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Richter R, Bruns J, Obst W, Keitel-Anselmino V, Weigt J. Influence of Artificial Intelligence on the Adenoma Detection Rate throughout the Day. Dig Dis 2022; 41:615-619. [PMID: 36404713 PMCID: PMC11548891 DOI: 10.1159/000528163] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Artificial intelligence systems recently demonstrated an increase in polyp and adenoma detection rate. Over the daytime, the adenoma detection rate decreases as tiredness leads to a lack of attention. It is not clear if a polyp detection system with artificial intelligence leads to constant adenoma detection over the day. METHODS We performed a database analysis of screening and surveillance colonoscopies with and without the use of AI. In both groups, patients were investigated with the same endoscopy equipment and by the same endoscopists. Only patients with good bowel preparation (BBPS >6) were included. We correlated the daytime, the investigational time, day of the week, and the adenoma and polyp detection. RESULTS A total of 303 colonoscopies were analyzed. 163 endoscopies in the AI+ group and 140 procedures in the AI- group were included. In both groups, the total adenoma detection rate was equal (AI+ 0.39 vs. AI- 0.43). The adenoma detection rate throughout the day had a significant decreasing trend in the group without the use of AI (p = 0.015), whereas this trend was not present in the investigations that have been performed with AI (p = 0.65). The duration of investigation did not show a significant difference between the groups (8.9 min in both groups). No relevant effect was noticed in adenoma detection between single days of the working week with or without the use of AI. CONCLUSION AI helps overcome the decay in adenoma detection over the daytime. This may be attributed to a constant awareness caused by the use of the AI system.
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Affiliation(s)
- Rino Richter
- Department of Gastroenterology, Hepatology and Infectious Diseases Otto-v.-Guericke University Magdeburg, Magdeburg, Germany
| | - Johannes Bruns
- Department of Gastroenterology, Hepatology and Infectious Diseases Otto-v.-Guericke University Magdeburg, Magdeburg, Germany
| | - Wilfried Obst
- Department of Gastroenterology, Hepatology and Infectious Diseases Otto-v.-Guericke University Magdeburg, Magdeburg, Germany
| | - Verena Keitel-Anselmino
- Department of Gastroenterology, Hepatology and Infectious Diseases Otto-v.-Guericke University Magdeburg, Magdeburg, Germany
| | - Jochen Weigt
- Department of Gastroenterology, Hepatology and Infectious Diseases Otto-v.-Guericke University Magdeburg, Magdeburg, Germany
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Spada C, Koulaouzidis A, Hassan C, Amaro P, Agrawal A, Brink L, Fischbach W, Hünger M, Jover R, Kinnunen U, Ono A, Patai Á, Pecere S, Petruzziello L, Riemann JF, Staines H, Stringer AL, Toth E, Antonelli G, Fuccio L, on behalf of the ECQI Group. Factors Associated with Polyp Detection Rate in European Colonoscopy Practice: Findings of The European Colonoscopy Quality Investigation (ECQI) Group. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3388. [PMID: 35329077 PMCID: PMC8954761 DOI: 10.3390/ijerph19063388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 01/07/2023]
Abstract
Background: The European Colonoscopy Quality Investigation (ECQI) Group aims to raise awareness for improvement in colonoscopy standards across Europe. We analysed data collected on a sample of procedures conducted across Europe to evaluate the achievement of the polyp detection rate (PDR) target. We also investigated factors associated with PDR, in the hope of establishing areas that could lead to a quality improvement. Methods: 6445 form completions from 12 countries between 2 June 2016 and 30 April 2018 were considered for this analysis. We performed an exploratory analysis looking at PDR according to European Society of Gastrointestinal Endoscopy (ESGE) definition. Stepwise multivariable logistic regression analysis was conducted to determine the most influential associated factors after adjusting for the other pre-specified variables. Results: In our sample there were 3365 screening and diagnostic procedures performed in those over 50 years. The PDR was 40.5%, which is comparable with the ESGE minimum standard of 40%. The variables found to be associated with PDR were in descending order: use of high-definition equipment, body mass index (BMI), patient gender, age group, and the reason for the procedure. Use of HD equipment was associated with a significant increase in the reporting of flat lesions (14.3% vs. 5.7%, p < 0.0001) and protruded lesions (34.7% vs. 25.4%, p < 0.0001). Conclusions: On average, the sample of European practice captured by the ECQI survey meets the minimum PDR standard set by the ESGE. Our findings support the ESGE recommendation for routine use of HD colonoscopy.
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Affiliation(s)
- Cristiano Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, 25124 Brescia, Italy
- Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (S.P.); (L.P.)
| | - Anastasios Koulaouzidis
- Department of Medicine, OUH Svendborg Sygehus, 5700 Svendborg, Denmark;
- Department of Clinical Research, University of Southern Denmark (SDU), 5000 Odense, Denmark
- Surgical Research Unit, OUH, 5000 Odense, Denmark
- Department of Social Medicine and Public Health, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Cesare Hassan
- Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, 20089 Milan, Italy;
| | - Pedro Amaro
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal;
| | - Anurag Agrawal
- Gastroenterology, Doncaster Royal Infirmary, Doncaster DN2 5LT, UK;
| | - Lene Brink
- Gastro Unit, Division of Endoscopy, Herlev and Gentofte Hospital, Copenhagen University, 2730 Herlev, Denmark;
| | | | - Matthias Hünger
- Independent Researcher for Internal Medicine, 97070 Würzburg, Germany;
| | - Rodrigo Jover
- Instituto de Investigación Sanitaria ISABIAL—Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, 03010 Alicante, Spain;
| | - Urpo Kinnunen
- Department of Gastroenterology, Tampere University Hospital, 33521 Tampere, Finland;
| | - Akiko Ono
- Department of Gastroenterology, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain;
| | - Árpád Patai
- Department of Gastroenterology and Medicine, Markusovszky University Teaching Hospital, 9700 Szombathely, Hungary;
| | - Silvia Pecere
- Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (S.P.); (L.P.)
- Digestive Endoscopy Unit, Fondazione Policlinico Gemelli IRCCS, 00168 Rome, Italy
| | - Lucio Petruzziello
- Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (S.P.); (L.P.)
- Digestive Endoscopy Unit, Fondazione Policlinico Gemelli IRCCS, 00168 Rome, Italy
| | - Jürgen Ferdinand Riemann
- Department of Medicine C, Klinikum Ludwigshafen, 67063 Ludwigshafen, Germany;
- LebensBlicke Foundation, 67063 Ludwigshafen, Germany
| | - Harry Staines
- Sigma Statistical Services Ltd., Saint Andrews KY16 0BD, UK;
| | | | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Lund University, 205 02 Malmö, Sweden;
| | - Giulio Antonelli
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, 00185 Rome, Italy;
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, 00040 Rome, Italy
| | - Lorenzo Fuccio
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy;
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Tribonias G, Theodoropoulou A, Stylianou K, Giotis I, Mpitouli A, Moschovis D, Komeda Y, Manola ME, Paspatis G, Tzouvala M. Irrigating Acetic Acid Solution During Colonoscopy for the Detection of Sessile Serrated Neoplasia: A Randomized Controlled Trial. Dig Dis Sci 2022; 67:282-292. [PMID: 33515378 DOI: 10.1007/s10620-021-06858-x] [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: 05/26/2020] [Accepted: 01/18/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Misdiagnosed sessile serrated lesions (SSLs) are important precursors for interval colorectal cancers. AIMS We investigated the usage of acetic acid (AA) solution for improving the detection of SSLs in the right colon in a randomized controlled trial. METHODS A tandem observation of the right colon was performed in 412 consecutive patients. A first inspection was performed under white light high-definition endoscopy. In the AA group, a low concentration vinegar solution (AA: 0.005%) irrigated by a water pump in the right colon was compared with a plain solution of normal saline (NS) in the diagnostic yield of SSLs during the second inspection. Secondary outcomes in overall polyp detection were measured. RESULTS Qualitative comparisons showed significant differences in the detection rates of all polyps except adenomas, with remarkable improvement in the demonstration of advanced (> 20 mm), SSLs, and hyperplastic polyps during the second inspection of the right colon using the AA solution. Significant improvement was also noted in the AA group, as far as the mean number of polyps/patient detected, not only in SSLs (AA group: 0.14 vs. NS group: 0.01, P < 0.001), but also in all histological types and all size-categories in the right colon. Small (≤ 9 mm) polyps were detected at a higher rate in the sigmoid colon expanding the effect of the method in the rest of the colon. CONCLUSION AA-assisted colonoscopy led to a significant increase in SSLs detection rate in the right colon in a safe, quick, and effective manner.
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Affiliation(s)
- George Tribonias
- Gastroenterology Department, General Hospital of Nikaia-Piraeus "Agios Panteleimon", Mantouvalou D. 3, 18454, Athens, Greece.
| | - Angeliki Theodoropoulou
- Gastroenterology Department, General Hospital of Heraklion "Venizeleio - Pananeio", Crete, Greece
| | | | - Ioannis Giotis
- Gastroenterology Department, General Hospital of Nikaia-Piraeus "Agios Panteleimon", Mantouvalou D. 3, 18454, Athens, Greece
| | - Afroditi Mpitouli
- Gastroenterology Department, General Hospital of Heraklion "Venizeleio - Pananeio", Crete, Greece
| | - Dimitrios Moschovis
- Gastroenterology Department, General Hospital of Nikaia-Piraeus "Agios Panteleimon", Mantouvalou D. 3, 18454, Athens, Greece
| | - Yoriaki Komeda
- Gastroenterology Department, Kindai University Hospital, Osaka, Japan
| | - Margarita-Eleni Manola
- Gastroenterology Department, General Hospital of Nikaia-Piraeus "Agios Panteleimon", Mantouvalou D. 3, 18454, Athens, Greece
| | - Gregorios Paspatis
- Gastroenterology Department, General Hospital of Heraklion "Venizeleio - Pananeio", Crete, Greece
| | - Maria Tzouvala
- Gastroenterology Department, General Hospital of Nikaia-Piraeus "Agios Panteleimon", Mantouvalou D. 3, 18454, Athens, Greece
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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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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: 0.5] [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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Tribonias G, Paspatis G. Prospective comparison of deep versus moderate sedation in polyp and adenoma detection rate. Gastrointest Endosc 2020; 92:985. [PMID: 32964849 DOI: 10.1016/j.gie.2020.05.023] [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] [Received: 04/29/2020] [Accepted: 05/10/2020] [Indexed: 02/08/2023]
Affiliation(s)
- George Tribonias
- Gastroenterology Department, General Hospital of Nikaia - Piraeus "Agios Panteleimon", Athens, Greece
| | - Gregorios Paspatis
- Gastroenterology Department, General Hospital of Heraklion "Venizeleio - Pananeio", Crete, Greece
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Comparative systematic review and meta-analysis of 1- to 5-mm versus 6- to 9-mm adenomas on the risk of metachronous advanced colorectal neoplasia. Gastrointest Endosc 2020; 92:692-701.e2. [PMID: 32334021 DOI: 10.1016/j.gie.2020.04.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/13/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The current guidelines recommend the same surveillance interval for ≥3 nonadvanced adenomas (NAAs), without discriminating between diminutive (1-5 mm) and small (6-9 mm) adenomas. Additionally, the same surveillance interval is recommended for patients with ≤2 diminutive NAAs and those with ≤2 small NAAs. However, it is questionable whether these recommendations are appropriate. METHODS We searched all relevant studies published through September 2019 that examined the risk of metachronous advanced colorectal neoplasia (ACRN) according to the size (diminutive vs small) and the number of adenomas found during an index colonoscopy. Low-risk adenomas (LRAs) were subclassified into 2 categories (LRA-1, ≤2 diminutive NAAs; and LRA-2, ≤2 small NAAs), and high-risk adenomas (HRAs) were subclassified into 3 categories (HRA-1, ≥3 diminutive NAAs; HRA-2, ≥3 small NAAs; and HRA-3, advanced adenoma). RESULTS Eight studies involving 36,142 patients were evaluated. The LRA-2 group had a higher risk of metachronous ACRN than the LRA-1 group (risk ratio, 1.49; 95% confidence interval [CI], 1.23-1.81). Additionally, the HRA-2 and HRA-3 groups had a higher risk of metachronous ACRN than the HRA-1 group (hazard ratios [HRs], 1.51 [95% CI, 1.002-2.28] and 1.92 [95% CI, 1.11-3.33], respectively). However, there was no significant difference between the HRA-1 versus LRA-2 groups (HR, 1.23; 95% CI, .78-1.94). CONCLUSIONS Among the HRA and LRA groups, those with diminutive NAAs had a lower risk of metachronous ACRN than those with small NAAs. We believe that clinical guidelines should consider extending the surveillance intervals in patients with diminutive NAAs only.
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Tziatzios G, Gkolfakis P, Lazaridis LD, Facciorusso A, Antonelli G, Hassan C, Repici A, Sharma P, Rex DK, Triantafyllou K. High-definition colonoscopy for improving adenoma detection: a systematic review and meta-analysis of randomized controlled studies. Gastrointest Endosc 2020; 91:1027-1036.e9. [PMID: 31954133 DOI: 10.1016/j.gie.2019.12.052] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/30/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Previous meta-analysis showed marginal benefit of high-definition white-light endoscopy (HD-WLE) over standard-definition colonoscopy (SDC) for adenoma detection, but with residual uncertainty due to inclusion of nonrandomized studies. We aimed to further assess the effect of HD-WLE on adenoma detection by including only randomized controlled trials (RCTs). METHODS A literature search was performed for RCTs evaluating HD-WLE versus SDC in terms of adenoma, advanced adenoma, and serrated sessile adenoma detection rates as well as the mean number of adenomas per colonoscopy (MAC), the mean number of advanced adenomas per colonoscopy (MAAC), and the mean number of sessile serrated adenomas per colonoscopy (MSSAC). The effect size on study outcomes is presented as the risk ratio (RR; 95% confidence interval [CI]) or mean difference (MD; 95% CI). We assessed the strength of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS Six RCTs involving 4594 individuals (HD-WLE, 2323; SDC, 2271) were included. Clinical indications were screening (1 study), positive result for fecal occult blood test, personal/family history of colorectal cancer (1 study), and mixed indications (4 studies). Withdrawal time was similar between the 2 arms (MD, -0.06; 95% CI, -0.25 to 0.12; P = .50). The adenoma detection rate was significantly higher in the HD-WLE arm compared with the SDC arm (40% vs 35%; RR, 1.13; 95% CI, 1.05-1.22; P = .001; I2 = 0%; GRADE, low). This effect was consistent for advanced and sessile serrated adenoma detection rates (RR, 1.33; 95% CI, 1.03-1.72; P = .03; I2 = 0%; GRADE, low; and RR, 1.55; 95% CI, 1.05-2.28; P = .03; I2 = 0%; GRADE, low, respectively). In contrast, the difference was not significant for MAC, MAAC, and MSSAC. CONCLUSIONS Meta-analyses of RCT data support the use of HD-WLE in clinical practice, although the additional benefit is limited.
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Affiliation(s)
- Georgios Tziatzios
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Paraskevas Gkolfakis
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Lazaros Dimitrios Lazaridis
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia AOU, Ospedali Riunity Viale Pinto, Foggia, Italy
| | - Giulio Antonelli
- Endoscopy Unit, Sant'Andrea University Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Cesare Hassan
- Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center and Humanitas University, Rozzano, Italy
| | - Prateek Sharma
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Kansas Medical Center, Kansas, Missouri; Department of Gastroenterology, Veteran Affairs Medical Center, Kansas, Missouri
| | - Douglas K Rex
- Division of Gastroenterology/Hepatology, Indiana University Hospital, Indianapolis, Indiana, USA
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
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Li L, Ou Y, Yue H, Sun H, Chen P, Liu S, He F, Peng Q, Deng S. Comparison of the detection of colorectal lesions in different endoscopic modalities: A network meta-analysis and systematic review. Exp Ther Med 2019; 18:154-162. [PMID: 31258649 DOI: 10.3892/etm.2019.7535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 10/19/2018] [Indexed: 12/11/2022] Open
Abstract
A colonoscopy is considered to be the standard diagnostic test used to detect early colorectal lesions. Detection rates are expected to improve with optimised visualisation. A systematic review and network meta-analysis was conducted to evaluate detection efficiency in several colonoscopic modalities. Relevant articles were identified in searches of the PubMed, EMBASE and Cochrane Library databases. The modalities, comprising of standard-definition white light (SDWL), high-definition white light (HDWL), narrow-band imaging (NBI), autofluorescence imaging (AFI), PENTAX image enhanced technology (i-SCAN), Fuji Intelligent Color Enhancement (FICE), dye-based chromoendoscopy and novel image enhanced systems, including blue laser imaging (BLI) and linked color imaging (LCI), were compared to identify the most efficient modalities that could be used to detect colorectal lesions. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated. As a result, 40 studies fulfilled the inclusion criteria. Overall, in the network meta-analyses, NBI (OR, 1.29; 95% CI, 1.04-1.58), FICE (OR, 1.39; 95% CI, 1.11-1.77), chromoendoscopy (OR, 1.53; 95% CI, 1.22-1.93) and AFI (OR, 1.81; 95% CI, 1.07-2.87) were significantly better compared with SDWL at identifying adenoma in patients, and chromoendoscopy also proved significantly superior to HDWL (OR, 1.30; 95% CI, 1.06-1.60). In pairwise analyses, it was demonstrated that chromoendoscopy was significantly superior to HDWL at detecting the number of polyps (MD, -1.11; 95% CI, -1.46, -0.76) and flat lesions (MD, -0.30; 95% CI, -0.49, -0.10) per subject. Additionally, FICE detected a significantly greater number of subjects with polyps (OR, 0.78; 95% CI, 0.64-0.96) and NBI was significantly better at detecting the number of subjects with flat lesions (OR, 0.77; 95% CI, 0.60-0.99) compared with HDWL. Based on the meta-analysis, NBI, FICE and AFI were significantly better compared with SDWL at detecting patients with adenoma. Additionally, chromoendoscopy was significantly better than SDWL and HDWL at detecting the number of colorectal adenoma, however additional studies are needed to confirm these findings.
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Affiliation(s)
- Lifu Li
- Department of Gastroenterology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Yinghua Ou
- Department of Gastroenterology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Hui Yue
- Department of Gastroenterology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Hong Sun
- Department of Gastroenterology, Nanfang Hospital, Guangzhou, Guangdong 510000, P.R. China
| | - Peisheng Chen
- Department of Gastroenterology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Suying Liu
- Department of Gastroenterology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Fengjian He
- Department of Gastroenterology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Qianqian Peng
- Department of Gastroenterology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Sanhua Deng
- Department of Gastroenterology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
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Ngu WS, Rees C. Can technology increase adenoma detection rate? Therap Adv Gastroenterol 2018; 11:1756283X17746311. [PMID: 29383029 PMCID: PMC5784538 DOI: 10.1177/1756283x17746311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 10/16/2017] [Indexed: 02/04/2023] Open
Abstract
Colorectal cancer is the third most common cancer worldwide and the second most common cause of cancer-related death in Europe and North America. Colonoscopy is the gold standard investigation for the colon but is not perfect, and small or flat adenomas can be missed which increases the risk of patients subsequently developing colorectal cancer. Adenoma detection rate is the most widely used marker of quality, and low rates are associated with increased rates of post-colonoscopy colorectal cancer. Standards of colonoscopy and adenoma detection vary widely between different endoscopists. Interventions to improve adenoma detection rate are therefore required. Many devices have been purported to increase adenoma detection rate. This review looks at current available evidence for device technology to improve adenoma detection rate during colonoscopy.
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Affiliation(s)
- Wee Sing Ngu
- Department of Gastroenterology, South Tyneside District Hospital, South Shields, UK
| | - Colin Rees
- Department of Gastroenterology, South Tyneside District Hospital, South Shields, NE34 0PL, UK
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Riverso M, Perbtani YB, Shuster JJD, Chakraborty J, Brar TS, Agarwal M, Zhang H, Gupte A, Chauhan SS, Forsmark CE, Draganov PV, Yang D. Carbon dioxide insufflation is associated with increased serrated polyp detection rate when compared to room air insufflation during screening colonoscopy. Endosc Int Open 2017; 5:E905-E912. [PMID: 28924598 PMCID: PMC5597937 DOI: 10.1055/s-0043-116382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 06/16/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Sessile serrated adenomas (SSA) and traditional serrated adenomas (TSA) have been increasingly recognized as precursors of colorectal cancer. The aim of this study was to compare the effect of carbon dioxide insufflation (CO 2 I) vs. room air insufflation (AI) on serrated polyp detection rate (SPDR) and to identify factors associated with SPDR. PATIENTS AND METHODS Single-center retrospective cohort study of 2083 screening colonoscopies performed with AI (November 2011 through January 2013) or CO 2 I (February 2013 to June 2015). Data on demographics, procedure characteristics and histology results were obtained from a prospectively maintained endoscopy database and chart review. SPDR was defined as proportion of colonoscopies in which ≥ 1 SSA, TSA or hyperplastic polyp (HP) ≥ 10 mm in the right colon was detected. Multi-variate analysis (MVA) was performed to identify predictors of SPDR. RESULTS A total of 131 histologically confirmed serrated polyps (129 SSA, 2 TSA and 0 HP ≥ 10 mm) were detected. SPDR was higher with CO 2 I vs. AI (4.8 % vs. 1.4 %; P < 0.0001). On MVA, CO 2 I was associated with higher SPDR when compared to AI (OR: 9.52; 95 % CI: 3.05 - 30.3). Both higher body mass index (OR 1.05; 95 % CI:1.02 - 1.09) and longer colonoscope withdrawal time (OR 1.11; 95 % CI: 1.07 - 1.16) were also associated with higher SPDR. CONCLUSION CO 2 I is associated with higher SPDR when compared to AI during screening colonoscopy. While the mechanism remains unknown, we speculate that the favorable gas characteristics of CO 2 compared to room air results in improved polyp detection by optimizing bowel insufflation. These findings suggest an additional reason to prefer the use of CO 2 I over AI during colonoscopy.
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Affiliation(s)
- Michael Riverso
- Division of Gastroenterology, University of Florida, Gainesville, Florida, United States
| | - Yaseen B. Perbtani
- Division of Gastroenterology, University of Florida, Gainesville, Florida, United States
| | - Jonathan J. D. Shuster
- Department of Health Outcomes and Policy, University of Florida, Gainesville, Florida, United States
| | - Joydeep Chakraborty
- Department of Medicine, University of Florida, Gainesville, Florida, United States
| | - Tony S. Brar
- Department of Medicine, University of Florida, Gainesville, Florida, United States
| | - Mitali Agarwal
- Department of Medicine, University of Florida, Gainesville, Florida, United States
| | - Han Zhang
- Department of Medicine, University of Florida, Gainesville, Florida, United States
| | - Anand Gupte
- Division of Gastroenterology, University of Florida, Gainesville, Florida, United States
| | - Shailendra S. Chauhan
- Division of Gastroenterology, University of Florida, Gainesville, Florida, United States
| | | | - Peter V. Draganov
- Division of Gastroenterology, University of Florida, Gainesville, Florida, United States
| | - Dennis Yang
- Division of Gastroenterology, University of Florida, Gainesville, Florida, United States,Corresponding author Dennis Yang, MD Division of GastroenterologyUniversity of Florida1329 SW 16th Street, Suite 5251Gainesville, FL 32608+1-352-627-9002
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12
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Perbtani YB, Riverso M, Shuster JJ, Chakraborty J, Brar TS, Agarwal M, Zhang H, Gupte A, Chauhan SS, Forsmark CE, Draganov PV, Yang D. Does carbon dioxide insufflation impact adenoma detection rate? A single-center retrospective analysis. Endosc Int Open 2016; 4:E1275-E1279. [PMID: 27995188 PMCID: PMC5161121 DOI: 10.1055/s-0042-118177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 09/12/2016] [Indexed: 12/21/2022] Open
Abstract
Background and study aims: Carbon dioxide (CO2) has been associated with reduced post-procedural pain and improved patient satisfaction when compared to air insufflation (AI). The effect of CO2 insufflation (CO2I) on the adenoma detection rate (ADR) remains unclear. The aims of this study are to compare ADR in patients undergoing screening colonoscopy with AI vs. CO2I and identify predictors of ADR. Patients and methods: Single-center retrospective cohort study of 2,107 patients undergoing screening colonoscopy at the University of Florida Hospital between November 2011 and June 2015. Patient demographics, procedural parameters, and histology results were retrospectively obtained from a prospectively maintained colonoscopy database. Univariate and multivariate analysis were performed to identify predictors of ADR. Results: A total of 2107 colonoscopies (644 with AI and 1463 with CO2I) were analyzed. Overall ADR was 27.8 %. There was no significant difference in ADR between AI (27.6 %) vs. CO2I (27.8 %) (P = 0.93). Method of insufflation (AI vs. CO2I) was not significantly associated with ADR (OR 0.9; 95 % CI:0.7 - 1.2). Older age (OR: 1.02; 95 % CI: 1.001 - 1.03 per year increase), male gender (OR 1.48; 95 % CI: 1.17 - 1.87), and longer scope withdraw time (OR 1.13; 95 % CI: 1.1 - 1.16 per minute) were associated with a higher ADR. Fellow involvement was negatively associated with ADR (OR 0.60; 95 % CI: 0.47 - 0.77). Conclusion: ADR was similar between patients who underwent screening colonoscopy with AI vs. CO2I. While CO2I has been associated with improved patient comfort and post-procedural recovery time, there is no definitive evidence to suggest that this method of luminal distention enhances ADR.
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Affiliation(s)
- Yaseen B. Perbtani
- Department of Medicine, University of
Florida, Gainesville, Florida, United States
| | - Michael Riverso
- Department of Medicine, University of
Florida, Gainesville, Florida, United States
| | - Jonathan J. Shuster
- Department of Health Outcomes and Policy
University of Florida, Gainesville, Florida, United States
| | - Joydeep Chakraborty
- Department of Medicine, University of
Florida, Gainesville, Florida, United States
| | - Tony S. Brar
- Department of Medicine, University of
Florida, Gainesville, Florida, United States
| | - Mitali Agarwal
- Department of Medicine, University of
Florida, Gainesville, Florida, United States
| | - Han Zhang
- Department of Medicine, University of
Florida, Gainesville, Florida, United States
| | - Anand Gupte
- Division of Gastroenterology, University of
Florida, Gainesville, Florida, United States
| | - Shailendra S. Chauhan
- Division of Gastroenterology, University of
Florida, Gainesville, Florida, United States
| | | | - Peter V. Draganov
- Division of Gastroenterology, University of
Florida, Gainesville, Florida, United States
| | - Dennis Yang
- Division of Gastroenterology, University of
Florida, Gainesville, Florida, United States,Corresponding author Dennis Yang,
MD Division of Gastroenterology, University of
Florida1329 SW 16th Street, Suite
5251Gainesville, FL 32608United
States+1-352-273-9474+1-352-627-9002
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Rees CJ, Bevan R, Zimmermann-Fraedrich K, Rutter MD, Rex D, Dekker E, Ponchon T, Bretthauer M, Regula J, Saunders B, Hassan C, Bourke MJ, Rösch T. Expert opinions and scientific evidence for colonoscopy key performance indicators. Gut 2016; 65:2045-2060. [PMID: 27802153 PMCID: PMC5136701 DOI: 10.1136/gutjnl-2016-312043] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 09/08/2016] [Accepted: 09/11/2016] [Indexed: 12/12/2022]
Abstract
Colonoscopy is a widely performed procedure with procedural volumes increasing annually throughout the world. Many procedures are now performed as part of colorectal cancer screening programmes. Colonoscopy should be of high quality and measures of this quality should be evidence based. New UK key performance indicators and quality assurance standards have been developed by a working group with consensus agreement on each standard reached. This paper reviews the scientific basis for each of the quality measures published in the UK standards.
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Affiliation(s)
- Colin J Rees
- Department of Gastroenterology, South Tyneside District Hospital, South Shields, UK
| | - Roisin Bevan
- Department of Gastroenterology, North Tees University Hospital, Stockton-on-Tees, UK
| | | | - Matthew D Rutter
- Department of Gastroenterology, North Tees University Hospital, Stockton-on-Tees, UK
| | - Douglas Rex
- Department of Gastroenterology, Indiana University, Indianapolis, USA
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Thierry Ponchon
- Department of Gastroenterology and Hepatology, Edouard Herriot Hospital, Lyon University, Lyon, France
| | - Michael Bretthauer
- Department of Health Management and Health Economics and KG Jebsen Center for Colorectal Cancer Research, University of Oslo, Oslo, Norway
| | - Jaroslaw Regula
- Department of Gastroenterology, Medical Center for Postgraduate Education and the Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Brian Saunders
- Department of Gastroenterology, St Mark's Hospital and Academic Institute, Harrow, UK
| | - Cesare Hassan
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | - Michael J Bourke
- Department of Gastroenterology, Westmead Hospital, Sydney, Australia
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Preliminary Experience Using Full-Spectrum Endoscopy for Colorectal Cancer Screening: Matched Case Controlled Study. Gastroenterol Res Pract 2016; 2016:1349436. [PMID: 27994617 PMCID: PMC5138473 DOI: 10.1155/2016/1349436] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/11/2016] [Accepted: 10/31/2016] [Indexed: 12/18/2022] Open
Abstract
Background/Aim. High-quality colonoscopy is needed to reduce the morbidity and mortality of colorectal cancer. Full-spectrum endoscopy (FUSE) has recently shown potential in improving adenoma detection during colonoscopy. This study aimed to evaluate the feasibility and utility of FUSE colonoscopy. Methods. From April 2015 to February 2016, 130 patients underwent FUSE colonoscopy for screening at a tertiary cancer center. Cecal intubation rate (CIR), procedure time, polyp/adenoma detection rate (PDR/ADR), and mean number of adenomas per colonoscopy (APC) were compared in matched-control patients (n = 260) who underwent standard colonoscopy (SC). Accordingly, endoscopists subjectively evaluated the utility of FUSE colonoscopy. Results. The CIR of FUSE colonoscopy was 94.6%. Cecal intubation time (8.8 min versus 5.1 min, P < 0.001) and total procedure time (21.6 min versus 17.3 min, P < 0.001) in the FUSE group were significantly longer than those in the SC group. PDR (68.3 versus 71.2%, P = 0.567), ADR (63.4% versus 58.5%, P = 0.355), and APC (1.4 versus 1.4, P = 0.917) were not significantly different between the two groups. The wide view of FUSE colonoscopy was superior to that of SC based on the questionnaires. Conclusions. FUSE colonoscopy did not demonstrate superiority to SC in a clinical setting.
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Abstract
In order for screening colonoscopy to be an effective tool in reducing colon cancer incidence, exams must be performed in a high-quality manner. Quality metrics have been presented by gastroenterology societies and now include higher adenoma detection rate targets than in the past. In many cases, the quality of colonoscopy can often be improved with simple low-cost interventions such as improved procedure technique, implementing split-dose bowel prep, and monitoring individuals' performances. Emerging technology has expanded our field of view and image quality during colonoscopy. We will critically review several technological advances in the context of quality metrics and discuss if technology can really improve the quality of colonoscopy.
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Affiliation(s)
- Selvi Thirumurthi
- Department of Gastroenterology, Hepatology & Nutrition, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA.
| | - William A Ross
- Department of Gastroenterology, Hepatology & Nutrition, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Gottumukkala S Raju
- Department of Gastroenterology, Hepatology & Nutrition, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
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16
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High-definition colonoscopy increases adenoma detection rate. Surg Endosc 2016; 31:78-84. [PMID: 27287897 DOI: 10.1007/s00464-016-4986-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 05/09/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND The adenoma detection rate (ADR) is a quality indicator for colonoscopy. High-definition (HD) imaging has been reported to increase polyp detection rates. OBJECTIVE The primary objective of this study was to compare polyp detection rate (PDR) and adenoma detection rate (ADR) before and after the implementation of HD colonoscopy. METHODS A retrospective chart review was performed on patients aged 48-55 years old, who underwent first-time screening colonoscopy. The first group underwent standard-definition (SD) colonoscopy in the first 6 months of 2011. The second group underwent screening with HD colonoscopy during the first 6 months of 2012. We compared age, gender, PDR, ADR, and average sizes of adenomatous polyps between gastroenterologist and colorectal surgeon and among physicians themselves. Statistical analysis was performed with Fischer's exact test and Pearson Chi-square. RESULTS A total of 1268 patients were involved in the study (634 in each group). PDR (35.6 vs. 48.2 %, p < 0.001) and ADR (22.2 vs. 30.4 %, p = 0.02) were higher in the HD group. The average size of an adenomatous polyp was the same in the two groups (0.58 vs. 0.57, p = 0.69). However, this difference was not seen among colorectal surgeons PDR (35.7 vs. 37 %, p = 0.789), ADR (22.9 vs. 24.5 % p = 0.513), but clearly seen among gastroenterologist, PDR (35.6 vs. 53.1 % p < 0.001) and ADR (21.9 vs. 32.9 % p < 0.001). When polyps were categorized into size groups, there was no difference in ADR between the two timeframes (<5 mm in size (41.5 vs. 35.4 %), 5-10 mm (49.3 vs. 60.1 %) and >10 mm (9.2 vs. 4.5 %), p = 0.07). Polyps were most commonly seen in the sigmoid colon (26.1 vs. 24.7 %). There was no difference in the rate of synchronous polyp detection between modalities (25.6 vs. 29 %, p = 0.51). Withdrawal time was the same in both procedure (9.2 vs. 8.5 min, p = 0.10). CONCLUSION Screening colonoscopy with high-definition technology significantly improved both PDR and ADR. In addition, high-definition colonoscopy may be particularly useful and advantageous among less experienced endoscopists in various community settings. However, there needs to be application to specific patient populations in future studies to assess for any statistical differences between standard- and high-definition modalities to determine clinical utility.
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Song JY, Cho YH, Kim MA, Kim JA, Lee CT, Lee MS. Feasibility of full-spectrum endoscopy: Korea’s first full-spectrum endoscopy colonoscopic trial. World J Gastroenterol 2016; 22:2621-2629. [PMID: 26937150 PMCID: PMC4768208 DOI: 10.3748/wjg.v22.i8.2621] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 10/20/2015] [Accepted: 11/19/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the full-spectrum endoscopy (FUSE) colonoscopy system as the first report on the utility thereof in a Korean population.
METHODS: We explored the efficacy of the FUSE colonoscopy in a retrospective, single-center feasibility study performed between February 1 and July 20, 2015. A total of 262 subjects (age range: 22-80) underwent the FUSE colonoscopy for colorectal cancer screening, polyp surveillance, or diagnostic evaluation. The cecal intubation success rate, the polyp detection rate (PDR), the adenoma detection rate (ADR), and the diverticulum detection rate (DDR), were calculated. Also, the success rates of therapeutic interventions were evaluated with biopsy confirmation.
RESULTS: All patients completed the study and the success rates of cecal and terminal ileal intubation were 100% with the FUSE colonoscope; we found 313 polyps in 142 patients and 173 adenomas in 95. The overall PDR, ADR and DDR were 54.2%, 36.3%, and 25.2%, respectively, and were higher in males, and increased with age. The endoscopists and nurses involved considered that the full-spectrum colonoscope improved navigation and orientation within the colon. No colonoscopy was aborted because of colonoscope malfunction.
CONCLUSION: The FUSE colonoscopy yielded a higher PDR, ADR, DDR than did traditional colonoscopy, without therapeutic failure or complications, showing feasible, effective, and safe in this first Korean trial.
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Hüneburg R, Kukuk G, Nattermann J, Endler C, Penner AH, Wolter K, Schild H, Strassburg C, Sauerbruch T, Schmitz V, Willinek W. Colonoscopy detects significantly more flat adenomas than 3-tesla magnetic resonance colonography: a pilot trial. Endosc Int Open 2016; 4:E164-9. [PMID: 26878043 PMCID: PMC4751010 DOI: 10.1055/s-0041-111501] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 12/09/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Colorectal cancer (CRC) is one of the most common cancers worldwide, and several efforts have been made to reduce its occurrence or severity. Although colonoscopy is considered the gold standard in CRC prevention, it has its disadvantages: missed lesions, bleeding, and perforation. Furthermore, a high number of patients undergo this procedure even though no polyps are detected. Therefore, an initial screening examination may be warranted. Our aim was to compare the adenoma detection rate of magnetic resonance colonography (MRC) with that of optical colonoscopy. PATIENTS AND METHODS A total of 25 patients with an intermediate risk for CRC (17 men, 8 women; mean age 57.6, standard deviation 11) underwent MRC with a 3.0-tesla magnet, followed by colonoscopy. The endoscopist was initially blinded to the results of MRC and unblinded immediately after examining the distal rectum. Following endoscopic excision, the size, anatomical localization, and appearance of all polyps were described according to the Paris classification. RESULTS A total of 93 lesions were detected during colonoscopy. These included a malignant infiltration of the transverse colon due to gastric cancer in 1 patient, 28 adenomas in 10 patients, 19 hyperplastic polyps in 9 patients, and 45 non-neoplastic lesions. In 5 patients, no lesion was detected. MRC detected significantly fewer lesions: 1 adenoma (P = 0.001) and 1 hyperplastic polyp (P = 0.004). The malignant infiltration was seen with both modalities. Of the 28 adenomas, 23 (82 %) were 5 mm or smaller; only 4 adenomas 10 mm or larger (14 %) were detected. CONCLUSION MRC does not detect adenomas sufficiently independently of the location of the lesion. Even advanced lesions were missed. Therefore, colonoscopy should still be considered the current gold standard, even for diagnostic purposes.
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Affiliation(s)
- Robert Hüneburg
- Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany,Corresponding author Robert Hüneburg, MD Department of Internal Medicine I University of BonnSigmund-Freud Straße 25D-53115 Bonn Germany+49-228-2871-9638
| | - Guido Kukuk
- Department of Radiology, University Hospital of Bonn, Bonn, Germany
| | - Jacob Nattermann
- Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany
| | - Christoph Endler
- Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany
| | | | - Karsten Wolter
- Department of Radiology, University Hospital of Bonn, Bonn, Germany
| | - Hans Schild
- Department of Radiology, University Hospital of Bonn, Bonn, Germany
| | | | - Tilman Sauerbruch
- Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany
| | - Volker Schmitz
- Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany
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Guo CG, Ji R, Li YQ. Accuracy of i-Scan for Optical Diagnosis of Colonic Polyps: A Meta-Analysis. PLoS One 2015; 10:e0126237. [PMID: 25978459 PMCID: PMC4433272 DOI: 10.1371/journal.pone.0126237] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 03/31/2015] [Indexed: 02/07/2023] Open
Abstract
Background i-Scan is a novel virtual chromoendoscopy system designed to enhance surface and vascular patterns to improve optical diagnostic performance. Numerous prospective studies have been done to evaluate the accuracy of i-Scan in differentiating colonic neoplasms from non-neoplasms. i-Scan could be an effective endoscopic technique for optical diagnosis of colonic polyps. Objective Our aim of this study was to perform a meta-analysis of published data to establish the diagnostic accuracy of i-Scan for optical diagnosis of colonic polyps. Methods We searched PubMed, Medline, Elsevier ScienceDirect and Cochrane Library databases. We used a bivariate meta-analysis following a random effects model to summarize the data and plotted hierarchical summary receiver-operating characteristic (HSROC) curves. The area under the HSROC curve (AUC) serves as an indicator of the diagnostic accuracy. Results The meta-analysis included a total of 925 patients and 2312 polyps. For the overall studies, the area under the HSROC curve was 0.96. The summary sensitivity was 90.4% (95%CI 85%-94.1%) and specificity was 90.9% (95%CI 84.3%-94.9%). In 11 studies predicting polyps histology in real-time, the summary sensitivity and specificity was 91.5% (95%CI 85.7%-95.1%) and 92.1% (95%CI 84.5%-96.1%), respectively, with the AUC of 0.97. For three different diagnostic criteria (Kudo, NICE, others), the sensitivity was 86.3%, 93.0%, 85.0%, respectively and specificity was 84.8%, 94.4%, 91.8%, respectively. Conclusions Endoscopic diagnosis with i-Scan has accurate optical diagnostic performance to differentiate neoplastic from non-neoplastic polyps with an area under the HSROC curve exceeding 0.90. Both the sensitivity and specificity for diagnosing colonic polyps are over 90%.
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Affiliation(s)
- Chuan-Guo Guo
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, Shandong Province, China
| | - Rui Ji
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, Shandong Province, China
| | - Yan-Qing Li
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, Shandong Province, China
- * E-mail:
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McGill SK, Kothari S, Friedland S, Chen A, Park WG, Banerjee S. Short turn radius colonoscope in an anatomical model: Retroflexed withdrawal and detection of hidden polyps. World J Gastroenterol 2015; 21:593-599. [PMID: 25593483 PMCID: PMC4294171 DOI: 10.3748/wjg.v21.i2.593] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 08/21/2014] [Accepted: 09/29/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the new RetroView™ colonoscope and compare its ability to detect simulated polyps “hidden” behind colonic folds with that of a conventional colonoscope, utilizing anatomic colon models.
METHODS: Three anatomic colon models were prepared, with twelve simulated polyps “hidden” behind haustral folds and five placed in easily viewed locations in each model. Five blinded endoscopists examined two colon models in random order with the conventional or RetroView™ colonoscope, utilizing standard withdrawal technique. The third colon model was then examined with the RetroView™ colonoscope withdrawn initially in retroflexion and then in standard withdrawal. Polyp detection rates during standard and retroflexed withdrawal of the conventional and RetroView™ colonoscopes were determined. Polyp detection rates for combined standard and retroflexed withdrawal (combination withdrawal) with the RetroView™ colonoscope were also determined.
RESULTS: For hidden polyps, retroflexed withdrawal using the RetroView™ colonoscope detected more polyps than the conventional colonoscope in standard withdrawal (85% vs 12%, P = 0.0001). For hidden polyps, combination withdrawal with the RetroView™ colonoscope detected more polyps than the conventional colonoscope in standard withdrawal (93% vs 12%, P≤ 0.0001). The RetroView™ colonoscope in “combination withdrawal” was superior to other methods in detecting all (hidden + easily visible) polyps, with successful detection of 80 of 85 polyps (94%) compared to 28 (32%) polyps detected by the conventional colonoscope in standard withdrawal (P < 0.0001) and 67 (79%) polyps detected by the RetroView™ colonoscope in retroflexed withdrawal alone (P < 0.01). Continuous withdrawal of the colonoscope through the colon model while retroflexed was achieved by all endoscopists. In a post-test survey, four out of five colonoscopists reported that manipulation of the colonoscope was easy or very easy.
CONCLUSION: In simulated testing, the RetroView™ colonoscope increased detection of hidden polyps. Combining standard withdrawal with retroflexed withdrawal may become the new paradigm for “complete screening colonoscopy”.
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Endoscopists with low adenoma detection rates benefit from high-definition endoscopy. Surg Endosc 2014; 29:466-73. [PMID: 25005016 DOI: 10.1007/s00464-014-3688-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 06/17/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND An endoscopists adenoma detection rate (ADR) of less than 20 % correlates with high risk for occurrence of interval cancer. The impact of high-definition (HD) imaging on the ADR is discussed controversially. We aimed to investigate whether detection rates of individual endoscopists increase within 1 year before and 1 year after the switch from standard to HD endoscopy. METHODS This cohort study analyzed 6,330 screening colonoscopies (2,968 with standard and 3,362 with HD) performed by 42 endoscopists between November 2007 and March 2013 within a nationwide quality assurance program for screening colonoscopy. RESULTS The ADR of endoscopists with a low ADR (<20 %) increased significantly higher (from 11.8 to 18.1 %, p = 0.003) than of those with a high ADR (≥ 20 %) (from 28.6 to 30.7 %, p = 0.439) after switch from standard to HD colonoscopes (p = 0.0076). The proportion of endoscopists with an ADR < 20 % decreased from 45 to 42.9 % (p = 0.593). There was no significant increase in age- and sex-adjusted detection rates of adenomas (20.2 vs 23.7 %; p = 0.089), advanced adenomas (4.7 vs 5.5 %; p = 0.479), flat adenomas (2.7 vs 3.1 %; p = 0.515), polyps (38.8 vs 41.5 %; p = 0.305), proximal polyps (18.5 vs 20 %; p = 0.469) and hyperplastic polyps (15 vs 17.2 %; p = 0.243) of endoscopists after switch to HD colonoscopes. There was no difference in detection rates of flat polyps (5.5 vs 5.5 %; p = 0.987). CONCLUSIONS The use of HD scopes is associated with marginal improvement in adenoma detection rates limited to those endoscopists with low adenoma detection rates prior to its introduction.
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Longcroft-Wheaton G, Brown J, Cowlishaw D, Higgins B, Bhandari P. High-definition vs. standard-definition endoscopy with indigo carmine for the in vivo diagnosis of colonic polyps. United European Gastroenterol J 2014; 1:425-9. [PMID: 24917993 DOI: 10.1177/2050640613502963] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 08/03/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There is growing evidence that indigo carmine chromoendoscopy is effective for the in vivo diagnosis of colonic polyps. However, the impact of colonoscope resolution on diagnostic accuracy has not been investigated. OBJECTIVE We aimed to compare the effectiveness of in vivo diagnosis of small colonic polyps using indigo carmine dye spray with standard-definition and high-definition colonoscopes. METHODS Procedures were performed using Fujinon colonoscopes and EPX 4400 processor. Fujinon standard-definition (SD) and high-definition (HD) colonoscopes were used, with the endoscopist blinded to colonoscope definition. Polyps <10 mm were assessed using 0.2% indigo carmine dye spray, with the predicted diagnosis recorded. In each case the kind of colonoscope (SD or HD) was recorded. Polyps were removed and sent for histological analysis, with the pathologist blinded to the diagnosis made by the endoscopist. The predicted diagnosis was compared with the true histology to calculate the accuracy, sensitivity and specificity of in vivo assessment using either SD or HD scopes. RESULTS In total 237 polyps <10 mm in size were examined. There was no statistically significant difference for any of the measured parameters between SD and HD assessments, with an accuracy, sensitivity and specificity of 89%, 91% and 87% with SD colonoscopes and 92%, 96% and 84% with HD colonoscopes. CONCLUSIONS The accuracy of in vivo assessment of small colonic polyps with indigo carmine dye spray is excellent with standard-definition colonoscopes and is not improved with high-definition colonoscopes.
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Affiliation(s)
| | | | | | - Bernard Higgins
- Department of Mathematics (Biostatistics) Research Area, Portsmouth University, Portsmouth, UK
| | - Pradeep Bhandari
- Queen Alexandra Hospital, Portsmouth, UK ; University of Portsmouth, Portsmouth, UK
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Dik VK, Moons LMG, Siersema PD. Endoscopic innovations to increase the adenoma detection rate during colonoscopy. World J Gastroenterol 2014; 20:2200-2211. [PMID: 24605019 PMCID: PMC3942825 DOI: 10.3748/wjg.v20.i9.2200] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 12/06/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
Up to a quarter of polyps and adenomas are missed during colonoscopy due to poor visualization behind folds and the inner curves of flexures, and the presence of flat lesions that are difficult to detect. These numbers may however be conservative because they mainly come from back-to-back studies performed with standard colonoscopes, which are unable to visualize the entire mucosal surface. In the past several years, new endoscopic techniques have been introduced to improve the detection of polyps and adenomas. The introduction of high definition colonoscopes and visual image enhancement technologies have been suggested to lead to better recognition of flat and small lesions, but the absolute increase in diagnostic yield seems limited. Cap assisted colonoscopy and water-exchange colonoscopy are methods to facilitate cecal intubation and increase patients comfort, but show only a marginal or no benefit on polyp and adenoma detection. Retroflexion is routinely used in the rectum for the inspection of the dentate line, but withdrawal in retroflexion in the colon is in general not recommended due to the risk of perforation. In contrast, colonoscopy with the Third-Eye Retroscope® may result in considerable lower miss rates compared to standard colonoscopy, but this technique is not practical in case of polypectomy and is more time consuming. The recently introduced Full Spectrum Endoscopy™ colonoscopes maintains the technical capabilities of standard colonoscopes and provides a much wider view of 330 degrees compared to the 170 degrees with standard colonoscopes. Remarkable lower adenoma miss rates with this new technique were recently demonstrated in the first randomized study. Nonetheless, more studies are required to determine the exact additional diagnostic yield in clinical practice. Optimizing the efficacy of colorectal cancer screening and surveillance requires high definition colonoscopes with improved virtual chromoendoscopy technology that visualize the whole colon mucosa while maintaining optimal washing, suction and therapeutic capabilities, and keeping the procedural time as low and patient discomfort as optimal as possible.
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Saito Y, Gimeno-García A, Matsuda T, Nicolás-Pérez D, Uraoka T, Quintero E. New Imaging Modalities for Identification of Hidden Polyps. CURRENT COLORECTAL CANCER REPORTS 2014. [DOI: 10.1007/s11888-013-0206-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Urquhart P, DaCosta R, Marcon N. Endoscopic mucosal imaging of gastrointestinal neoplasia in 2013. Curr Gastroenterol Rep 2013; 15:330. [PMID: 23771504 DOI: 10.1007/s11894-013-0330-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The holy grail of gastrointestinal endoscopy consists of the detection, in vivo characterization, and endoscopic removal of early or premalignant mucosal lesions. While our ability to achieve this goal has improved substantially since the development of the modern video-endoscope, inadequate visual inspection, errors of interpretation, and lesion subtlety all contribute to the continued suboptimal detection and assessment of early neoplasia. A myriad of new technologies has thus emerged that may help resolve these shortcomings; high magnification endoscopes, as well as the techniques of dye-based and virtual chromoendoscopy, are now widely available, while confocal laser endomicroscopy and endocystoscopy, optical coherence tomography, and autofluorescence imaging are generally applicable only in a research setting. Such technologies can be broadly categorized according to whether they potentially afford endoscopists improved detection, or real-time characterization, of mucosal lesions. Enhanced detection of otherwise "invisible" lesions, such as a flat area of intramucosal adenocarcinoma within Barrett's esophagus, carries the potential of an endoscopic cure prior to the development into a more advanced or metastatic disease. The ability to characterize a lesion to achieve an in vivo diagnosis, such as a colonic polyp, potentially affords endoscopists the ability to decide which lesions require removal and which can be safely left behind or discarded without histological assessment. Furthermore targeted biopsies, such as in the surveillance of chronic colitis, may prove to be more accurate and efficacious than the current protocol of random biopsies. An important caveat in the discussion of developing technologies in early cancer detection is the fundamental importance of a health-care system that promotes screening programs to recruit at-risk individuals. The ideal tool to optimize the use of endoscopy in population screening would be a panel of reliable biomarkers (blood, stool, or urine) that could effectively select a high-risk group, thus reducing the indiscriminate use of an expensive technology. The following review summarizes the current endoscopic imaging techniques available, and in development, for the early identification of gastrointestinal neoplasia.
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Affiliation(s)
- P Urquhart
- St Michael's Hospital, Toronto, ON, Canada
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Abstract
Advancements in image technology have allowed recognition of mucosal architecture in more detail and may improve adenoma detection. This review provides a technical overview on individual imaging technologies and their effect on detection of adenomas. Only high-definition endoscopy has been shown to improve detection of small adenomas. None of the digital chromoendoscopy technologies improves adenoma detection. Limited studies on autoimmunfluorescence imaging in conjunction with high-definition endoscopy may improve detection of small adenomas.
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Affiliation(s)
- Zilla H Hussain
- Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA
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Kyanam Kabir Baig KR, Wallace MB. Endoscopic Mucosal Resection: Therapy for Early Colorectal Cancer. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/jct.2013.41036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Xu JC, Liu BR. Endoscopic techniques for improving colorectal adenoma detection: Recent progress. Shijie Huaren Xiaohua Zazhi 2012; 20:3118-3123. [DOI: 10.11569/wcjd.v20.i32.3118] [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] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is one of the most common malignant neoplasms worldwide and develops mostly from precancerous lesions such as colorectal adenomas. Therefore, early detection and resection of colorectal adenomas is key to preventing CRC. At present, colonoscopy is acknowledged as the gold standard for the diagnosis and treatment of colorectal lesions; however, conventional colonoscopy is still associated with a certain rate of missed lesions. It is reported that the missed detection rate is 6% when adenomas are more than 1 cm, 13% for adenomas 6-9 mm, and 27% for adenomas less than 5 mm. The missed detection rate for right colonic adenomas is higher than that for left colonic adenomas. The missed diagnosis of colorectal adenomas or malignant tumors invariably increases surgical rate and mortality. Currently, great efforts have been made to improve the detection rate of colorectal adenomas. This paper will briefly review recent advances in endoscopic techniques for improving the detection rate of colorectal adenomas.
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Testoni PA, Notaristefano C, Vailati C, Leo MD, Viale E. High-definition colonoscopy with i-Scan: Better diagnosis for small polyps and flat adenomas. World J Gastroenterol 2012; 18:5231-9. [PMID: 23066318 PMCID: PMC3468856 DOI: 10.3748/wjg.v18.i37.5231] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 05/02/2012] [Accepted: 05/05/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate if high-definition (HD) colonoscope with i-Scan gave a higher detection rate of mucosal lesions vs standard white-light instruments.
METHODS: Data were collected from the computerized database of the endoscopy unit of our tertiary referral center. We retrospectively analyzed 1101 consecutive colonoscopies that were performed over 1 year with standard white-light (n = 849) or HD+ with i-Scan (n = 252) instruments by four endoscopists, in an outpatient setting. Colonoscopy records included patients’ main details and family history for colorectal cancer, indication for colonoscopy (screening, diagnostic or surveillance), type of instrument used (standard white-light or HD+ plus i-Scan), name of endoscopist and bowel preparation. Records for each procedure included whether the cecum was reached or not and the reason for failure, complications during or immediately after the procedure, and number, size, location and characteristics of the lesions. Polyps or protruding lesions were defined as sessile or pedunculated, and nonprotruding lesions were defined according to Paris classification. For each lesion, histological diagnosis was recorded.
RESULTS: Eight hundred and forty-nine colonoscopies were carried with the standard white-light video colonoscope and 252 with the HD+ plus i-Scan video colonoscope. The four endoscopists did 264, 300, 276 and 261 procedures, respectively; 21.6%, 24.0%, 21.7% and 24.1% of them with the HD+ plus i-Scan technique. There were no significant differences between the four endoscopists in either the number of procedures done or the proportions of each imaging technique used. Both techniques detected one or more mucosal lesions in 522/1101 procedures (47.4%). The overall number of lesions recognized was 1266; 645 in the right colon and 621 in the left. A significantly higher number of colonoscopies recognized lesions in the HD+ plus i-Scan mode (171/252 = 67.9%) than with the standard white-light technique (408/849 = 48.1%) (P < 0.0001). HD+ with i-Scan colonoscopies identified more lesions than standard white-light imaging (459/252 and 807/849, P < 0.0001), in the right or left colon (mean ± SD, 1.62 ± 1.36 vs 1.33 ± 0.73, P < 0.003 and 1.55 ± 0.98 vs 1.17 ± 0.93, P = 0.033), more lesions < 10 mm (P < 0.0001) or nonprotruding (P < 0.022), and flat polyps (P = 0.04). The cumulative mean number of lesions per procedure detected by the four endoscopists was significantly higher with HD+ with i-Scan than with standard white-light imaging (1.82 ± 2.89 vs 0.95 ± 1.35, P < 0.0001).
CONCLUSION: HD imaging with i-Scan during the withdrawal phase of colonoscopy significantly increased the detection of colonic mucosal lesions, particularly small and nonprotruding polyps.
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Chokshi RV, Hovis CE, Hollander T, Early DS, Wang JS. Prevalence of missed adenomas in patients with inadequate bowel preparation on screening colonoscopy. Gastrointest Endosc 2012; 75:1197-203. [PMID: 22381531 DOI: 10.1016/j.gie.2012.01.005] [Citation(s) in RCA: 270] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 01/03/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND The prevalence of missed polyps in patients with inadequate bowel preparation on screening colonoscopy is unknown. OBJECTIVE To determine the prevalence of missed adenomas in average-risk patients presenting for screening colonoscopy who are found to have inadequate bowel preparation. DESIGN Retrospective chart review. Endoscopy and pathology reports were examined to determine the characteristics of polyps. Data from repeat colonoscopies were collected through 2010. SETTING Outpatient endoscopy center at an academic medical center. PATIENTS This study involved patients who underwent outpatient average-risk screening colonoscopy between 2004 and 2009 documented to have inadequate bowel preparation and who had colonoscopy to the cecum. MAIN OUTCOME MEASUREMENTS Initial adenoma detection rate and adenoma detection rate on follow-up examination. RESULTS Inadequate bowel preparation was reported on 373 patients, with an initial adenoma detection rate of 25.7%. Of 133 patients who underwent repeat colonoscopy, 33.8% had at least 1 adenoma detected, and 18.0% had high-risk states detected (≥ 3 adenomas, 1 adenoma ≥ 1 cm, or any adenoma with villous features or high-grade dysplasia). Per-adenoma miss rate was 47.9%. Among patients with at least 1 adenoma on repeat colonoscopy, 31.1% had no polyps on initial colonoscopy; mean time between colonoscopies was 340 days. Among patients with high-risk states, 25.0% had no polyps seen on initial colonoscopy; mean time between colonoscopies was 271 days. LIMITATIONS Retrospective design. CONCLUSION Adenomas and high-risk lesions were frequently detected on repeat colonoscopy in patients with inadequate bowel preparation on initial screening colonoscopy, suggesting that these lesions were likely missed on initial colonoscopy.
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Affiliation(s)
- Reena V Chokshi
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
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Hong SN, Choe WH, Lee JH, Kim SI, Kim JH, Lee TY, Kim JH, Lee SY, Cheon YK, Sung IK, Park HS, Shim CS. Prospective, randomized, back-to-back trial evaluating the usefulness of i-SCAN in screening colonoscopy. Gastrointest Endosc 2012; 75:1011-1021.e2. [PMID: 22381530 DOI: 10.1016/j.gie.2011.11.040] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 11/28/2011] [Indexed: 12/18/2022]
Abstract
BACKGROUND The newly developed i-SCAN application can theoretically maximize the effectiveness of colonoscopy. However, the practical usefulness of the i-SCAN application during screening colonoscopy has not been assessed. OBJECTIVE To assess the efficacy of the i-SCAN application during screening colonoscopy. DESIGN A prospective, randomized trial that used a modified, back-to-back colonoscopy. SETTING Academic hospital. PATIENTS This study involved 389 asymptomatic, consecutive, average-risk patients who underwent screening colonoscopy. INTERVENTION The patients were randomized to the first withdrawal with either conventional high-definition white light (HDWL group; n = 119), i-SCAN contrast/surface enhancement (CE/SE) mode (i-SCAN1 group; n = 115), or i-SCAN CE/SE/tone enhancement-colorectal mode (i-SCAN2 group; n = 118). All patients underwent a second examination with HDWL as the criterion standard. MAIN OUTCOME MEASUREMENTS The primary outcome measurement was the adenoma detection rate and adenoma miss rate. The secondary outcome measurement was the accuracy of the histologic prediction of neoplastic and nonneoplastic polyps. RESULTS The adenoma detection rates during the first withdrawal of HDWL, i-SCAN1, and i-SCAN2 were 31.9%, 36.5%, and 33.1%, respectively (P = .742), and the adenoma miss rates of each group were 22.9%, 19.3%, and 15.9%, respectively (P = .513). Based on the multivariate analysis, the application of i-SCAN was not associated with an improvement in adenoma detection and the prevention of missed polyps. However, the prediction of neoplastic and nonneoplastic colorectal lesions was more precise in the i-SCAN2 group compared with the HDWL group (accuracy 79.3% vs 75.5%, P = .029; sensitivity 86.5% vs 72.6%, P = .020; and specificity 91.4% vs 80.6%, P = .040). LIMITATIONS Single-center trial. CONCLUSION i-SCAN during the screening colonoscopy may fail to improve adenoma detection and the prevention of missed polyps, but i-SCAN appears to be effective for real-time histologic prediction of polyps compared with conventional HDWL colonoscopy. ( CLINICAL TRIAL REGISTRATION NUMBER NCT01417611.).
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Affiliation(s)
- Sung Noh Hong
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
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The relationship between distal and proximal colonic neoplasia: a meta-analysis. J Gen Intern Med 2012; 27:361-70. [PMID: 22065335 PMCID: PMC3286557 DOI: 10.1007/s11606-011-1919-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 09/29/2011] [Accepted: 10/03/2011] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To investigate the association between proximal colonic neoplasia and distal lesions as a function of the lesion type. The extent to which health, demographic, and study characteristics moderate this association was also examined. DATA SOURCES Google Scholar, Web of Science, Scopus, and PubMed. STUDY ELIGIBILITY CRITERIA Studies allowing the calculation of OR of proximal neoplasia (PN) and proximal advanced neoplasia (PAN) for distal hyperplastic polyps (HP), nonadvanced adenomas (NAA), adenomas (AD), and advanced neoplasia (AN); also, studies for which the proportions of subjects with isolated (i.e., not accompanied by distal lesions) PN (IPN) and PAN (IPAN) over the total number of subjects with PN or PAN could be calculated. STUDY APPRAISAL AND SYNTHESIS METHODS Thirty-two studies were included for calculating OR between proximal neoplasia and distal lesions and 40 studies for proportions of IPN and IPAN. Subgroup analyses were conducted for presence of symptoms, prevalence of PN and PAN, age, proportion of males, geographic region, study design, and demarcation point. RESULTS The association between distal lesions and proximal neoplasia increased with the severity of the distal lesions. Odds of PN were higher in subjects with HP compared to subjects with a normal distal colon. Odds of PN and PAN were higher in subjects with NAA, AD, and AN than in subjects with a normal distal colon. PAN were more strongly associated with distal lesions in asymptomatic populations, in young populations, and in populations with a low prevalence of PAN. In approximately 60% of the subjects with PN and PAN, these neoplasia were isolated. LIMITATIONS The present results may be affected by publication bias and dichotomization in the subgroup analyses. Limitations related to the individual studies include self-selection, lesion misclassification and misses, and technological advances leading to changes in the detection of lesions during the time span of the included studies. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS All types of distal lesions are predictive of PN. All types of distal neoplasia are predictive of PAN. The association between distal lesions and proximal neoplasia increases with the severity of the distal lesion. The association between distal lesions and proximal advanced neoplasia is stronger in low-risk groups as compared to high-risk groups.
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Adler A, Aminalai A, Aschenbeck J, Drossel R, Mayr M, Scheel M, Schröder A, Yenerim T, Wiedenmann B, Gauger U, Roll S, Rösch T. Latest generation, wide-angle, high-definition colonoscopes increase adenoma detection rate. Clin Gastroenterol Hepatol 2012; 10:155-9. [PMID: 22056301 DOI: 10.1016/j.cgh.2011.10.026] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 10/05/2011] [Accepted: 10/20/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Improvements to endoscopy imaging technologies might improve detection rates of colorectal cancer and patient outcomes. We compared the accuracy of the latest generation of endoscopes with older generation models in detection of colorectal adenomas. METHODS We compared data from 2 prospective screening colonoscopy studies (the Berlin Colonoscopy Project 6); each study lasted approximately 6 months and included the same 6 colonoscopists, who worked in private practice. Participants in group 1 (n = 1256) were all examined by using the latest generation of wide-angle, high-definition colonoscopes that were manufactured by the same company. Individuals in group 2 (n = 1400) were examined by endoscopists who used routine equipment (a mixture of endoscopes from different companies; none of those used to examine group 1). The adenoma detection rate was calculated on the basis of the number of all adenomas/number of all patients. RESULTS There were no differences in patient parameters or withdrawal time between groups (8.0 vs 8.2 minutes). The adenoma detection rate was significantly higher in group 1 (0.33) than in group 2 (0.27; P = .01); a greater number of patients with least 1 adenoma were identified in group 1 (22.1%) than in group 2 (18.2%; P = .01). A higher percentage of high-grade dysplastic adenomas were detected in group 1 (1.19%) than in group 2 (0.57%), but this difference was not statistically significant (P = .06). CONCLUSIONS The latest generation of wide-angle, high-definition colonoscopes improves rates of adenoma detection by 22%, compared with mixed, older technology endoscopes used in routine private practice. These findings might affect definitions of quality control parameters for colonoscopy screening for colorectal cancer.
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Affiliation(s)
- Andreas Adler
- Central Interdisciplinary Endoscopy Unit, Department of Gastroenterology, Charité University Medical Hospitals, Berlin, Germany
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Abstract
PURPOSE OF REVIEW Prevention of colorectal cancer relies on the detection and removal of colorectal neoplasia. Recent advances in mucosal imaging and inspection techniques have increased the detection of small and diminutive colorectal polyps with unknown clinical impact. The ability to accurately predict whether a polyp is neoplastic may allow for an optical triage approach to polyp management, improving efficiency while reducing the cost and risk of polypectomy. RECENT FINDINGS High-definition white light colonoscopy, cap-fitted colonoscopy, and dye-based pan-chromoendoscopy have each shown to increase polyp detection. Virtual chromoendoscopy, although not beneficial for polyp detection, allows for accurate in-vivo prediction of polyp pathology. Endoscopists' behaviors, independent of patient factors, strongly influence adenoma detection. Training methods focused on the techniques of high adenoma detectors also increase adenoma and polyp detection. SUMMARY Advances in mucosal imaging and improvements in inspection technique have allowed us to detect more polyps and to predict their pathology with greater accuracy. An optical triage approach to either 'diagnose and discard' or 'diagnose and leave behind' has the potential to reduce the risk and cost of polypectomy.
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Erim T, Rivas JM, Velis E, Castro F. Role of high definition colonoscopy in colorectal adenomatous polyp detection. World J Gastroenterol 2011; 17:4001-4006. [PMID: 22046088 PMCID: PMC3199558 DOI: 10.3748/wjg.v17.i35.4001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 03/11/2011] [Accepted: 03/18/2011] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the rates of polyp detection in a mixed risk population using standard definition (SDC) vs high definition colonoscopes (HDC). METHODS This was a retrospective cohort comparative study of 3 colonoscopists who each consecutively performed 150 SDC (307, 200 pixel) and 150 HDC (792, 576 pixels) in a community teaching hospital. RESULTS A total of 900 colonoscopies were evaluated (mean age 56, 46.8% men), 450 with each resolution. Polyps of any type were detected in 46.0% of patients using SDC and 43.3% with HDC (P = 0.42). There was no significant difference between the overall number of polyps, HDC (397) and SDC (410), detected among all patients examined, (P = 0.73). One or more adenomatous polyps were detected in 24.2% of patients with HDC and 24.9% of patients with SDC colonoscopy (P = 0.82). There was no significant difference between HDC (M = 0.41) and SDC (M = 0.42) regarding adenomatous polyp (P = 0.88) or advanced adenoma (P = 0.56) detection rate among all patients examined. CONCLUSION HDC did not improve yield of adenomatous polyp, advanced adenoma or overall polyp detection in a population of individuals with mixed risk for colorectal cancer.
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Abstract
Colonoscopy is considered the 'gold standard' for detection and removal of premalignant lesions in the colon. However, studies suggest that colonoscopy is less protective for right-sided than for left-sided colorectal cancer. Optimizing the effectiveness of colonoscopy is a continuous process, and during the past decade several important quality indicators have been defined that can be used to measure the performance of colonoscopy and to identify areas for quality improvement. The quality of bowel preparation can be enhanced by split-dose regimens, which are superior to single-dose regimens. Cecal intubation rates should approximate 95% and can be optimized by good technique. In selected patients, specific devices can be used to facilitate cecal intubation. Adenoma detection rates should be monitored and exceed a minimum of 25% in men and 15% in women. To this aim, optimal withdrawal technique and adequate time for inspection are of utmost importance. Of all advanced imaging techniques, chromoendoscopy is the only technique with proven benefit for adenoma detection. Finally, the technique of polypectomy affects the number of complications as well as the success of completely removing a lesion. In this Review, we provide an overview of both standard and novel colonoscopy techniques and their impact on quality indicators.
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Affiliation(s)
- Yark Hazewinkel
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, PO Box 22700, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
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Abstract
PURPOSE OF REVIEW This review summarizes recent clinical studies of colonoscopy technique and new technologies. RECENT FINDINGS Water immersion reduces pain and sedation doses in unsedated and lightly sedated colonoscopy. Cap-fitted colonoscopy makes insertion faster and improves detection of lesions behind folds, but the latter effect is operator-dependent. A single controlled trial showed improved detection with the Third Eye Retroscope, but the two arms of the study were not controlled for withdrawal time. Chromoendoscopy increases detection of diminutive adenomas, but adds time to the colonoscopy procedure. Electronic chromoendoscopy methods (narrow band imaging, Fujinon Intelligent ChromoEndoscopy, i-scan, and autofluorescence) have been either unsuccessful in improving detection or require more study. However, these methods and several other methods (chromoendoscopy with magnification, confocal laser microscopy, and endocytoscopy) allow accurate real time determination of polyp histology. SUMMARY Water immersion is a clear advance in unsedated colonoscopy. Cap-fitted colonoscopy is a promising method for both practical and effective visualization of the proximal sides of haustral folds. Electronic chromoendoscopy has been largely ineffective at improving polyp detection, but is effective (as are confocal laser microscopy and endocytoscopy) for diagnosis of polyp histology.
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Kuiper T, van den Broek FJC, Naber AH, van Soest EJ, Scholten P, Mallant-Hent RC, van den Brande J, Jansen JM, van Oijen AHAM, Marsman WA, Bergman JJGHM, Fockens P, Dekker E. Endoscopic trimodal imaging detects colonic neoplasia as well as standard video endoscopy. Gastroenterology 2011; 140:1887-94. [PMID: 21419769 DOI: 10.1053/j.gastro.2011.03.008] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 02/08/2011] [Accepted: 03/04/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Endoscopic trimodal imaging (ETMI) is a novel endoscopic technique that combines high-resolution endoscopy (HRE), autofluorescence imaging (AFI), and narrow-band imaging (NBI) that has only been studied in academic settings. We performed a randomized, controlled trial in a nonacademic setting to compare ETMI with standard video endoscopy (SVE) in the detection and differentiation of colorectal lesions. METHODS The study included 234 patients scheduled to receive colonoscopy who were randomly assigned to undergo a colonoscopy in tandem with either ETMI or SVE. In the ETMI group (n=118), first examination was performed using HRE, followed by AFI. In the other group, both examinations were performed using SVE (n=116). In the ETMI group, detected lesions were differentiated using AFI and NBI. RESULTS In the ETMI group, 87 adenomas were detected in the first examination (with HRE), and then 34 adenomas were detected during second inspection (with AFI). In the SVE group, 79 adenomas were detected during the first inspection, and then 33 adenomas were detected during the second inspection. Adenoma detection rates did not differ significantly between the 2 groups (ETMI: 1.03 vs SVE: 0.97, P=.360). The adenoma miss-rate was 29% for HRE and 28% for SVE. The sensitivity, specificity, and accuracy of NBI in differentiating adenomas from nonadenomatous lesions were 87%, 63%, and 75%, respectively; corresponding values for AFI were 90%, 37%, and 62%, respectively. CONCLUSIONS In a nonacademic setting, ETMI did not improve the detection rate for adenomas compared with SVE. NBI and AFI each differentiated colonic lesions with high levels of sensitivity but low levels of specificity.
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Affiliation(s)
- Teaco Kuiper
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Paspatis GA, Tribonias G, Manolaraki MM, Konstantinidis K, Chainaki I, Theodoropoulou A, Vardas E, Chlouverakis G. Deep sedation compared with moderate sedation in polyp detection during colonoscopy: a randomized controlled trial. Colorectal Dis 2011; 13:e137-44. [PMID: 21564466 DOI: 10.1111/j.1463-1318.2011.02555.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
AIM The detection rate of adenomas is one of the current quality indicators in high-quality colonoscopy. We compared the performance of colonoscopy for the detection of polyps in patients sedated with deep and moderate sedation. Secondary objectives included the patient's and the endoscopist's satisfaction, recovery time and the adverse events related to sedation between the two groups. METHOD Five hundred and twenty patients submitted for colonoscopy were prospectively randomized into a deep sedation group (DS group, n = 258) and a moderate sedation (MS group, n = 262) group. In both, sedation and analgesia were performed using midazolam with pethidine. RESULTS There were no differences between the two groups in the following three areas: (1) The overall detection of polyps (DS, 1 [0-20]; MS, 1 [0-15]; P = 0.67), (2): polyp size ≥ 10 mm (DS, 0.00 [0-7]; MS, 0.00 [0-6]; P = 0.30), and (3) polyp size < 10 mm (DS, 0.00 [0-20]; MS, 0.00 [0-13]; P = 0.83). There was no significant difference in the rate of adenoma detection (DS, 1 [0-10]; MS, 1 [0-9]; P = 0.99). CONCLUSION The study demonstrated no difference in the detection of polyps by colonoscopy using deep or moderate sedation.
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Affiliation(s)
- G A Paspatis
- Department of Gastroenterology Anesthesiology, Benizelion General Hospital, University of Crete, Heraklion-Crete, Greece.
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Optical Enhancements in Diagnosis and Surveillance of Colorectal Neoplasia. CURRENT COLORECTAL CANCER REPORTS 2011. [DOI: 10.1007/s11888-010-0083-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Abstract
PURPOSE OF REVIEW Colorectal cancer screening and prevention is a pivotal element in every gastroenterologist practice. Recent advances in imaging technology and treatment opened the field for endoscopic management of large flat colorectal polyps and early cancer. RECENT FINDINGS High-definition white light colonoscopy allowed for better characterization of colon polyps, particularly flat lesions. Chromoendoscopy facilitated the identification of colon polyps as well as better endoscopic polyp characterization, with strong correlation with final pathological diagnosis, opening the field of 'virtual' biopsy. One particular technology, confocal endomicroscopy can magnify an image approximately 1000 times resembling optical microscopy with very good correlation with histology. Endoscopic mucosal resection has gained great acceptance to manage flat colorectal polyps with the two major complications being bleeding and perforation, both now under 5% in experienced hands. Endoscopic submucosal resection was developed to increase en-bloc resection (less residual disease) of a flat colorectal lesion but one has to accept a higher perforation rate around 10%. SUMMARY Current technology allows for better polyp identification and characterization, which can be managed endoscopically.
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Sauk J, Hoffman A, Anandasabapathy S, Kiesslich R. High-definition and filter-aided colonoscopy. Gastroenterol Clin North Am 2010; 39:859-81. [PMID: 21093760 DOI: 10.1016/j.gtc.2010.08.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
New high-resolution colonoscopes and filter technologies are allowing us to visualize more lesions and better characterize lesions within the gastrointestinal tract. In light of recent findings that flat and serrated lesions are more likely to contain invasive cancer and that even small lesions (5-10 mm) may contain advanced histology, detecting these lesions earlier with improved optical technologies may help decrease the rate of interval cancers after colonoscopy. With the limited accuracy of white-light colonoscopy (59%-84%) in distinguishing non-neoplastic lesions from neoplastic lesions, these new technologies can help us improve our abilities to risk stratify patients and determine more precise surveillance intervals.
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Affiliation(s)
- Jenny Sauk
- The Henry D. Janowitz Division of Gastroenterology, Mount Sinai School of Medicine, 1 Gustave Levy Place, Box 1069, New York, NY 10029, USA
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Tribonias G, Chlouverakis G, Paspatis GA. How strong is the evidence that high-definition colonoscopy improves polyp detection rate compared with standard white-light colonoscopy? Clin Gastroenterol Hepatol 2010; 8:903; author reply 904. [PMID: 20580943 DOI: 10.1016/j.cgh.2010.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Accepted: 05/08/2010] [Indexed: 02/07/2023]
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