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Kim HJ, Yoon H, Lee JW. [Efficacy of Second Forward-View Colonoscopy to Improve Adenoma Detection of Right-Side Colon: Systematic Review and Meta-Analysis]. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2024; 84:265-273. [PMID: 39716948 DOI: 10.4166/kjg.2024.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Revised: 10/13/2024] [Accepted: 10/14/2024] [Indexed: 12/25/2024]
Abstract
Background/Aims The second forward view (SFV) has been considered an effective method to improve the adenoma detection rate (ADR) in the right-side colon. On the other hand, there is insufficient evidence on how much the ADR is improved compared to standard one forward view (OFV) colonoscopy. A systematic review and meta-analysis were performed to determine the efficacy of improvement in the ADR by SFV colonoscopy. Methods This study conducted a systematic literature search in Medline, Embase, and Cochrane Library until Sep 2024. Two independent investigators (HJK, JWL) conducted a database search, and studies regarding the SFV or retroflexion were selected. The primary outcomes were the ADR of the right-side colon, polyp detection rate, and withdrawal time. Statistical analyses were performed using STATA 18.0 Special edition. Results Ten studies with 5,886 patients were included in this review. The pooled ADR of SFV colonoscopy for the right colon was significantly higher than that of the OFV, with a risk ratio (RR) of 1.25 (95% CI, 1.13-1.38 I2=0.0%). This result was statistically significant in three non-randomized trials (RR 1.19, 95% CI 1.06-1.34, I2=0.0%) with low heterogeneity. The right-sided polyp detection rate (RR 1.19, 95% CI 1.06-1.34, I2=61.6%) and the ADR of the whole colon (RR 1.10, 95% CI 1.01-1.20, I2=0.0%) were also significantly higher than those of OFV colonoscopy. Conclusions SFV colonoscopy is an effective method to improve the ADR of the right colon.
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Affiliation(s)
- Hyun Jung Kim
- Institute for Evidence-based Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Hyuk Yoon
- Department of Internal, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Won Lee
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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2
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Shaukat A, Tuskey A, Rao VL, Dominitz JA, Murad MH, Keswani RN, Bazerbachi F, Day LW. Interventions to improve adenoma detection rates for colonoscopy. Gastrointest Endosc 2022; 96:171-183. [PMID: 35680469 DOI: 10.1016/j.gie.2022.03.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/25/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Aasma Shaukat
- Division of Gastroenterology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Anne Tuskey
- Division of Gastroenterology, Department of Medicine, University of Virginia, Arlington, Virginia, USA
| | - Vijaya L Rao
- Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Jason A Dominitz
- Division of Gastroenterology, Department of Medicine, Puget Sound Veterans Affairs Medical Center and University of Washington, Seattle, Washington, USA
| | - M Hassan Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rajesh N Keswani
- Division of Gastroenterology, Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Fateh Bazerbachi
- Division of Gastroenterology, CentraCare, Interventional Endoscopy Program, St Cloud, Minnesota, USA
| | - Lukejohn W Day
- Division of Gastroenterology, Department of Medicine, Zuckerberg San Francisco General Hospital and University of San Francisco, San Francisco, California, USA
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Turshudzhyan A, Rezaizadeh H, Tadros M. Lessons learned: Preventable misses and near-misses of endoscopic procedures. World J Gastrointest Endosc 2022; 14:302-310. [PMID: 35719899 PMCID: PMC9157695 DOI: 10.4253/wjge.v14.i5.302] [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: 11/04/2021] [Revised: 12/30/2021] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
Endoscopy is a complex procedure that requires advanced training and a highly skilled practitioner. The advances in the field of endoscopy have made it an invaluable diagnostic tool, but the procedure remains provider dependent. The quality of endoscopy may vary from provider to provider and, as a result, is not perfect. Consequently, 11.3% of upper gastrointestinal neoplasms are missed on the initial upper endoscopy and 2.1%-5.9% of colorectal polyps or cancers are missed on colonoscopy. Pathology is overlooked if endoscopic exam is not done carefully, bypassing proper visualization of the scope's entry and exit points or, if exam is not taken to completion, not visualizing the most distal bowel segments. We hope to shed light on this issue, establish areas of weakness, and propose possible solutions and preventative measures.
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Affiliation(s)
- Alla Turshudzhyan
- Department of Medicine, University of Connecticut, Farmington, CT 06030, United States
| | - Houman Rezaizadeh
- Department of Gastroenterology and Hepatology, University of Connecticut, Farmington, CT 06030, United States
| | - Micheal Tadros
- Department of Gastroenterology and Hepatology, Albany Medical College, Albany, NY 12208, United States
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Vemulapalli KC, Lahr RE, Lee CJ, Abdullah N, Rex DK. Yield of a second right colon examination during colonoscopy after a first examination using a mucosal exposure device. Gastrointest Endosc 2022; 95:149-154.e1. [PMID: 34284026 DOI: 10.1016/j.gie.2021.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/08/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Double right colon examination during colonoscopy has been advocated to reduce the risk of interval cancer in the right colon. Whether 2 examinations are necessary when the first examination is performed with a mucosal exposure device is uncertain. We documented the rates of missed adenomas, sessile serrated lesions, and hyperplastic polyps after an initial right colon examination by a high-level detector using a mucosal exposure device. METHODS At a single tertiary hospital outpatient practice, we prospectively collected data on the yield of a second examination of the right colon after an initial examination by a single high-detecting colonoscopist using a mucosal exposure device. RESULTS During the study period, 1331 eligible consecutive patients underwent colonoscopy. Right colon adenoma, sessile serrated lesion, and hyperplastic polyp miss rates were 15.8%, 14.1%, and 16.7%, respectively. Four percent of patients had adenomas detected in the right colon only with a second examination. CONCLUSIONS A second examination of the right colon is warranted, even when using a distal mucosal exposure device to perform colonoscopy.
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Affiliation(s)
- Krishna C Vemulapalli
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Rachel E Lahr
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Christopher J Lee
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Noor Abdullah
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Douglas K Rex
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Almario CV, Shergill J, Oh J. Measuring and Improving Quality of Colonoscopy for Colorectal Cancer Screening. TECHNIQUES AND INNOVATIONS IN GASTROINTESTINAL ENDOSCOPY 2022; 24:269-283. [PMID: 36778081 PMCID: PMC9910391 DOI: 10.1016/j.tige.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Colorectal cancer (CRC) is largely preventable, yet it remains a major public health issue as it is the third most common and deadly malignancy in the United States. While there are many ways to screen for CRC, colonoscopy remains the gold standard as it is the only test that is both cancer-detecting and cancer-preventing through removal of precancerous polyps. Through identifying and removing neoplastic lesions, colonoscopy reduces CRC incidence by 31%-91% and CRC mortality by 65%-88%. However, colonoscopy is not an infallible test-there is a chance for missed lesions during the exam and there is substantial variation in outcomes among endoscopists. To enhance the quality of colonoscopic exams, and ultimately to improve CRC outcomes, quality indicators have been developed for measuring endoscopists' performance. In this review, we describe the colonoscopic quality indicators and benchmarks recommended by the American Society for Gastrointestinal Endoscopy/American College of Gastroenterology Task Force on Quality in Endoscopy for screening colonoscopies in average-risk individuals. Measuring and monitoring endoscopists' performance on these measures are critical first steps in striving toward conducting high quality exams. We also review the evidence for interventions that aim to improve critical measures including adenoma detection rate, withdrawal time, cecal intubation, and bowel preparation quality. Finally, we provide a preview of the forthcoming Advancing Care for Appropriate Colon Health Merit-Based Incentive Payment System Value Pathway by the Centers for Medicare & Medicaid Services and its potential impact on clinical practice.
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Affiliation(s)
- Christopher V. Almario
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California;,Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California;,Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California;,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California;,Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, California;,Cancer Prevention & Control Program, Cedars-Sinai Cancer, Los Angeles, California
| | - Jaspreet Shergill
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Janice Oh
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
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Lv XH, Lu Q, Sun YN, Deng K, Yang JL. Retroflexed view for reexamination of the right colon after forward view examination: Systematic review and meta-analysis. Dig Endosc 2022; 34:33-42. [PMID: 34075629 DOI: 10.1111/den.14052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/15/2021] [Accepted: 05/30/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The effect of retroflexed view (RV) for the reexamination of the right colon after forward view (FV) examination has not been fully understood. METHODS We searched multiple databases including PubMed, Embase, and the Cochrane Library for prospective studies exploring the role of RV for reexamination of the right colon. A meta-analysis was performed on outcomes including lesion detection rates, lesion miss rates, and withdrawal time. RESULTS Four randomized controlled trials aimed to compare the impact of the second withdrawal from the right colon in RV vs. FV following a standard colonoscopy. Both the additional adenoma detection rate (AADR) and additional polyp detection rate (APDR) of the right colon were lower in the RV group compared with the FV group (risk ratio [RR] 0.73 for AADR; RR 0.76 for APDR); similar results were noted in comparisons of the adenoma miss rate and polyp miss rate. Six prospective cohort studies aimed to describe the effect of the RV examination of the right colon after one or two rounds of FV examination. Both the adenoma detection rate (ADR) and polyp detection rate (PDR) of the right colon were slightly higher in combined examinations with RV examination than single FV examination (RR 1.11 for ADR; RR 1.16 for PDR) or two FV examinations (RR 1.21 for ADR; RR 1.22 for PDR). CONCLUSIONS FV may detect more adenomas and polyps than RV during the second withdrawal from the right colon. RV may detect additional adenomas and polyps in the right colon after two FV examinations.
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Affiliation(s)
- Xiu-He Lv
- Department of Gastroenterology and Hepatology,, West China Hospital of Sichuan University, Chengdu, China.,Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital of Sichuan University, Chengdu, China
| | - Qing Lu
- Department of Gastroenterology and Hepatology,, West China Hospital of Sichuan University, Chengdu, China.,Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital of Sichuan University, Chengdu, China
| | - Yi-Ning Sun
- Department of Gastroenterology and Hepatology,, West China Hospital of Sichuan University, Chengdu, China.,Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital of Sichuan University, Chengdu, China
| | - Kai Deng
- Department of Gastroenterology and Hepatology,, West China Hospital of Sichuan University, Chengdu, China.,Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital of Sichuan University, Chengdu, China
| | - Jin-Lin Yang
- Department of Gastroenterology and Hepatology,, West China Hospital of Sichuan University, Chengdu, China.,Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital of Sichuan University, Chengdu, China
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Kim SY, Lee SJ, Chung JW, Kwon KA, Kim KO, Kim YJ, Kim JH, Park DK. Efficacy of repeat forward-view examination of the right-sided colon during colonoscopy: A prospective randomized controlled trial. J Gastroenterol Hepatol 2020; 35:1746-1752. [PMID: 32267568 DOI: 10.1111/jgh.15064] [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: 12/12/2019] [Revised: 03/29/2020] [Accepted: 04/01/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND AIM Generally, colonoscopy is less effective for detecting colorectal adenomas in the right-sided colon compared with the distal colon. Repeat forward-view (RF) examination of the right-sided colon has been suggested to increase the adenoma detection rate (ADR). However, studies investigating the efficacy of RF examination are lacking. Thus, the aim of this study was to determine whether RF examination in the right-sided colon enhances right-sided ADR. METHODS We performed a prospective, randomized controlled trial, including asymptomatic subjects who underwent screening colonoscopy. Subjects were randomized to the RF group, in which the right-sided colon was examined twice in the forward view, or to the standard forward-view (SF) group, in which the right-sided colon was examined once in the forward view. The primary outcome was the right-sided ADR on RF examination of the right-sided colon. RESULTS A total of 640 subjects completed the study protocol (RF group, n = 320; SF group, n = 320). The right-sided ADR in the RF group was significantly higher than that in the SF group (17.5% vs 11.9%, respectively; P = 0.044). In the RF group, an additional 31 adenomas were found, resulting in an increased detection rate of adenomas of 38.3% compared with the first forward view. The ADR of the whole colon was similar between the groups. CONCLUSIONS In our prospective randomized controlled trial, RF examination of the right-sided colon, which can be easily performed in clinical practice, was associated with an increased rate of detection of right-sided ADR.
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Affiliation(s)
- Su Young Kim
- Divison of Gastroenterology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Sang Jin Lee
- Divison of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, South Korea
| | - Jun-Won Chung
- Divison of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, South Korea
| | - Kwang An Kwon
- Divison of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, South Korea
| | - Kyoung Oh Kim
- Divison of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, South Korea
| | - Yoon Jae Kim
- Divison of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, South Korea
| | - Jung Ho Kim
- Divison of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, South Korea
| | - Dong Kyun Park
- Divison of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, South Korea
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8
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Aziz M, Fatima R, Dong C, Lee-Smith W, Nawras A. The impact of deep convolutional neural network-based artificial intelligence on colonoscopy outcomes: A systematic review with meta-analysis. J Gastroenterol Hepatol 2020; 35:1676-1683. [PMID: 32267558 DOI: 10.1111/jgh.15070] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/29/2020] [Accepted: 04/05/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM The utility of artificial intelligence (AI) in colonoscopy has gained popularity in current times. Recent trials have evaluated the efficacy of deep convolutional neural network (DCNN)-based AI system in colonoscopy for improving adenoma detection rate (ADR) and polyp detection rate (PDR). We performed a systematic review and meta-analysis of the available studies to assess the impact of DCNN-based AI-assisted colonoscopy in improving the ADR and PDR. METHODS We queried the following database for this study: PubMed, Embase, Cochrane Library, Web of Sciences, and Computers and Applied Sciences. We only included randomized controlled trials that compared AI colonoscopy to standard colonoscopy (SC). Our outcomes included ADR and PDR. Risk ratios (RR) with 95% confidence interval (CI) were calculated using random effects model and DerSimonian-Laird approach for each outcome. RESULTS A total of three studies with 2815 patients (1415 in SC group and 1400 in AI group) were included. AI colonoscopy resulted in significantly improved ADR (32.9% vs 20.8%, RR: 1.58, 95% CI 1.39-1.80, P = < 0.001) and PDR (43.0% vs 27.8%, RR: 1.55, 95% CI 1.39-1.72, P = < 0.001) compared with SC. CONCLUSION Given the results and limitations, the utility of AI colonoscopy holds promise and should be evaluated in more randomized controlled trials across different population, especially in patients solely undergoing colonoscopy for screening purpose as improved ADR will ultimately help in reducing incident colorectal cancer.
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Affiliation(s)
- Muhammad Aziz
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Rawish Fatima
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Charles Dong
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Ali Nawras
- Department of Gastroenterology, University of Toledo Medical Center, Toledo, Ohio, USA
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Rath T, Pfeifer L, Neufert C, Kremer A, Leppkes M, Hoffman A, Neurath MF, Zopf S. Retrograde inspection vs standard forward view for the detection of colorectal adenomas during colonoscopy: A back-to-back randomized clinical trial. World J Gastroenterol 2020; 26:1962-1970. [PMID: 32390706 PMCID: PMC7201142 DOI: 10.3748/wjg.v26.i16.1962] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/26/2020] [Accepted: 04/17/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The adenoma detection rate (ADR) is inversely associated with the incidence of interval colorectal cancer and serves as a benchmark quality criterion during screening colonoscopy. However, adenoma miss rates reach up to 26% and studies have shown that a second inspection of the right colon in retroflected view (RFV) can increase ADR. AIM To assess whether inspection of the whole colon in RFV compared to standard forward view (SFV) can increase ADR. METHODS Patients presenting for screening or surveillance colonoscopy were invited to participate in this randomized controlled trial and randomized into two arms. In RFV arm colonoscopy was initially performed with SFV, followed by a second inspection of the whole colon in RFV. In the SFV arm first withdrawal was performed with SFV, followed by a second inspection of the whole colon again with SFV. Number, size and morphology of polyps found during first and second inspection in each colonic segment were recorded and all polyps were removed and sent for histopathology in separate containers. RESULTS Two hundred and five patients were randomly assigned to the RFV (n = 101) and SFV (n = 104) arm. In the RFV arm, both polyp detection rate (PDR) and ADR were increased under second inspection in RFV (PDR 1st SFV: 39.8%, PDR 2nd RFV: 46.6%; ADR 1st SFV: 35.2%, ADR 2nd RFV: 42%). Likewise, in the SFV arm, PDR and ADR were increased under second inspection (PDR 1st SFV: 37.5%, PDR 2nd SFV: 46.6%; ADR 1st SFV: 34.1%, ADR 2nd SFV: 44.3%) with no significant differences in ADR and PDR between the SFV and RFV arm. Mean number of adenomas per patient (APP) was increased in the RFV and SFV (APP RFV arm: 1st SFV: 1.71; 2nd RFV: 2.38; APP SFV arm: 1st SFV: 1.83, 2nd SFV:2.2). The majority of adenomas additionally found during second inspection in RFV or in SFV were located in the transverse and left-sided colon and were > 5 mm in size. CONCLUSION Second inspection of the whole colon leads to increased adenoma detection with no differences between SFV and RFV. Hence, increased detection is most likely a feature of the second inspection itself but not of the inspection mode.
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Affiliation(s)
- Timo Rath
- Department of Internal Medicine 1, Division of Gastroenterology, Ludwig Demling Endoscopy Center of Excellence, Friedrich-Alexander-University, Erlangen Nuernberg, Erlangen 91054, Germany
| | - Lukas Pfeifer
- Department of Internal Medicine 1, Division of Gastroenterology, Ludwig Demling Endoscopy Center of Excellence, Friedrich-Alexander-University, Erlangen Nuernberg, Erlangen 91054, Germany
| | - Clemens Neufert
- Department of Internal Medicine 1, Division of Gastroenterology, Ludwig Demling Endoscopy Center of Excellence, Friedrich-Alexander-University, Erlangen Nuernberg, Erlangen 91054, Germany
| | - Andreas Kremer
- Department of Internal Medicine 1, Division of Gastroenterology, Ludwig Demling Endoscopy Center of Excellence, Friedrich-Alexander-University, Erlangen Nuernberg, Erlangen 91054, Germany
| | - Moritz Leppkes
- Department of Internal Medicine 1, Division of Gastroenterology, Ludwig Demling Endoscopy Center of Excellence, Friedrich-Alexander-University, Erlangen Nuernberg, Erlangen 91054, Germany
| | - Arthur Hoffman
- Department of Internal Medicine, Division of Gastroenterology, Klinikum Aschaffenburg, Aschaffenburg 63739, Germany
| | - Markus F Neurath
- Department of Internal Medicine 1, Division of Gastroenterology, Ludwig Demling Endoscopy Center of Excellence, Friedrich-Alexander-University, Erlangen Nuernberg, Erlangen 91054, Germany
| | - Steffen Zopf
- Department of Internal Medicine, Division of Gastroenterology, Klinikum Fürth, Fürth 90766, Germany
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Tseng CW, Leung FW, Hsieha YH. Impact of new techniques on adenoma detection rate based on meta-analysis data. Tzu Chi Med J 2020; 32:131-136. [PMID: 32269944 PMCID: PMC7137362 DOI: 10.4103/tcmj.tcmj_148_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/25/2019] [Accepted: 09/16/2019] [Indexed: 11/28/2022] Open
Abstract
The high incidence of colorectal cancer and the occurrence of interval cancers after screening colonoscopy support the need to develop methods to increase adenoma detection rate (ADR). This review focuses on the importance of ADR and the impact of new techniques on ADR based on meta-analysis data. The low-cost interventions (such as water-aided colonoscopy, second observation, and dynamic position change) were effective in increasing ADR. So were enhanced imaging techniques and add-on devices. Increase with higher cost interventions such as newer scopes is uncertain. Water exchange (WE) has the highest ADR compared with water immersion, air insufflation, and carbon dioxide insufflation. Second observation with forward or retroflexed views improved the right colon ADR. Add-on devices result in only modest improvement in ADR, of particular help in low performing endoscopists. The second-generation narrow-band imaging (NBI) provided a two-fold brighter image than the previous system. The improvement in ADR with NBI required the "best" quality bowel preparation. New endoscopic techniques incur various additional costs, nil for WE, small for tip attachments but large for the newer scopes. In conclusion, one or more of the above methods to improve ADR may be applicable in Taiwan. A comparison of these approaches to determine which is the most cost-effective is warranted.
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Affiliation(s)
- Chih-Wei Tseng
- Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Felix W. Leung
- Department of Medicine, Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hill, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Yu-Hsi Hsieha
- Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
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Buerger M, Kasper P, Allo G, Gillessen J, Schramm C. Ileal intubation is not associated with higher detection rate of right-sided conventional adenomas and serrated polyps compared to cecal intubation after adjustment for overall adenoma detection rate. BMC Gastroenterol 2019; 19:190. [PMID: 31730463 PMCID: PMC6858714 DOI: 10.1186/s12876-019-1111-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 11/07/2019] [Indexed: 12/24/2022] Open
Abstract
Background High cecal intubation rate (CIR) is associated with significant improved adenoma detection rate (ADR), however, self-reported CIR may be overestimated and inadequate documentation of cecal intubation is associated with a lower polyp detection rate compared to clear documentation. We aimed to investigate if ileal intubation may be associated with higher detection rates (DR) for right-sided conventional adenomas (cAD) and serrated polyps (SP) compared to cecal intubation in a large screening colonoscopy cohort. Material and methods Retrospective analysis of individuals ≥50 years with average risk for colorectal cancer (CRC) who underwent screening colonoscopy between 01/01/2012 and 14/12/2016 at a tertiary academic hospital and six community-based private practices. Exclusion criteria were conditions with increased risk for CRC (e.g. inflammatory bowel disease, history of CRC, hereditary cancer syndromes), previous colonoscopy at the same institution, and incomplete procedures. Right-sided colon was defined as caecum and ascending colon. Results 4.138 individuals were analysed (mean age 62 years, 52.1% female). DR for right-sided cADs and SPs were significantly higher after ileal compared to cecal intubation in univariate (12.5% vs. 6.8%, p < 0.001, and 6.3% vs. 3.3%, p < 0.001), but not in multivariate analysis (OR 1.025, 95%-CI 0.639–1.646, p = 0.918, and OR 0.937, 95%-CI 0.671–1.309, p = 0.704). DRs did not differ between ileal and cecal intubation for endoscopists with ADR ≥25 and < 25%, respectively. ADR ≥25% was significantly associated with ileal intubation (OR 21.862, 95%-CI 18.049–26.481, p < 0.001). Conclusion Ileal intubation may not provide any benefit over cecal intubation concerning the detection of cADs and SPs in the right-sided colon.
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Affiliation(s)
- Martin Buerger
- Department for Gastroenterology and Hepatology, Faculty of Medicine and University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Philipp Kasper
- Department for Gastroenterology and Hepatology, Faculty of Medicine and University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Gabriel Allo
- Department for Gastroenterology and Hepatology, Faculty of Medicine and University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Johannes Gillessen
- Department for Gastroenterology and Hepatology, Faculty of Medicine and University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Christoph Schramm
- Department for Gastroenterology and Hepatology, Faculty of Medicine and University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
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Sun M, Liu J, Hu H, Guo P, Shan Z, Yang H, Wang J, Xiao W, Zhou X. A novel panel of stool-based DNA biomarkers for early screening of colorectal neoplasms in a Chinese population. J Cancer Res Clin Oncol 2019; 145:2423-2432. [PMID: 31456088 DOI: 10.1007/s00432-019-02992-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/27/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE The mortality of colorectal cancer ranked fifth in China according to cancer statistics in 2015. Cancer screening had been repeatedly proved to play a vital role in decreasing the incidence and mortality of colorectal cancer, but the existing screening methods could not meet the requirements. So it is of urgent need to develop a non-invasive, convenient and accurate screening method. METHODS In this study, stool samples were collected from 102 colorectal cancer, 20 colorectal adenoma, 6 hyperplastic polyps patients and 105 normal controls, and stool DNA was extracted for detection of methylation (BMP3, NDRG4, SDC2 and SFRP2) and KRAS mutations. Meanwhile, hemoglobin in stool samples was detected by immunoassays. Then, the logistic regression model used for classification was built with these biomarkers, and a ROC curve was drawn to evaluate the performance of each biomarker and the panel of them. Meanwhile, conventional serum biomarkers were detected for the comparison of positive rate in colorectal cancer between serum biomarkers and stool DNA biomarkers. RESULTS As a result, a classification model built with methylation of SDC2 and SFRP2, KRAS mutations and hemoglobin showed a sensitivity of 91.4% for colorectal cancer and 60% for adenoma with the specificity of 86.1%. Compared with it, most of the conventional serum biomarkers showed a sensitivity of less than 20% for colorectal cancer which was significantly lower than stool DNA biomarkers. CONCLUSIONS A novel panel comprised of stool DNA biomarkers was of much higher sensitivity and specificity in early screening of colorectal neoplasms than conventional serum biomarkers.
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Affiliation(s)
- Minghao Sun
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
| | - Jie Liu
- 1Gene Bio-tech Co., Ltd., Hangzhou, 310026, Zhejiang, China
| | - Hao Hu
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
| | - Peng Guo
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
| | - Zhili Shan
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
| | - Hengying Yang
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
| | - Junyi Wang
- 1Gene Bio-tech Co., Ltd., Hangzhou, 310026, Zhejiang, China
| | - Wen Xiao
- 1Gene Bio-tech Co., Ltd., Hangzhou, 310026, Zhejiang, China.
| | - Xiaojun Zhou
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China.
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13
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Maida M, Morreale G, Sinagra E, Ianiro G, Margherita V, Cirrone Cipolla A, Camilleri S. Quality measures improving endoscopic screening of colorectal cancer: a review of the literature. Expert Rev Anticancer Ther 2019; 19:223-235. [PMID: 30614284 DOI: 10.1080/14737140.2019.1565999] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 01/04/2019] [Indexed: 02/09/2023]
Abstract
Colorectal cancer (CRC) is a major health-care problem all over the world and CRC screening is effective in reducing mortality and increasing the 5-year survival. Colonoscopy has a central role in CRC screening. It can be performed as a primary test, as a recall policy after a positive result of another screening test, and for surveillance. Since effectiveness of endoscopic screening depends on adequate detection and removal of colonic polyps, consistent quality measures, which are useful in enhancing the diagnostic yield of examination, are essential. Areas covered: The aim of this review is to analyze current evidence from literature supporting quality measures able to refine endoscopic screening of colorectal cancer. Expert commentary: Quality measures namely a) time slot allotted to colonoscopy, b) assessment of indication, c) bowel preparation, d) Cecal intubation, e) withdrawal time, f) adenoma detection rate, g) proper management of lesions (polypectomy technique, polyps retrieval rate and tattooing of resection sites), and h) adequate follow-up intervals play a key role in identifying malignant and at-risk lesions and improving the outcome of screening. Adherence to these quality measures is critical to maximize the effectiveness of CRC screening, as well as, a proper technique of colonoscopy and a quality report of the procedure. Among all recommended measures, adenoma detection rate is the most important and must be kept above the recommended quality threshold by all physicians practicing in the setting of screening.
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Affiliation(s)
- Marcello Maida
- a Section of Gastroenterology , S.Elia - Raimondi Hospital , Caltanissetta , Italy
| | - Gaetano Morreale
- a Section of Gastroenterology , S.Elia - Raimondi Hospital , Caltanissetta , Italy
| | - Emanuele Sinagra
- b Gastroenterology and Endoscopy Unit , Fondazione Istituto San Raffaele Giglio , Cefalù , Italy
| | - Gianluca Ianiro
- c Internal Medicine, Gastroenterology & Liver Unit , Università Cattolica Sacro Cuore , Rome , Italy
| | - Vito Margherita
- d Section of Public Health Epidemiology and Preventive Medicine , S.Elia-Raimondi Hospital , Caltanissetta , Italy
| | - Alfonso Cirrone Cipolla
- d Section of Public Health Epidemiology and Preventive Medicine , S.Elia-Raimondi Hospital , Caltanissetta , Italy
| | - Salvatore Camilleri
- a Section of Gastroenterology , S.Elia - Raimondi Hospital , Caltanissetta , Italy
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14
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Desai M, Bilal M, Hamade N, Gorrepati VS, Thoguluva Chandrasekar V, Jegadeesan R, Gupta N, Bhandari P, Repici A, Hassan C, Sharma P. Increasing adenoma detection rates in the right side of the colon comparing retroflexion with a second forward view: a systematic review. Gastrointest Endosc 2019; 89:453-459.e3. [PMID: 30222971 DOI: 10.1016/j.gie.2018.09.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 09/07/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Right-sided lesions are often missed during standard colonoscopy (SC). A second forward-view examination or retroflexion in the right side of the colon have both been proposed as techniques to improve adenoma detection rate (ADR) in the right side of the colon. Comparative data on examining the right side of the colon with a second forward view or retroflexion is not known in a pooled analysis. We performed a systematic review of the literature to assess the yield of a second forward view compared with retroflexion examination for the detection of right-sided adenomas. METHODS A systematic literature search was performed using the following databases: PubMed, Embase, Web of Science, and Cochrane. Only full-length published articles that provided information on adenoma detection and miss rates during either a second forward view or retroflexed view of the right side of the colon after the initial standard forward withdrawal (SC) were included. The following outcomes were assessed: comparison of adenoma miss rate (AMR) for second forward view versus retroflexion after SC, AMR of SC compared with second forward view, AMR of SC compared with retroflexion, and right-sided adenoma detection with second forward view and retroflexion. Pooled rates were reported as risk difference or odds ratios (OR) with 95% confidence intervals (CI) with a P value <.05 indicating statistical significance. Statistical analysis was performed with Review Manager v5.3. RESULTS We identified 4 studies with 1882 patients who underwent a second forward view of the right side of the colon after an initial SC. The average age of the patients was 58.3 years. Data on right-sided ADR were available from all 4 studies for the second forward view; however, only 2 of the studies provided information on right-sided ADR with retroflexion. The pooled estimate of AMR of a single SC was 13.3% (95% CI, 6.6%-20%) compared with a second forward-view examination (n = 4), whereas it was 8.1% (3.7%-12.5%) compared with a retroflexion examination (n = 3). However, when the second forward view was compared with retroflexion in terms of AMR from an analysis of 3 eligible studies, there was no statistically significant difference (7.3% vs 6.3%; pooled OR, 1.2; 95% CI, 0.9-1.61; P = .21). Second forward view of the right side of the colon increased the right-sided ADR by 10% (n = 4; second forward view vs SC, 33.6% vs 26.7%) with a pooled risk difference of 0.09 (95% CI, 0.03-0.15; P < .01). Retroflexion increased the right-sided ADR by 6% (n = 3; retroflexion vs SC, 28.4% vs 22.7%) with a pooled risk difference of 0.06 (95% CI, 0.03-0.09; P < 01). CONCLUSION After SC withdrawal, a second forward view and retroflexed view of the right side of the colon are both associated with improvement in ADR. One of these techniques should be considered during SC to increase ADR and to improve the quality of colonoscopy.
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Affiliation(s)
- Madhav Desai
- Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mohammad Bilal
- Gastroenterology and Hepatology, University of Texas Medical Branch Galveston, Galveston, Texas, USA
| | - Nour Hamade
- Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | | | - Ramprasad Jegadeesan
- Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Neil Gupta
- Gastroenterology and Hepatology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Pradeep Bhandari
- Gastroenterology and Hepatology, University of Portsmouth, Portsmouth, United Kingdom
| | - Alessandro Repici
- Gastroenterology and Hepatology, Istituto Clinico Humanitas, Milan, Italy
| | - Cesare Hassan
- Gastroenterology and Hepatology, Istituto Clinico Humanitas, Milan, Italy
| | - Prateek Sharma
- Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA
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Lee AHH, Lojanapiwat N, Balakrishnan V, Chandra R. Is there a difference in adenoma detection rates between gastroenterologists and surgeons? World J Gastrointest Endosc 2018; 10:109-116. [PMID: 29988847 PMCID: PMC6033718 DOI: 10.4253/wjge.v10.i6.109] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/05/2018] [Accepted: 04/11/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the adenoma detection rate (ADR) between gastroenterologists and colorectal surgeons at Box Hill Hospital, Melbourne, Australia.
METHODS A total of 300 colonoscopies performed by gastroenterologists and colorectal surgeons at Box Hill Hospital were retrospectively reviewed from May 2016 to June 2017. Exclusion criteria were: Patients ≤ 50 years old, colonoscopies with failure of caecal intubation, patients who previously had colon cancer and/or a colonic resection, history of polyposis syndromes or inflammatory bowel disease, or a colonoscopy within the last 10 years. Patient demographics, indications, symptoms and procedural-related outcomes were measured.
RESULTS The ADR was not significantly different between gastroenterologists and colorectal surgeons (34% vs 34.67%; P = 0.90). The adjusted odds ratio correcting for gender, age, 1st degree relative with colorectal cancer, previous colonoscopy, trainee involvement and caecal or terminal ileum intubation rate was 1.19 (0.69-2.05).
CONCLUSION Both specialties at our institution exceed benchmark standards suggested by published Australian and American guidelines. An association between endoscopist specialty and ADR was not observed.
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Affiliation(s)
- Adele Hwee Hong Lee
- Eastern Health Clinical School, Monash University Clayton Campus, Melbourne 3128, Australia
| | - Nuttaradee Lojanapiwat
- Eastern Health Clinical School, Monash University Clayton Campus, Melbourne 3128, Australia
| | - Vikram Balakrishnan
- Department of Colorectal Surgery, Box Hill Hospital, Melbourne 3128, Australia
| | - Raaj Chandra
- Department of Colorectal Surgery, Box Hill Hospital, Melbourne 3128, Australia
- Royal Melbourne Hospital, Melbourne 3050, Australia
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