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Missed adenomas with behind-folds visualizing colonoscopy technologies compared with standard colonoscopy: a pooled
Eelco C Brand1, Vincent K Dik1, Martijn G H van Oijen2
1Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
Background And Aims:
The Third Eye Retroscope, Full Spectrum Endoscope (FUSE), and EndoRings devices have been shown to reduce overall adenoma miss rates. We evaluated the characteristics of adenomas and patient subgroups for which these behind-folds visualizing technologies mostly reduce adenoma miss rates.
Methods:
Data of 3 multicenter randomized trials (NCT01044732, NCT01549535, NCT01955122) were combined. Patients underwent same-day, back-to-back tandem examinations with standard colonoscopy and Third Eye Retroscope, FUSE, or EndoRings colonoscopy, respectively. Adenoma miss rates were stratified by adenoma characteristics and patient subgroups.
Results:
A total of 650 patients (60% male, mean age 57.5 years, standard deviation 9.7 years) were included; 330 patients underwent behind-folds visualizing colonoscopy first, and 320 patients underwent standard colonoscopy first. Regarding adenoma characteristics, adenoma miss rates were significantly (P < .001) lower with behind-folds visualizing technologies compared with standard colonoscopy for proximal (14% vs 38%) and distal (15% vs 35%), ≤5 mm (17% vs 38%), 6 to 9 mm (8% vs 44%), sessile (16% vs 37%), flat (9% vs 52%; P = .014), and tubular (15% vs 38%) adenomas and sessile serrated polyps (7% vs 50%; P = .039) but were not statistically significantly (P > .05) different for ≥10 mm, pedunculated, (tubulo-)villous, and advanced adenomas. Regarding patient subgroups, adenoma miss rates were significantly (P ≤ .020) lower with behind-folds visualizing technologies for patients ≥50 years, both sexes, and all indications.
Conclusions:
Behind-folds visualizing colonoscopy reduces miss rates for 1 to 9 mm adenomas in the entire colon, whereas no advantage was found for ≥10 mm and advanced adenomas. Whether increased detection and removal of <10 mm adenomas also reduces colorectal cancer incidence and mortality remains to be determined. Future research is needed to determine which colonoscopy technology would be most beneficial for which patient or endoscopist.
Insights
Behind-folds visualizing colonoscopy significantly reduces adenoma miss rates for small and flat polyps. This technology shows promise for improving colonoscopy detection but its impact on cancer outcomes requires further study.
Area of Science:
- Gastroenterology
- Endoscopy
- Cancer Prevention
Background:
- Adenoma miss rates during colonoscopy remain a concern.
- Technologies like Third Eye Retroscope, FUSE, and EndoRings aim to improve adenoma detection by visualizing behind folds.
Purpose of the Study:
- To evaluate the effectiveness of behind-folds visualizing technologies in reducing adenoma miss rates.
- To identify specific adenoma characteristics and patient subgroups that benefit most from these advanced colonoscopy tools.
Main Methods:
- Combined data from three multicenter randomized trials (NCT01044732, NCT01549535, NCT01955122).
- Patients underwent tandem colonoscopies: one with standard colonoscopy and another with a behind-folds visualizing device.
- Adenoma miss rates were analyzed based on adenoma size, morphology, and patient demographics.
Main Results:
- Behind-folds visualizing technologies significantly lowered miss rates for proximal, distal, small (≤9 mm), flat, and sessile adenomas, as well as sessile serrated polyps.
- No significant difference in miss rates was observed for larger (≥10 mm), pedunculated, or advanced adenomas.
- Improved detection was noted across various patient subgroups, including those aged 50 and older, both sexes, and all indications.
Conclusions:
- Behind-folds visualizing colonoscopy effectively reduces miss rates for adenomas up to 9 mm throughout the colon.
- The clinical impact of detecting smaller adenomas on colorectal cancer incidence and mortality needs further investigation.
- Future research should focus on determining the optimal use of different colonoscopy technologies for specific patient and endoscopist profiles.
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