Miyaguchi
- Department of General Internal Medicine, Saitama Medical University, Moroyama, Japan.,Department of Gastroenterology, Saitama Medical University, Moroyama, Japan
| | - Yoshikazu Tsuzuki
- Department of Gastroenterology, Saitama Medical University, Moroyama, Japan
| | - Nobutaka Hirooka
- Department of General Internal Medicine, Saitama Medical University, Moroyama, Japan
| | - Rie Shiomi
- Department of General Internal Medicine, Saitama Medical University, Moroyama, Japan
| | - Hideki Ohgo
- Department of Gastroenterology, Saitama Medical University, Moroyama, Japan
| | - Hidetomo Nakamoto
- Department of General Internal Medicine, Saitama Medical University, Moroyama, Japan
| | - Hiroyuki Imaeda
- Department of Gastroenterology, Saitama Medical University, Moroyama, Japan
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19
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Ikematsu H, Murano T, Shinmura K. Detection of colorectal lesions during colonoscopy. DEN OPEN 2022; 2:e68. [PMID: 35310752 PMCID: PMC8828173 DOI: 10.1002/deo2.68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 12/11/2022]
Abstract
Owing to its high mortality rate, the prevention of colorectal cancer is of particular importance. The resection of colorectal polyps is reported to drastically reduce colorectal cancer mortality, and examination by endoscopists who had a high adenoma detection rate was found to lower the risk of colorectal cancer, highlighting the importance of identifying lesions. Various devices, imaging techniques, and diagnostic tools aimed at reducing the rate of missed lesions have therefore been developed to improve detection. The distal attachments and devices for improving the endoscopic view angle are intended to help avoid missing blind spots such as folds and flexures in the colon, whereas the imaging techniques represented by image‐enhanced endoscopy contribute to improving lesion visibility. Recent advances in artificial intelligence‐supported detection systems are expected to supplement an endoscopist's eye through the instant diagnosis of the lesions displayed on the monitor. In this review, we provide an outline of each tool and assess its impact on the reduction in the incidence of missed colorectal polyps by summarizing previous clinical research and meta‐analyses. Although useful, the many devices, image‐enhanced endoscopy, and artificial intelligence tools exhibited various limitations. Integrating these tools can improve their shortcomings. Combining artificial intelligence‐based diagnoses with wide‐angle image‐enhanced endoscopy may be particularly useful. Thus, we hope that such tools will be available in the near future.
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Affiliation(s)
- Hiroaki Ikematsu
- Division of Science and Technology for Endoscopy Exploratory Oncology Research & Clinical Trial Center National Cancer Center Chiba Japan.,Department of Gastroenterology and Endoscopy National Cancer Center Hospital East Chiba Japan
| | - Tatsuro Murano
- Department of Gastroenterology and Endoscopy National Cancer Center Hospital East Chiba Japan
| | - Kensuke Shinmura
- Department of Gastroenterology and Endoscopy National Cancer Center Hospital East Chiba Japan
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Huguet JM, Ferrer-Barceló L, Suárez P, Sanchez E, Prieto JD, Garcia V, Sempere J. Colorectal cancer screening and surveillance in patients with inflammatory bowel disease in 2021. World J Gastroenterol 2022; 28:502-516. [PMID: 35316962 PMCID: PMC8905018 DOI: 10.3748/wjg.v28.i5.502] [Citation(s) in RCA: 5] [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: 03/18/2021] [Revised: 07/10/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
The detection of dysplasia in patients with inflammatory bowel disease (IBD) continues to be important given the increased risk of colorectal cancer in this population. Therefore, in 2017, we performed a review and update of the recommendations for the management and follow-up of patients with IBD based on the clinical practice guidelines of various scientific societies. The present manuscript focuses on new aspects of the detection, follow-up, and management of dysplasia according to the latest studies and recommendations. While chromoendoscopy with targeted biopsy continues to be the technique of choice for the screening and detection of dysplasia in IBD, the associated difficulties mean that it is now being compared with other techniques (virtual chromoendoscopy), which yield similar results with less technical difficulties. Furthermore, the emergence of new endoscopy techniques that are still being researched but seem promising (e.g., confocal laser endomicroscopy and full-spectrum endoscopy), together with the development of devices that improve endoscopic visualization (e.g., Endocuff Vision), lead us to believe that these approaches can revolutionize the screening and follow-up of dysplasia in patients with IBD. Nevertheless, further studies are warranted to define the optimal follow-up strategy in this patient population.
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Affiliation(s)
- Jose Maria Huguet
- Department of Digestive Disease, General University Hospital of Valencia, Valencia 46014, Spain
| | - Luis Ferrer-Barceló
- Department of Digestive Disease, General University Hospital of Valencia, Valencia 46014, Spain
| | - Patrícia Suárez
- Department of Digestive Disease, General University Hospital of Valencia, Valencia 46014, Spain
| | - Eva Sanchez
- Department of Digestive Disease, General University Hospital of Valencia, Valencia 46014, Spain
| | - Jose David Prieto
- Department of Digestive Disease, General University Hospital of Valencia, Valencia 46014, Spain
| | - Victor Garcia
- Department of Digestive Disease, General University Hospital of Valencia, Valencia 46014, Spain
| | - Javier Sempere
- Department of Digestive Disease, General University Hospital of Valencia, Valencia 46014, Spain
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21
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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.
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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
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22
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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.
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EndoCuff-Assisted Colonoscopy Versus Standard Colonoscopy in Colonic Polyp Detection-Experience from a Single Tertiary Centre. CURRENT HEALTH SCIENCES JOURNAL 2021; 47:33-41. [PMID: 34211745 PMCID: PMC8200606 DOI: 10.12865/chsj.47.01.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/25/2021] [Indexed: 12/07/2022]
Abstract
Background. Standard colonoscopy fails to visualize the entire colon mucosa and consequently a significant amount of polyps are still being missed. New device, such as EndoCuff, have been developed to improve mucosal visualisation, hence the quality in colonoscopy. The aim of this study was to assess the diagnostic yield of EndoCuff-assisted colonoscopy in comparison with standard colonoscopy by taking into consideration several quality indicators. Methods. In this study, 965 adults ≥ 18 years referred for colonoscopy were randomly divided into two groups. The main statistical investigation compared the difference between EndoCuff-assisted colonoscopy (EC) vs. standard colonoscopy (SC) in the detection of colonic polyps and adenoma detection rate (ADR). The second inquiry sought to compare experienced vs. recently trained and female vs. male operators. Results. The ADR was higher for EC than for SC (37.50% vs. 26.64%). Regarding the mean number of detected polyps per procedure (MPP), the result was statistically significant when generally comparing the EC vs. SC (p=0.0009). There were no differences in MPP between EC and SC for recently trained endoscopists (p=0.7446), while a significant difference for experienced doctors (p=0,0020) was noted. A significant difference was observed between female doctors and male doctors only when using SC. EC was more helpful for female doctors when assessing MPP (p=0.0118). No serious adverse events related to EndoCuff-assisted colonoscopy was noted. Conclusions. EndoCuff-assisted colonoscopy seems to be safe and may bring benefits for improving the polyp/adenoma detection rates in regard to missed lesions, usually located in blind areas.
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Patel HK, Chandrasekar VT, Srinivasan S, Patel SK, Dasari CS, Singh M, Le Cam E, Spadaccini M, Rex D, Sharma P. Second-generation distal attachment cuff improves adenoma detection rate: meta-analysis of randomized controlled trials. Gastrointest Endosc 2021; 93:544-553.e7. [PMID: 33031786 DOI: 10.1016/j.gie.2020.09.045] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 09/19/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Multiple randomized controlled trials (RCTs) using the second-generation distal attachment cuff device (Endocuff Vision; Olympus America, Center Valley, Pa, USA) have reported conflicting results in improving adenoma detection rate (ADR) compared with standard high-definition colonoscopy without the distal attachment. We conducted a systematic review and meta-analysis of RCTs to compare outcomes between second-generation cuff colonoscopy (CC) versus colonoscopy without the distal attachment (standard colonoscopy [SC]). METHODS An electronic literature search was performed using PubMed, Google Scholar, Embase, and Cochrane Library through May 2020. The primary outcome was reporting of ADR, and secondary outcomes were polyp detection rate (PDR), mean withdrawal time, mean adenomas per colonoscopy (APC), sessile serrated lesion detection rate, and adverse events. Pooled rates and risk ratios (RRs) with 95% confidence intervals were reported. RESULTS Eight RCTs with 5695 patients were included in the final analysis, with 2862 patients (mean age, 62.8 years; 52.9% men) in the CC group and 2833 patients (mean age, 62.6 years; 54.2% men) in the SC group. Compared with SC, use of CC was associated with a significant improvement in ADR (49.8% vs 45.6%, respectively; RR, 1.12; P = .02), PDR (58.1% vs 53%, respectively; RR, 1.12; P = .009), and APC (P < .01). Furthermore, use of CC had a .93-minute lower mean withdrawal time (P < .01) when compared with SC. The difference in ADR was larger in the screening/surveillance population (6.5%, P = .02) and when used by endoscopists with ADRs <30% (9.4%, P = .03). CONCLUSIONS The results of this meta-analysis of randomized trials show a significant improvement in ADR and APC with shorter withdrawal times using the second-generation cuff device compared with SC.
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Affiliation(s)
- Harsh K Patel
- Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | | | - Sachin Srinivasan
- Department of Internal Medicine, University of Kansas School of Medicine, Wichita, Kansas, USA
| | - Suchi K Patel
- Department of Statistics, Anand Institute of Management, Anand, Gujarat, India
| | - Chandra S Dasari
- Department of Gastroenterology, Veterans Affairs Medical Center, Kansas City, Missouri, USA
| | - Munraj Singh
- Faculty of Medicine, The University of Queensland Ochsner Clinical School, New Orleans, Louisiana, USA
| | - Elise Le Cam
- Faculty of Medicine, The University of Queensland Ochsner Clinical School, New Orleans, Louisiana, USA
| | - Marco Spadaccini
- Department of Gastroenterology, Humanitas University, Milan, Italy
| | - Douglas Rex
- Department of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Prateek Sharma
- Department of Gastroenterology, Veterans Affairs Medical Center, Kansas City, Missouri, USA
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25
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Floer M, Tschaikowski L, Schepke M, Kempinski R, Neubauer K, Poniewierka E, Kunsch S, Ameis D, Heinzow HS, Auer A, Schmidt HH, Ellenrieder V, Meister T. Standard versus Endocuff versus cap-assisted colonoscopy for adenoma detection: A randomised controlled clinical trial. United European Gastroenterol J 2021; 9:443-450. [PMID: 33349200 PMCID: PMC8259258 DOI: 10.1177/2050640620982952] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/27/2020] [Indexed: 12/18/2022] Open
Abstract
Background and aims Adenoma detection rate (ADR) in colon cancer screening is most important for cancer prophylaxis. This work is the first three‐armed randomised controlled clinical trial aimed at comparing a head‐to‐head setting standard colonoscopy (SC) with Endocuff‐assisted colonoscopy (EC) and cap‐assisted colonoscopy (CAC) for improvement of ADR. Methods Patients from Poland and Germany with independent indication for colonoscopy were randomised into three arms of this trial: EC, CAC and SC. Exclusion criteria were age <18 years, active Crohn's disease or ulcerative colitis, known stenosis and post‐colonic resection status. Results A total of 585 patients (195 SC, 189 EC and 186 CAC) were enrolled in this study. Indications were not different between the groups (colorectal cancer screening 51%, diagnostic colonoscopy in 31% and post‐polypectomy follow‐up in 18%; p = 0.94). Withdrawal time was a mean of 7 min in all groups (p = 0.658), and bowel preparation did not differ between the groups. The time to reach the caecum was significantly reduced when using the cap (a mean of 6 min for CAC vs. 7 min for SC; p = 0.0001). There was no significant difference in the primary outcome of the ADR between the groups (EC 32%, CAC 30%, SC 30%; p = 0.815). EC proved to be superior (EC vs. SC) in the sigmoid colon and transverse colon for polyp detection. Conclusion The use of EC increased the total number of polyps seen during colonoscopy. In contrast to recent studies, no significant improvement of the ADR was detected.
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Affiliation(s)
- Martin Floer
- Department of Medicine 1, Klinikum Ibbenbueren, Teaching Hospital University of Muenster, Münster, Germany.,Department of Medicine 2, Helios Albert-Schweitzer-Klinik Northeim, Teaching Hospital University Goettingen, Northeim, Germany
| | - Laura Tschaikowski
- Department of Medicine 2, Helios Albert-Schweitzer-Klinik Northeim, Teaching Hospital University Goettingen, Northeim, Germany
| | - Michael Schepke
- Department of Gastroenterology, Helios Klinikum Siegburg, Siegburg, Germany
| | - Radoslaw Kempinski
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland
| | - Katarzyna Neubauer
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland
| | - Elzbieta Poniewierka
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland
| | - Steffen Kunsch
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Centre Goettingen, Goettingen, Germany
| | - Detlev Ameis
- Department of Gastroenterology, Helios Hospital Helmstedt, Helmstedt, Germany
| | | | - Agneta Auer
- Department of Medicine 1, Klinikum Ibbenbueren, Teaching Hospital University of Muenster, Münster, Germany.,Department of Medicine 2, Helios Albert-Schweitzer-Klinik Northeim, Teaching Hospital University Goettingen, Northeim, Germany
| | - Hartmut H Schmidt
- Department of Medicine B, University Hospital Muenster, Muenster, Germany
| | - Volker Ellenrieder
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Centre Goettingen, Goettingen, Germany
| | - Tobias Meister
- Department of Medicine 1, Klinikum Ibbenbueren, Teaching Hospital University of Muenster, Münster, Germany.,Department of Medicine 2, Helios Albert-Schweitzer-Klinik Northeim, Teaching Hospital University Goettingen, Northeim, Germany
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26
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Zimmermann-Fraedrich K, Pohl H, Rösch T, Rex DK, Hassan C, Dekker E, Kaminski MF, Bretthauer M, de Heer J, Werner Y, Schachschal G, Groth S. Designs of colonoscopic adenoma detection trials: more positive results with tandem than with parallel studies - an analysis of studies on imaging techniques and mechanical devices. Gut 2021; 70:268-275. [PMID: 32409588 DOI: 10.1136/gutjnl-2020-320984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/15/2020] [Accepted: 04/19/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Adenoma detection rate (ADR) has been shown to correlate with interval cancers after screening colonoscopy and is commonly used as surrogate parameter for its outcome quality. ADR improvements by various techniques have been studied in randomised trials using either parallel or tandem methodololgy. METHODS A systematic literature search was done on randomised trials (full papers, English language) on tandem or parallel studies using either adenoma miss rates (AMR) or ADR as main outcome to test different novel technologies on imaging (new endoscope generation, narrow band imaging, iScan, Fujinon intelligent chromoendoscopy/blue laser imaging and wide angle scopes) and mechanical devices (transparent caps, endocuff, endorings and balloons). Available meta analyses were also screened for randomised studies. RESULTS Overall, 24 randomised tandem trials with AMR (variable definitions and methodology) and 42 parallel studies using ADR (homogeneous methodology) as primary outcome were included. Significant differences in favour of the new method were found in 66.7% of tandem studies (8222 patients) but in only 23.8% of parallel studies (28 059 patients), with higher rates of positive studies for mechanical devices than for imaging methods. In a random-effects model, small absolute risk differences were found, but these were double in magnitude for tandem as compared with parallel studies (imaging: tandem 0.04 (0.01, 0.07), parallel 0.02 (0.00, 0.04); mechanical devices: tandem 0.08 (0.00, 0.15), parallel 0.04 (0.01, 0.07)). Nevertheless, 94.2% of missed adenomas in the tandem studies were small (<1 cm) and/or non-advanced. CONCLUSIONS A tandem study is more likely to yield positive results than a simple parallel trial; this may be due to the use of different parameters, variable definitions and methodology, and perhaps also a higher likelihood of bias. Therefore, we suggest to accept positive results of tandem studies only if accompanied by positive results from parallel trials.
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Affiliation(s)
| | - Heiko Pohl
- Gastroenterology and Hepatology, VA White River Junction/Dartmout Hitchcock Medical Center, White River Junction, Vermont, USA
| | - Thomas Rösch
- Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Douglas K Rex
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indiana University Hospital, Indianapolis, Indiana, USA
| | - Cesare Hassan
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Michal Filip Kaminski
- Department of Gastroenterology, Hepatology and Oncology, Center for Postgraduate Medical Education, Warsaw, Poland
| | - Michael Bretthauer
- Clinical Effectiveness Research Group, Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.,Section of Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Jocelyn de Heer
- Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yuki Werner
- Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Guido Schachschal
- Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Sze SF, Cheung WI, Wong WC, Hui YT, Lam JTW. AmplifEYE assisted colonoscopy versus standard colonoscopy: A randomized controlled study. J Gastroenterol Hepatol 2021; 36:376-382. [PMID: 33141979 DOI: 10.1111/jgh.15331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/07/2020] [Accepted: 10/24/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIM AmplifEYE is a mucosal exposure device mounted to the tip of colonoscope to improve polyp or adenoma detection. We aim to compare the adenoma detection rates (ADR) of AmplifEYE-assisted colonoscopy (AC) with standard colonoscopy (SC). METHODS We performed a randomized controlled trial involving patients aged 50 to 79 who underwent AC or SC in two centers. Procedures were performed by five experienced colonoscopists. RESULTS Three hundred fifty-five patients were recruited, with 334 patients (170 AC and 164 SC) included into analysis. The ADR was numerically higher in AC (47.1%) versus SC (40.9%), P = 0.253. The polyp detection rate (PDR) in AC was 68.2% versus 54.3% in SC, P = 0.009, and serrated polyp detection rate (SDR) in AC was 37.6% versus 20.1% in SC, P < 0.001, both statistically significant higher in the study group. The mean cecal intubation time was shorter with AmplifEYE (8.0 min in AC vs 8.9 min in SC, P = 0.030), and there was no difference in pain score (3 in AC vs 4 in SC, P = 0.121). CONCLUSIONS AmplifEYE-assisted colonoscopy significantly improved the PDR and SDR, while the ADR was numerically higher in AC that did not reach statistical significance. Using the device resulted in shorter cecal intubation time and did not cause more pain.
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Affiliation(s)
- Shun Fung Sze
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong
| | - Wing I Cheung
- Department of Medicine and Geriatrics, Our Lady of Maryknoll Hospital, Hong Kong
| | - Wai Chuen Wong
- Department of Medicine and Geriatrics, Our Lady of Maryknoll Hospital, Hong Kong
| | - Yee Tak Hui
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong
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28
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Abdelbary M, Hamdy S, Shehab H, ElGarhy N, Menesy M, Marzaban R. Colonoscopic techniques in polyp detection: An Egyptian study. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021. [DOI: 10.1016/j.rgmxen.2020.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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29
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Aziz M, Haghbin H, Gangwani MK, Sharma S, Nawras Y, Khan Z, Chandan S, Mohan BP, Lee-Smith W, Nawras A. Efficacy of Endocuff Vision compared to first-generation Endocuff in adenoma detection rate and polyp detection rate in high-definition colonoscopy: a systematic review and network meta-analysis. Endosc Int Open 2021; 9:E41-E50. [PMID: 33403235 PMCID: PMC7775814 DOI: 10.1055/a-1293-7327] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/30/2020] [Indexed: 12/18/2022] Open
Abstract
Background and study aims Recently, the newer Endocuff Vision (ECV) has been evaluated for improving colonoscopy outcome metrics such as adenoma detection rate (ADR) and polyp detection rate (PDR). Due to lack of direct comparative studies between ECV and original Endocuff (ECU), we performed a systematic review and network meta-analysis to evaluate these outcomes. Methods The following databases were searched: PubMed, Embase, Cochrane, and Web of Sciences to include randomized controlled trials (RCTs) comparing ECV or ECU colonoscopy to high-definition (HD) colonoscopy. Direct as well as network meta-analyses comparing ADR and PDR were performed using a random effects model. Relative-risk (RR) with 95 % confidence interval (CI) was calculated. Results A total of 12 RCTs with 8638 patients were included in the final analysis. On direct meta-analysis, ECV did not demonstrate statistically improved ADR compared to HD colonoscopy (RR: 1.12, 95 % CI 0.99-1.27). A clinically and statistically improved PDR was noted for ECV compared to HD (RR: 1.15, 95 % CI 1.03-1.28) and ECU compared to HD (RR: 1.26, 95 % CI 1.09-1.46) as well as improved ADR (RR: 1.22, 95 % CI 1.05-1.43) was observed for ECU colonoscopy when compared to HD colonoscopy. These results were also consistent on network meta-analysis. Lower overall complication rates (RR: 0.14, 95 % CI 0.02-0.84) and particularly lacerations/erosions (RR: 0.11, 95 % CI 0.02-0.70) were noted with ECV compared to ECU colonoscopy. Conclusions Although safe, the newer ECV did not significantly improve ADR compared to ECU and HD colonoscopy. Further device modification is needed to increase the overall ADR and PDR.
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Affiliation(s)
- Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, Ohio, United States
| | - Hossein Haghbin
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, United States
| | - Manesh Kumar Gangwani
- Department of Internal Medicine, Mercy Hospital St. Louis, St. louis, Missouri, 63141
| | - Sachit Sharma
- Department of Internal Medicine, University of Toledo and Promedica Toledo Hospital, Toledo, Ohio, United States
| | - Yusuf Nawras
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, United States
| | - Zubair Khan
- Department of Gastroenterology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, United States
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, United States
| | - Babu P. Mohan
- Divison of Gastroenterology and Hepatology, University of Utah Healthcare, Salt Lake City, Utah, United States
| | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo Medical Center, Toledo, Ohio, United States
| | - Ali Nawras
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, Ohio, United States
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Karsenti D, Tharsis G, Perrot B, Cattan P, Tordjman G, Venezia F, Zrihen E, Gillot D, Gillet A, Hagege C, Samama J, Etienney I, Lab JP, Guigui B, Zago J, Benkessou B, Burtin P, Cavicchi M. Adenoma detection by Endocuff-assisted versus standard colonoscopy in routine practice: a cluster-randomised crossover trial. Gut 2020; 69:2159-2164. [PMID: 32209605 DOI: 10.1136/gutjnl-2019-319565] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 02/18/2020] [Accepted: 03/08/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Endocuff Vision (ECV) is the second generation of a device designed to improve polyp detection. The aim of this study was to evaluate its impact on adenoma detection rate (ADR) in routine colonoscopy. DESIGN This cluster-randomised crossover trial compared Endocuff-assisted (ECV+) with standard (ECV-) colonoscopy. Two teams of 11 endoscopists each with prior ECV experience, balanced in terms of basal ADR, gender and case volume were compared. In randomised fashion, the teams started with ECV+ or ECV- and switched group after inclusion of half of the cases. The main outcome criterion was ADR difference between ECV+ and ECV-. Subgroup analysis was done for physicians with low and high ADR (< or ≥ 25%). RESULTS During two periods of 20 and 21 weeks, respectively, the 22 endoscopists included 2058 patients (1032 ECV- vs 1026 ECV+, both groups being comparable). Overall ADR for both groups taken together was higher with ECV (39.2%) than without (29.4%; p<0.001) irrespective of the sequence of use (ECV+ or ECV- first), but mostly in adenomas <1 cm. In the physician subgroup analysis, only high detectors showed a significant ADR increase (from 31% to 41%, p<0.001), while the increase in the low detectors was not significant (from 24% to 30%, p=0.11). ECV had a positive impact in all colonic locations, except for the rectum. No ECV- related complication was reported. CONCLUSION We observed a significant ADR difference of approximately 10% by the use of ECV. By subgroup analysis, this increase was significant only in physicians classified as high detectors. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT03344055).
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Affiliation(s)
- David Karsenti
- Digestive Endoscopy Unit, Pôle Digestif Paris Bercy, Clinique Paris-Bercy, Charenton-le-Pont, France
| | - Gaelle Tharsis
- Digestive Endoscopy Unit, Pôle Digestif Paris Bercy, Clinique Paris-Bercy, Charenton-le-Pont, France
| | - Bastien Perrot
- Methodology Unit, UMR INSERM 1246 SPHERE, Université de Nantes, Université de Tours, Institut de Recherche en Santé (IRS2), Universite de Nantes, Nantes, Pays de la Loire, France
| | - Philippe Cattan
- Digestive Endoscopy Unit, Pôle Digestif Paris Bercy, Clinique Paris-Bercy, Charenton-le-Pont, France
| | - Gilles Tordjman
- Digestive Endoscopy Unit, Pôle Digestif Paris Bercy, Clinique Paris-Bercy, Charenton-le-Pont, France
| | - Franck Venezia
- Digestive Endoscopy Unit, Pôle Digestif Paris Bercy, Clinique Paris-Bercy, Charenton-le-Pont, France
| | - Elie Zrihen
- Digestive Endoscopy Unit, Pôle Digestif Paris Bercy, Clinique Paris-Bercy, Charenton-le-Pont, France
| | - Dominique Gillot
- Digestive Endoscopy Unit, Pôle Digestif Paris Bercy, Clinique Paris-Bercy, Charenton-le-Pont, France
| | - Agnes Gillet
- Digestive Endoscopy Unit, Pôle Digestif Paris Bercy, Clinique Paris-Bercy, Charenton-le-Pont, France
| | - Charles Hagege
- Digestive Endoscopy Unit, Pôle Digestif Paris Bercy, Clinique Paris-Bercy, Charenton-le-Pont, France
| | - Joelle Samama
- Digestive Endoscopy Unit, Pôle Digestif Paris Bercy, Clinique Paris-Bercy, Charenton-le-Pont, France
| | - Isabelle Etienney
- Digestive Endoscopy Unit, Pôle Digestif Paris Bercy, Clinique Paris-Bercy, Charenton-le-Pont, France
| | | | - Bernard Guigui
- Private Pathology Institute, Rue de Wattignies, Paris, France
| | | | - Bouchra Benkessou
- Digestive Endoscopy Unit, Pôle Digestif Paris Bercy, Clinique Paris-Bercy, Charenton-le-Pont, France
| | - Pascal Burtin
- Digestive Oncology, Insitut Gustave Roussy, Villejuif, Île-de-France, France
| | - Maryan Cavicchi
- Digestive Endoscopy Unit, Pôle Digestif Paris Bercy, Clinique Paris-Bercy, Charenton-le-Pont, France
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Rees CJ, Brand A, Ngu WS, Stokes C, Hoare Z, Totton N, Bhandari P, Sharp L, Bastable A, Rutter MD, Verma AM, Lee TJ, Walls M. BowelScope: Accuracy of Detection Using Endocuff Optimisation of Mucosal Abnormalities (the B-ADENOMA Study): a multicentre, randomised controlled flexible sigmoidoscopy trial. Gut 2020; 69:1959-1965. [PMID: 32245908 DOI: 10.1136/gutjnl-2019-319621] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 01/27/2020] [Accepted: 02/18/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Adenoma detection rate (ADR) is an important quality marker at lower GI endoscopy. Higher ADRs are associated with lower postcolonoscopy colorectal cancer rates. The English flexible sigmoidoscopy (FS) screening programme (BowelScope), offers a one-off FS to individuals aged 55 years. However, variation in ADR exists. Large studies have demonstrated improved ADR using Endocuff Vision (EV) within colonoscopy screening, but there are no studies within FS. We sought to test the effect of EV on ADR in a national FS screening population. DESIGN BowelScope: Accuracy of Detection Using ENdocuff Optimisation of Mucosal Abnormalities was a multicentre, randomised controlled trial involving 16 English BowelScope screening centres. Individuals were randomised to Endocuff Vision-assisted BowelScope (EAB) or Standard BowelScope (SB). ADR, polyp detection rate (PDR), mean adenomas per procedure (MAP), polyp characteristics and location, participant experience, procedural time and adverse events were measured. Comparison of ADR within the trial with national BowelScope ADR was also undertaken. RESULTS 3222 participants were randomised (53% male) to receive EAB (n=1610) or SB (n=1612). Baseline demographics were comparable between arms. ADR in the EAB arm was 13.3% and that in the SB arm was 12.2% (p=0.353). No statistically significant differences were found in PDR, MAP, polyp characteristics or location, participant experience, complications or procedural characteristics. ADR in the SB control arm was 3.1% higher than the national ADR. CONCLUSION EV did not improve BowelScope ADR when compared with SB. ADR in both arms was higher than the national ADR. Where detection rates are already high, EV is unable to improve detection further. TRIAL REGISTRATION NUMBERS NCT03072472, ISRCTN30005319 and CPMS ID 33224.
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Affiliation(s)
- Colin J Rees
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Brand
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, Gwynedd, UK
| | - Wee Sing Ngu
- Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, South Tyneside, UK
| | - Clive Stokes
- Research, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, Gloucestershire, UK
| | - Zoe Hoare
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, Gwynedd, UK
| | - Nicola Totton
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, Gwynedd, UK
| | - Pradeep Bhandari
- Gastroenterology, Portsmouth Hospitals NHS Trust, Portsmouth, Portsmouth, UK
| | - Linda Sharp
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Alexandra Bastable
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, Gwynedd, UK
| | - Matthew D Rutter
- Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Hartlepool, Hartlepool, UK.,Medicine, University of Durham, Durham, Durham, UK
| | - Ajay Mark Verma
- Gastroenterology, Kettering General Hospital NHS Foundation Trust, Kettering, Northamptonshire, UK
| | - Thomas J Lee
- Gastroenterology Research, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Martin Walls
- Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, South Tyneside, UK
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Abdelbary M, Hamdy S, Shehab H, ElGarhy N, Menesy M, Marzaban R. Colonoscopic techniques in polyp detection: An Egyptian study. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2020; 86:36-43. [PMID: 32651028 DOI: 10.1016/j.rgmx.2020.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/17/2020] [Accepted: 02/26/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION AND AIMS The polyp detection rate (PDR) is defined as the percentage of colonoscopies in which one or more polyps are detected, and has been shown to be highly correlated with the adenoma detection rate. The aim of the present study was to evaluate the PDR at the Endoscopy Unit of the Kasr Al-Ainy Hospital, Cairo University, Egypt, through the i-SCAN, Endocuff, and underwater colonoscopy techniques. MATERIALS AND METHODS The study was conducted on 100 Egyptian subjects over 50 years of age. Their polyp detection rate was measured through 4 different colonoscopic techniques. An equal number of patients were divided into 4 groups: i-SCAN, Endocuff, underwater colonoscopy, and controls. The control group was examined using standard white light colonoscopy. The colonoscopy evaluation included the type of agent utilized for bowel preparation, preparation grade, and colonoscopy withdrawal time. RESULTS The general PDR was 48%. The i-SCAN technique had the highest rate (56%), followed by the underwater (52%) and the Endocuff (48%) techniques. CONCLUSION The i-SCAN and underwater colonoscopy techniques produced higher PDR than the Endocuff-assisted and standard techniques, but with no statistical significance.
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Affiliation(s)
- M Abdelbary
- Medicina Tropical, Facultad de Medicina, Universidad de El Cairo, El Cairo, Egipto
| | - S Hamdy
- Medicina Tropical, Facultad de Medicina, Universidad de El Cairo, El Cairo, Egipto
| | - H Shehab
- Medicina Tropical, Facultad de Medicina, Universidad de El Cairo, El Cairo, Egipto
| | - N ElGarhy
- Medicina Tropical, Facultad de Medicina, Universidad de El Cairo, El Cairo, Egipto
| | - M Menesy
- Medicina Tropical, Facultad de Medicina, Universidad de El Cairo, El Cairo, Egipto
| | - R Marzaban
- Medicina Tropical, Facultad de Medicina, Universidad de El Cairo, El Cairo, Egipto.
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Ciuti G, Skonieczna-Żydecka K, Marlicz W, Iacovacci V, Liu H, Stoyanov D, Arezzo A, Chiurazzi M, Toth E, Thorlacius H, Dario P, Koulaouzidis A. Frontiers of Robotic Colonoscopy: A Comprehensive Review of Robotic Colonoscopes and Technologies. J Clin Med 2020; 9:E1648. [PMID: 32486374 PMCID: PMC7356873 DOI: 10.3390/jcm9061648] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/16/2020] [Accepted: 05/19/2020] [Indexed: 12/15/2022] Open
Abstract
Flexible colonoscopy remains the prime mean of screening for colorectal cancer (CRC) and the gold standard of all population-based screening pathways around the world. Almost 60% of CRC deaths could be prevented with screening. However, colonoscopy attendance rates are affected by discomfort, fear of pain and embarrassment or loss of control during the procedure. Moreover, the emergence and global thread of new communicable diseases might seriously affect the functioning of contemporary centres performing gastrointestinal endoscopy. Innovative solutions are needed: artificial intelligence (AI) and physical robotics will drastically contribute for the future of the healthcare services. The translation of robotic technologies from traditional surgery to minimally invasive endoscopic interventions is an emerging field, mainly challenged by the tough requirements for miniaturization. Pioneering approaches for robotic colonoscopy have been reported in the nineties, with the appearance of inchworm-like devices. Since then, robotic colonoscopes with assistive functionalities have become commercially available. Research prototypes promise enhanced accessibility and flexibility for future therapeutic interventions, even via autonomous or robotic-assisted agents, such as robotic capsules. Furthermore, the pairing of such endoscopic systems with AI-enabled image analysis and recognition methods promises enhanced diagnostic yield. By assembling a multidisciplinary team of engineers and endoscopists, the paper aims to provide a contemporary and highly-pictorial critical review for robotic colonoscopes, hence providing clinicians and researchers with a glimpse of the major changes and challenges that lie ahead.
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Affiliation(s)
- Gastone Ciuti
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pisa, Italy; (V.I.); (M.C.); (P.D.)
- Department of Excellence in Robotics & AI, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Karolina Skonieczna-Żydecka
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland;
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland;
- Endoklinika sp. z o.o., 70-535 Szczecin, Poland
| | - Veronica Iacovacci
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pisa, Italy; (V.I.); (M.C.); (P.D.)
- Department of Excellence in Robotics & AI, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Hongbin Liu
- School of Biomedical Engineering & Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London SE1 7EH, UK;
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London W1W 7TY, UK;
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, 10126 Torino, Italy;
| | - Marcello Chiurazzi
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pisa, Italy; (V.I.); (M.C.); (P.D.)
- Department of Excellence in Robotics & AI, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Lund University, 20502 Malmö, Sweden;
| | - Henrik Thorlacius
- Department of Clinical Sciences, Section of Surgery, Lund University, 20502 Malmö, Sweden;
| | - Paolo Dario
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pisa, Italy; (V.I.); (M.C.); (P.D.)
- Department of Excellence in Robotics & AI, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
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Rameshshanker R, Tsiamoulos Z, Wilson A, Rajendran A, Bassett P, Tekkis P, Saunders BP. Endoscopic cuff-assisted colonoscopy versus cap-assisted colonoscopy in adenoma detection: randomized tandem study-DEtection in Tandem Endocuff Cap Trial (DETECT). Gastrointest Endosc 2020; 91:894-904.e1. [PMID: 31836474 DOI: 10.1016/j.gie.2019.11.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/26/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Adenoma miss rate during colonoscopy is directly linked to risk of postcolonoscopy colorectal cancer. One of the reasons for missed adenomas is poor visualization of proximal folds during standard colonoscopy withdrawal. Disposable distal attachments such as the plastic cap and Endocuff (Arc Medical Design, Leeds, UK) that hold back folds appear to improve adenoma detection. The primary aim of this study was to compare adenoma detection rates between Endocuff-assisted colonoscopy (EAC) and cap-assisted colonoscopy (CAC). METHODS This is a randomized, single-center, tandem colonoscopy trial performed by the same endoscopists on the same day, first with Endocuff Vision (Arc Medical Design, Leeds, UK) followed by cap or vice versa. All procedures were performed by 3 experienced gastroenterology fellows. RESULTS One hundred fifty-four patients were recruited. Seventy-eight (50.6%) had CAC as their first procedure. Mean patient age was 61 years (male-to-female ratio, 1:1). Adenoma detection rate was significantly higher for EAC when compared to CAC (53% vs 26%, P = .001). Polyp miss rate was significantly lower in EAC (8.4%) compared with CAC (26.1%, P < .001) as was adenoma miss rate (EAC vs CAC, 6%, vs 19%; P = .002) and diminutive adenoma (<5 mm) miss rate in the EAC group (1.8% vs 19.6%, P < .001). However, there was no significant differences in the miss rates for small adenomas (5-9 mm) (3.7% vs 2.9%, P = .69) or adenomas 10 mm or larger (1.6% vs 2.6%, P = .98 ). The mean number of adenomas per procedure was significantly higher with EAC compared with CAC (1.5 vs .8, P < .001). Cecal intubation time was significantly shorter with EAC than CAC (median 6 vs 7 minutes, P = .01). Conversely, withdrawal time (median 10 vs 8 minutes, P = .01) was significantly longer in EAC. CONCLUSIONS This randomized, tandem study demonstrates that EAC has a significantly higher adenoma detection rate and lower adenoma miss rate than CAC. Although insertion times were shorter with EAC, procedures were slightly more uncomfortable, and the cuff had to be removed in a small number of cases. (Clinical trial registration number: NCT03254498.).
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Affiliation(s)
- Rajaratnam Rameshshanker
- Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, Harrow, UK; Department of Surgery and Cancer, Imperial College, London, UK
| | - Zacharias Tsiamoulos
- Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, Harrow, UK
| | - Ana Wilson
- Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, Harrow, UK
| | - Arun Rajendran
- Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, Harrow, UK
| | | | - Paris Tekkis
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Brian P Saunders
- Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, Harrow, UK
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Abstract
BACKGROUND The adenoma detection rate (ADR) is of primary importance to the quality of screening colonoscopy. An online survey was conducted to assess knowledge and practices on ADR. METHODS Paid questionnaire distributed by email. Eligible respondents were board certified gastroenterologists who perform >80 colonoscopies per month with 3 to 35 years practice after fellowship. RESULTS There were 250 respondents. In total, 39% were unaware that ADR applies only to screening colonoscopies and 76% incorrectly answered that ADR includes sessile-serrated polyps/adenomas. A total of 51% of respondents incorrectly believe the threshold is set at 25% because 25% is a national ADR average. Many also believe the threshold depends on the patient population (current evidence suggests adjusting ADR for factors other than age and sex is unnecessary). 75% ranked ADR as highly important. 80% reported tracking ADR. A busy practice was the most common reason for not tracking ADR. Caps, chromoendoscopy, and good bowel preparation were viewed as valuable for improving ADR (this is true except for caps). High-definition colonoscopes and education were considered less valuable, despite evidence indicating that both are associated with improved ADR. In total, 57% reported not sharing ADR information with their patients, and 59% reported that no patients in the last 6 months asked for their ADR. CONCLUSIONS The importance of ADR as a quality measure is well understood, but there are misconceptions among gastroenterologists regarding the definition and measurement of ADR, and which methods are proven to increase ADR. Patients are having very little impact on ADR measurement.
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Rameshshanker R, Saunders BP. Number of significant polyps detected per six-minute withdrawal time at colonoscopy (SP6): a new measure of colonoscopy efficiency and quality. Frontline Gastroenterol 2020; 11:491-493. [PMID: 33101628 PMCID: PMC7569513 DOI: 10.1136/flgastro-2019-101184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 01/02/2020] [Accepted: 01/04/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Rajaratnam Rameshshanker
- Wolfson Unit for Endoscopy, St Mark’s Hospital, Harrow, London, UK,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Brian P Saunders
- Wolfson Unit for Endoscopy, St Mark’s Hospital, Harrow, London, UK,Department of Surgery and Cancer, Imperial College London, London, UK
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Okagawa Y, Sumiyoshi T, Tomita Y, Oiwa S, Ogata F, Jin T, Yoshida M, Fujii R, Minagawa T, Morita K, Ihara H, Hirayama M, Kondo H. Endocuff-Assisted versus Cap-Assisted Colonoscopy Performed by Trainees: A Retrospective Study. Clin Endosc 2020; 53:339-345. [PMID: 31918537 PMCID: PMC7280843 DOI: 10.5946/ce.2019.124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 09/09/2019] [Indexed: 12/22/2022] Open
Abstract
Background/Aims The adenoma detection rate (ADR) of screening colonoscopies performed by trainees is often lower than that of colonoscopies performed by experts. The effcacy of cap-assisted colonoscopy (CAC) in adenoma detection is well documented, especially that of CACs performed by trainees. Endocuff, a new endoscopic cap, is reportedly useful for adenoma detection; however, no trials have compared the effcacy of Endocuff-assisted colonoscopy (EAC) and CAC conducted by trainees. Therefore, the present study retrospectively compared the effcacy between EAC and CAC in trainees.
Methods This was a single-center, retrospective study involving 305 patients who underwent either EAC or CAC performed by three trainees between January and December 2018. We evaluated the ADR, mean number of adenomas detected per patient (MAP), cecal intubation rate, cecal intubation time, and occurrence of complications between the EAC and CAC groups.
Results The ADR was significantly higher in the EAC group than in the CAC group (54.3% vs. 37.3%, p=0.019), as was the MAP (1.36 vs. 0.74, p=0.003). No significant differences were found between the groups with respect to the cecal intubation rate or cecal intubation time. No major complications occurred in either group.
Conclusions Our results suggest that EAC exhibits increased ADR and MAP compared to CAC when performed by trainees.
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Affiliation(s)
- Yutaka Okagawa
- Department of Gastroenterology, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Tetsuya Sumiyoshi
- Department of Gastroenterology, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Yusuke Tomita
- Department of Gastroenterology, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Shutaro Oiwa
- Department of Gastroenterology, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Fumihiro Ogata
- Department of Gastroenterology, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Takashi Jin
- Department of Gastroenterology, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Masahiro Yoshida
- Department of Gastroenterology, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Ryoji Fujii
- Department of Gastroenterology, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Takeyoshi Minagawa
- Department of Gastroenterology, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Kohtaro Morita
- Department of Gastroenterology, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Hideyuki Ihara
- Department of Gastroenterology, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Michiaki Hirayama
- Department of Gastroenterology, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Hitoshi Kondo
- Department of Gastroenterology, Tonan Hospital, Sapporo, Hokkaido, Japan
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Impact of a ring-fitted cap on insertion time and adenoma detection: a randomized controlled trial. Gastrointest Endosc 2020; 91:115-120. [PMID: 31299257 DOI: 10.1016/j.gie.2019.06.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/27/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Devices for flattening colon folds can improve polyp detection at colonoscopy. However, there are few data on the endoscopic ring-fitted cap (EndoRings; EndoAid, Caesarea, Israel). We sought to compare adenoma detection with EndoRings with that of standard high-definition colonoscopy. METHODS This was a single-center, randomized controlled trial of 562 patients (284 randomized to EndoRings and 278 to standard colonoscopy) at 2 outpatient endoscopy units in the Indiana University Hospital system. Adenoma detection was the primary outcome measured as adenoma detection rate (ADR) and adenomas per colonoscopy (APC). We also compared sessile serrated polyp detection rate, insertion times, withdrawal times, and ease of passage through the sigmoid colon. RESULTS EndoRings was superior to standard colonoscopy in terms of APC (1.46 vs 1.06, P = .025), but there were no statistically significant differences in ADR or sessile serrated polyp detection rate. Mean withdrawal time (in patients with no polyps) was shorter and insertion time (all patients) was longer in the EndoRings arm by 1.8 minutes and 0.75 minutes, respectively. One provider had significantly higher detection with Endo-Rings and contributed substantially to the overall results. CONCLUSIONS EndoRings can increase adenoma detection without a significant increase in procedure time, but the effect varies between operators. The use of EndoRings slows colonoscope insertion. (Clinical trial registration number: NCT03418662.).
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Pamudurthy V, Lodhia N, Konda VJA. Advances in endoscopy for colorectal polyp detection and classification. Proc (Bayl Univ Med Cent) 2019; 33:28-35. [PMID: 32063760 DOI: 10.1080/08998280.2019.1686327] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 06/03/2019] [Accepted: 06/10/2019] [Indexed: 02/08/2023] Open
Abstract
While colonoscopy is considered the gold standard for colon cancer screening, recent advancements in endoscopes have allowed for improved visualization of the colonic mucosa and improved polyp detection rates. Newer technologies also allow for assessment of structural changes for polyp discrimination and determination of histologic type. Classification of polyps prevents the need for a histopathologic report, which requires the additional time and expertise of a pathologist and adds to the overall cost. This review considered advances in endoscopic technologies reported in PubMed over the past 12 years. Technologies that allow for increased visual field of colonic mucosa and may lead to improved colon polyp detection rates include cap-assisted colonoscopy, RetroView, extra-wide-angle view colonoscope, full-spectrum endoscopy, Third Eye Retroscope, NaviAid G-EYE balloon colonoscope, EndoRings, and Endocuff. Image-enhancing methods allow for pit pattern analysis of colorectal lesions, which enables the physician to classify colorectal polyps according to certain polyp characteristics. Image-enhancing methods include chromoendoscopy, autofluorescence, and virtual chromoendoscopy, including narrow band imaging, i-SCAN, flexible spectral imaging chromoendoscopy, and STORZ professional image enhancement systems. In addition, advancements have been made in in vivo microscopic evaluation of colonic epithelium, including confocal laser endomicroscopy, endocytoscopy, optical coherence tomography, spectroscopy, and autofluorescence spectroscopy. Colon capsule endoscopy also has a role in colon polyp detection and classification. The advancements in polyp detection and classification have great promise for earlier detection and removal of advanced adenomas before they advance to colorectal cancer.
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Affiliation(s)
| | - Nayna Lodhia
- Department of Medicine, University of Chicago Medical CenterChicagoIllinois
| | - Vani J A Konda
- Section of Gastroenterology, Baylor University Medical CenterDallasTexas
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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.
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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
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Affiliation(s)
| | - Pradeep Bhandari
- Queen Alexandra Hospital, Portsmouth, United Kingdom of Great Britain and Northern Ireland,Corresponding author Professor Pradeep Bhandari Queen Alexandra Hospital – GastroenterologySouthwick Hill Road Cosham Portsmouth PO6 3LYUnited Kingdom of Great Britain and Northern Ireland+023-9228-6000
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Rex DK, Sagi SV, Kessler WR, Rogers NA, Fischer M, Bohm ME, Dewitt JM, Lahr RE, Searight MP, Sullivan AW, McWhinney CD, Garcia JR, Broadley HM, Vemulapalli KC. A comparison of 2 distal attachment mucosal exposure devices: a noninferiority randomized controlled trial. Gastrointest Endosc 2019; 90:835-840.e1. [PMID: 31319060 DOI: 10.1016/j.gie.2019.06.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/30/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Endocuff (Arc Medical Design, Leeds, UK) and Endocuff Vision (Arc Medical Design, Leeds, UK) are effective mucosal exposure devices for improving polyp detection during colonoscopy. AmplifEYE (Medivators Inc, Minneapolis, Minn, USA) is a device that appears similar to the Endocuff devices but has received minimal clinical testing. METHODS We performed a randomized controlled clinical trial using a noninferiority design to compare Endocuff Vision with AmplifEYE. RESULTS The primary endpoint of adenomas per colonoscopy was similar in AmplifEYE at 1.63 (standard deviation 2.83) versus 1.51 (2.29) with Endocuff Vision (P = .535). The 95% lower confidence limit was 0.88 for ratio of means, establishing noninferiority of AmplifEYE (P = .008). There was no difference between the arms for mean insertion time, and mean inspection time (withdrawal time minus polypectomy time and time for washing and suctioning) was shorter with AmplifEYE (6.8 minutes vs 6.9 minutes, P = .042). CONCLUSIONS AmplifEYE is noninferior to Endocuff Vision for adenoma detection. The decision on which device to use can be based on cost. Additional comparisons of AmplifEYE with Endocuff by other investigators are warranted. (Clinical trial registration number: NCT03560128.).
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Affiliation(s)
- Douglas K Rex
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sashidhar V Sagi
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | | | - Monika Fischer
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Matthew E Bohm
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - John M Dewitt
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Rachel E Lahr
- Indiana University School of Medicine, Indianapolis, Indiana, USA
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Jian HX, Feng BC, Zhang Y, Qu JY, Li YY, Zuo XL. EndoCuff-assisted colonoscopy could improve adenoma detection rate: A meta-analysis of randomized controlled trials. J Dig Dis 2019; 20:578-588. [PMID: 31429214 DOI: 10.1111/1751-2980.12814] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 08/08/2019] [Accepted: 08/16/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This meta-analysis aimed to evaluate whether EndoCuff-assisted colonoscopy (EAC) could improve adenoma detection rate (ADR) compared with standard colonoscopy (SC). METHODS PubMed, EMBASE, Scopus, Cochrane Library, and Google Scholar databases were searched for articles published up to March 2019. All pure randomized controlled trials comparing ADR between EAC and SC groups were included. Dichotomous data were pooled to obtain the odds ratio with a 95% confidence interval (CI), whereas continuous data were pooled using a mean difference with 95% CI. Review Manager Version 5.3 was used for data analysis. RESULTS Thirteen randomized controlled trials consisting of 9038 patients (EAC: 4574; SC: 4464) were included. The EAC group showed significant superiority over the SC group in ADR (odds ratio 1.37, 95% CI 1.15-1.62). However, there were no differences between the EAC and SC groups in adverse events, cecal intubation rate, and cecal intubation time. CONCLUSIONS EAC could significantly improve ADR without increasing adverse events, especially for operators with low ADRs. In addition, no significant difference was observed in cecal intubation time and cecal intubation rate between EAC and SC.
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Affiliation(s)
- Hai Xu Jian
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.,Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Bing Cheng Feng
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.,Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Yan Zhang
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.,Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Jun Yan Qu
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.,Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Yue Yue Li
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.,Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Xiu Li Zuo
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.,Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
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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.
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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
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Fang WC, Haridy J, Keung C, Van Langenberg D, Saunders BP, Garg M. Endocuff Vision is safe to use for dysplasia surveillance in patients with ulcerative colitis: a feasibility study. Endosc Int Open 2019; 7:E1044-E1048. [PMID: 31475220 PMCID: PMC6713553 DOI: 10.1055/a-0886-6421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/22/2019] [Indexed: 12/26/2022] Open
Abstract
Background and study aims Endocuff Vision improves adenoma detection rates in patients without inflammatory bowel disease. This study aimed to investigate the safety and feasibility of Endocuff Vision-assisted high-definition white light endoscopy (HDWLE) with dye-spray chromoendoscopy for detection of dysplasia in patients with ulcerative colitis. Patients and methods Patients with clinically inactive ulcerative colitis due for dysplasia surveillance were recruited. Procedural endpoints included safety, cecal intubation rate (CIR), terminal ileum intubation rate (TIR), withdrawal time, polyp detection rate, dysplasia detection rate (DDR), and sessile serrated lesion detection rate. Results Twenty-five patients (9 female, median age 57 [range 28 - 82] years) were studied. Endocuff Vision-assisted HDWLE was completed in all participants, with a CIR of 100 %, in a median 4 minutes (range 2 - 16), and a TIR of 88% in a median of 6.5 minutes (range 3 - 19). Median withdrawal time was 18 minutes (range 10 - 55), including application of dye-spray, biopsies and polypectomy. The Mayo Endoscopic subscore was 0 in 11, 1 in 9, and 2 in 5 patients. The DDR was 24 % (6 patients had a total of 12 dysplastic lesions) and sessile serrated lesion detection rate was 12 % (3 patients had a total of 4 sessile serrated polyps). No serious adverse events occurred, with one patient developing clinically insignificant minor mucosal bleeding. Conclusion Endocuff Vision-assisted HDWLE is feasible and safe in patients with ulcerative colitis undergoing dysplasia surveillance. Further studies are required to assess superiority of this technique compared with standard high-definition white light endoscopy with chromoendoscopy.
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Affiliation(s)
- Wendy C. Fang
- Department of Gastroenterology, Eastern Health, Melbourne, Australia
| | - James Haridy
- Department of Gastroenterology, Eastern Health, Melbourne, Australia
| | - Charlotte Keung
- Department of Gastroenterology, Eastern Health, Melbourne, Australia
| | - Daniel Van Langenberg
- Department of Gastroenterology, Eastern Health, Melbourne, Australia,Eastern Health Clinical School, Monash University, Melbourne, Australia
| | | | - Mayur Garg
- Department of Gastroenterology, Eastern Health, Melbourne, Australia,Eastern Health Clinical School, Monash University, Melbourne, Australia,Corresponding author Dr. Mayur Garg Eastern Health Clinical School, Monash UniversityDepartment of Gastroenterology, Eastern HealthLevel 3W, Building B, 8 Arnold St, Box Hill 3128Australia+613-9882-2159
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Lahiff C, East JE. Distal attachments for adenoma detection go head-to-head: Cap or cuff? J Gastroenterol Hepatol 2019; 34:1471-1473. [PMID: 31591791 DOI: 10.1111/jgh.14850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Conor Lahiff
- Gastrointestinal Unit, Mater Misericordiae University Hospital, Dublin, Ireland.,School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - James E East
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, UK.,Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
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Imaeda H, Yamaoka M, Ohgo H, Soma H, Ashitani K, Miyaguchi K, Tsuzuki Y, Hosoe N, Nakamoto H. Randomized control trial of adenoma detection rate in Endocuff-assisted colonoscopy versus transparent hood-assisted colonoscopy. J Gastroenterol Hepatol 2019; 34:1492-1496. [PMID: 31254485 DOI: 10.1111/jgh.14771] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 03/30/2019] [Accepted: 06/20/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Transparent hood-assisted colonoscopy (TAC) has been reported to improve the cecal insertion rate and adenoma detection rate (ADR). An endoscopic cap (Endocuff) with two rows of soft wings was recently developed to improve ADR, by flattening the mucosal folds during withdrawal. This randomized prospective control study aimed to compare ADR between Endocuff-assisted colonoscopy (EAC) and TAC. METHODS A total of 513 patients undergoing colon adenoma screening were included. EAC was performed in 256 patients and TAC in 260 patients. Cecal intubation rate, cecal intubation time, ADR, and mean adenoma number per patient (MAP) were investigated in both groups (clinical trial registration: UMIN000016278). RESULTS We excluded six patients in the EAC group and two patients in the TAC group because of colonic stenosis due to colonic adenocarcinomas. Finally, 250 patients (151 men/99 women, median age 62.1 years) were assigned to EAC and 258 patients (165 men/93 women, median age 64.3 years) were assigned to TAC. There were no significant differences in cecal intubation rate, intubation time, withdrawal time, and cleanliness score between groups. The ADR was 50.8% in EAC and 52.7% in TAC, with no significant difference (P = 0.666). The MAP was 1.35 in EAC and 1.20 in TAC, with no significant difference (P = 0.126). However, The MAP of diminutive adenomas (< 5 mm) tended to be higher in EAC than in TAC (P = 0.077). There was no significant difference in MAP in each segment between groups. CONCLUSIONS Endocuff-assisted colonoscopy might be equivalent to TAC in cecal intubation time, ADR, and MAP.
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Affiliation(s)
- Hiroyuki Imaeda
- Department of Gastroenterology, Saitama Medical University, Saitama, Japan
| | - Minoru Yamaoka
- Department of General Internal Medicine, Saitama Medical University, Saitama, Japan
| | - Hideki Ohgo
- Department of Gastroenterology, Saitama Medical University, Saitama, Japan
| | - Hiromitsu Soma
- Department of Gastroenterology, Saitama Medical University, Saitama, Japan
| | - Keigo Ashitani
- Department of General Internal Medicine, Saitama Medical University, Saitama, Japan
| | - Kazuya Miyaguchi
- Department of General Internal Medicine, Saitama Medical University, Saitama, Japan
| | - Yoshikazu Tsuzuki
- Department of Gastroenterology, Saitama Medical University, Saitama, Japan
| | - Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan
| | - Hidetomo Nakamoto
- Department of General Internal Medicine, Saitama Medical University, Saitama, Japan
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Yu TM, Tradonsky A, Tang J, Arnold RJG. Cost-effectiveness of adding Endocuff ® to standard colonoscopies for interval colorectal cancer screening. CLINICOECONOMICS AND OUTCOMES RESEARCH 2019; 11:487-504. [PMID: 31447569 PMCID: PMC6682758 DOI: 10.2147/ceor.s201328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 04/11/2019] [Indexed: 12/30/2022] Open
Abstract
Background and aims: Higher screening colonoscopy adenoma detection rates (ADRs) correlate with reduced risk of interval colorectal cancer (CRC). The Endocuff® device has been shown to improve ADRs compared to standard colonoscopy (SC). This cost-effectiveness analysis compared interval CRC screening using Endocuff®-assisted colonoscopy (EC) vs SC. Methods: A decision-analytic Markov model followed patients through screening, CRC diagnosis, progression, remission, and death. ADRs, CRC progression, and utilities were from literature. CRC incidence, stage distribution, and mortality were from the Surveillance, Epidemiology, and End Results (SEER) and SEER-Medicare linked databases. Screening and annual patient costs were from public databases and literature. Endocuff® device average sales price was applied. Lifetime device and medical costs were evaluated separately for device purchaser, health plan, and accountable care organization (ACO) perspectives. Results: Consistent use of EC instead of SC was expected to reduce lifetime risks of interval CRC and related death by 0.98% and 0.19%, respectively, preventing one case per 102 patients and one death per 526 patients. Survival and quality-of-life (QoL) improved by 0.025 life-years and 0.011 quality-adjusted life-years (QALYs) per patient on average. EC instead of SC led to incremental cost-effectiveness ratios to the device purchaser of $4,421 per life-year gained and $9,843 per QALY gained, and $199 or $87 average cost-savings per patient to the health plan or ACO, respectively. Conclusion: Endocuff® for screening colonoscopies was expected to reduce interval CRC incidence and death, improve QoL, and be cost-effective to the device purchaser and cost-saving to a health plan or ACO.
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Affiliation(s)
- Tiffany M Yu
- Department of Life Sciences, Navigant Consulting, Inc, San Francisco, CA, USA
| | - Alison Tradonsky
- Department of Life Sciences, Navigant Consulting, Inc, San Francisco, CA, USA
| | - Jun Tang
- Department of Life Sciences, Navigant Consulting, Inc, San Francisco, CA, USA
| | - Renée JG Arnold
- Department of Life Sciences, Navigant Consulting, Inc, San Francisco, CA, USA
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Allescher HD, Weingart V. Optimizing Screening Colonoscopy: Strategies and Alternatives. Visc Med 2019; 35:215-225. [PMID: 31602382 DOI: 10.1159/000501835] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 06/27/2019] [Indexed: 12/11/2022] Open
Abstract
Screening colonoscopy is the most effective screening procedure for the prevention of colorectal cancer. The efficacy of colonoscopy is highly dependent on the overall quality of how this procedure is indicated, planned, prepared, and performed. The quality is directly linked to the number of polyps and/or adenomas detected or, in other words, to the number of polyps or adenomas missed during the procedure. The quality has a direct impact on the rate of interval carcinoma and on the range of how the incidence and occurrence of colorectal cancer is reduced. This review summarizes the current status on general measures and procedure improvements and standards as well as technical advances which have been suggested and established to improve the quality of polyp and adenoma detection rate. This includes selection and preparation of the patients, planning, methodological and technical performance of the procedure, and technical advances of the endoscope technology in order to improve screening results. It also covers new technologies with wide angle endoscopes (Ewave) and IT-based approaches using artificial intelligence to such as ai4GI for the polyp detection and image analysis.
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Affiliation(s)
- Hans-Dieter Allescher
- Department of Gastroenterology, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany
| | - Vincens Weingart
- Department of Gastroenterology, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany
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Jacob A, Schafer A, Yong J, Tonkin D, Rodda D, Eteuati J, Ganesh S, Hewett P. Endocuff Vision‐assisted colonoscopy: a randomized controlled trial. ANZ J Surg 2019; 89:E174-E178. [DOI: 10.1111/ans.15067] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/16/2018] [Accepted: 12/16/2018] [Indexed: 01/16/2023]
Affiliation(s)
- Abraham Jacob
- Colorectal Surgical UnitThe University of Adelaide Adelaide South Australia Australia
- Department of SurgeryThe Queen Elizabeth Hospital Adelaide South Australia Australia
- Colorectal Surgical Unit, Department of SurgeryRoyal Perth Hospital Perth Western Australia Australia
| | - Amy Schafer
- Colorectal Surgical UnitThe University of Adelaide Adelaide South Australia Australia
- Department of SurgeryThe Queen Elizabeth Hospital Adelaide South Australia Australia
| | - Johnathan Yong
- Colorectal Surgical UnitThe University of Adelaide Adelaide South Australia Australia
- Department of SurgeryThe Queen Elizabeth Hospital Adelaide South Australia Australia
| | - Darren Tonkin
- Colorectal Surgical UnitThe University of Adelaide Adelaide South Australia Australia
- Department of SurgeryThe Queen Elizabeth Hospital Adelaide South Australia Australia
| | - David Rodda
- Colorectal Surgical UnitThe University of Adelaide Adelaide South Australia Australia
- Department of SurgeryThe Queen Elizabeth Hospital Adelaide South Australia Australia
| | - Jimmy Eteuati
- Colorectal Surgical UnitThe University of Adelaide Adelaide South Australia Australia
- Department of SurgeryThe Queen Elizabeth Hospital Adelaide South Australia Australia
| | - Shanthan Ganesh
- Colorectal Surgical UnitThe University of Adelaide Adelaide South Australia Australia
- Department of SurgeryThe Queen Elizabeth Hospital Adelaide South Australia Australia
| | - Peter Hewett
- Colorectal Surgical UnitThe University of Adelaide Adelaide South Australia Australia
- Department of SurgeryThe Queen Elizabeth Hospital Adelaide South Australia Australia
| |
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