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Lau LHS, Ho JCL, Lai JCT, Ho AHY, Wu CWK, Lo VWH, Lai CMS, Scheppach MW, Sia F, Ho KHK, Xiao X, Yip TCF, Lam TYT, Kwok HYH, Chan HCH, Lui RN, Chan TT, Wong MTL, Ho MF, Ko RCW, Hon SF, Chu S, Futaba K, Ng SSM, Yip HC, Tang RSY, Wong VWS, Chan FKL, Chiu PWY. Effect of Real-Time Computer-Aided Polyp Detection System (ENDO-AID) on Adenoma Detection in Endoscopists-in-Training: A Randomized Trial. Clin Gastroenterol Hepatol 2024; 22:630-641.e4. [PMID: 37918685 DOI: 10.1016/j.cgh.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/12/2023] [Accepted: 10/19/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND The effect of computer-aided polyp detection (CADe) on adenoma detection rate (ADR) among endoscopists-in-training remains unknown. METHODS We performed a single-blind, parallel-group, randomized controlled trial in Hong Kong between April 2021 and July 2022 (NCT04838951). Eligible subjects undergoing screening/surveillance/diagnostic colonoscopies were randomized 1:1 to receive colonoscopies with CADe (ENDO-AID[OIP-1]) or not (control) during withdrawal. Procedures were performed by endoscopists-in-training with <500 procedures and <3 years' experience. Randomization was stratified by patient age, sex, and endoscopist experience (beginner vs intermediate level, <200 vs 200-500 procedures). Image enhancement and distal attachment devices were disallowed. Subjects with incomplete colonoscopies or inadequate bowel preparation were excluded. Treatment allocation was blinded to outcome assessors. The primary outcome was ADR. Secondary outcomes were ADR for different adenoma sizes and locations, mean number of adenomas, and non-neoplastic resection rate. RESULTS A total of 386 and 380 subjects were randomized to CADe and control groups, respectively. The overall ADR was significantly higher in the CADe group than in the control group (57.5% vs 44.5%; adjusted relative risk, 1.41; 95% CI, 1.17-1.72; P < .001). The ADRs for <5 mm (40.4% vs 25.0%) and 5- to 10-mm adenomas (36.8% vs 29.2%) were higher in the CADe group. The ADRs were higher in the CADe group in both the right colon (42.0% vs 30.8%) and left colon (34.5% vs 27.6%), but there was no significant difference in advanced ADR. The ADRs were higher in the CADe group among beginner (60.0% vs 41.9%) and intermediate-level (56.5% vs 45.5%) endoscopists. Mean number of adenomas (1.48 vs 0.86) and non-neoplastic resection rate (52.1% vs 35.0%) were higher in the CADe group. CONCLUSIONS Among endoscopists-in-training, the use of CADe during colonoscopies was associated with increased overall ADR. (ClinicalTrials.gov, Number: NCT04838951).
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Affiliation(s)
- Louis H S Lau
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR; Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR; State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Jacky C L Ho
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Jimmy C T Lai
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Agnes H Y Ho
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Claudia W K Wu
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Vincent W H Lo
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Carol M S Lai
- Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Markus W Scheppach
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR; Gastroenterology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Felix Sia
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR
| | - Kyle H K Ho
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR
| | - Xiang Xiao
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR; Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong SAR
| | - Terry C F Yip
- Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong SAR
| | - Thomas Y T Lam
- Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong SAR
| | - Hanson Y H Kwok
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Heyson C H Chan
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Rashid N Lui
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Ting-Ting Chan
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Marc T L Wong
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Man-Fung Ho
- Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Rachel C W Ko
- Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Sok-Fei Hon
- Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Simon Chu
- Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Koari Futaba
- Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Simon S M Ng
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR; Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Hon-Chi Yip
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR; Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Raymond S Y Tang
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR; Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR; State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Vincent W S Wong
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR; Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR; State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Francis K L Chan
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR; Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR; State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Philip W Y Chiu
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR; Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR.
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Yoshida N, Inagaki Y, Inada Y, Kobayashi R, Tomita Y, Hashimoto H, Dohi O, Hirose R, Inoue K, Murakami T, Morimoto Y, Okuyama Y, Morinaga Y, Itoh Y. Additional 30-Second Observation of the Right-Sided Colon for Missed Polyp Detection With Texture and Color Enhancement Imaging Compared with Narrow Band Imaging: A Randomized Trial. Am J Gastroenterol 2023:00000434-990000000-00893. [PMID: 37782280 DOI: 10.14309/ajg.0000000000002529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 08/10/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION The efficacy of texture and color enhancement imaging (TXI) in the novel light-emitting diode endoscopic system for polyp detection has not been examined. We aimed to evaluate the noninferiority of the additional 30-second (Add-30-s) observation of the right-sided colon (cecum/ascending colon) with TXI compared with narrow band imaging (NBI) for detecting missed polyps. METHODS We enrolled 381 patients ≥40 years old who underwent colonoscopy from September 2021 to June 2022 in 3 institutions and randomly assigned them to either the TXI or NBI groups. The right-sided colon was first observed with white light imaging in both groups. Second, after reinsertion from hepatic flexure to the cecum, the right-sided colon was observed with Add-30-s observation of either TXI or NBI. The primary endpoint was to examine the noninferiority of TXI to NBI using the mean number of adenomas and sessile serrated lesions per patient. The secondary ones were to examine adenoma detection rate, adenoma and sessile serrated lesions detection rates, and polyp detection rates in both groups. RESULTS The TXI and NBI groups consisted of 177 and 181 patients, respectively, and the noninferiorities of the mean number of adenomas and sessile serrated lesions per patients in the second observation were significant (TXI 0.29 [51/177] vs NBI 0.30 [54/181], P < 0.01). The change in adenoma detection rate, adenoma and sessile serrated lesions detection rate, and polyp detection rate for the right-sided colon between the TXI and NBI groups were not different (10.2%/10.5% [ P = 0.81], 13.0%/12.7% [ P = 0.71], and 15.3%/13.8% [ P = 0.71]), respectively. DISCUSSION Regarding Add-30-s observation of the right-sided colon, TXI was noninferior to NBI.
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Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | | | - Yutaka Inada
- Department of Gastroenterology, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Reo Kobayashi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Yuri Tomita
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Hikaru Hashimoto
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Ken Inoue
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Takaaki Murakami
- Department of Gastroenterology, Aiseikai Yamashina Hospital, Kyoto, Japan
| | - Yasutaka Morimoto
- Department of Gastroenterology, Kyoto Saiseikai Hospital, Kyoto, Japan
| | - Yusuke Okuyama
- Department of Gastroenterology, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Yukiko Morinaga
- Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
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Xu H, Tang RSY, Lam TYT, Zhao G, Lau JYW, Liu Y, Wu Q, Rong L, Xu W, Li X, Wong SH, Cai S, Wang J, Liu G, Ma T, Liang X, Mak JWY, Xu H, Yuan P, Cao T, Li F, Ye Z, Shutian Z, Sung JJY. Artificial Intelligence-Assisted Colonoscopy for Colorectal Cancer Screening: A Multicenter Randomized Controlled Trial. Clin Gastroenterol Hepatol 2023; 21:337-346.e3. [PMID: 35863686 DOI: 10.1016/j.cgh.2022.07.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/29/2022] [Accepted: 07/05/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Artificial intelligence (AI)-assisted colonoscopy improves polyp detection and characterization in colonoscopy. However, data from large-scale multicenter randomized controlled trials (RCT) in an asymptomatic population are lacking. METHODS This multicenter RCT aimed to compare AI-assisted colonoscopy with conventional colonoscopy for adenoma detection in an asymptomatic population. Asymptomatic subjects 45-75 years of age undergoing colorectal cancer screening by direct colonoscopy or fecal immunochemical test were recruited in 6 referral centers in Hong Kong, Jilin, Inner Mongolia, Xiamen, and Beijing. In the AI-assisted colonoscopy, an AI polyp detection system (Eagle-Eye) with real-time notification on the same monitor of the endoscopy system was used. The primary outcome was overall adenoma detection rate (ADR). Secondary outcomes were mean number of adenomas per colonoscopy, ADR according to endoscopist's experience, and colonoscopy withdrawal time. This study received Institutional Review Board approval (CRE-2019.393). RESULTS From November 2019 to August 2021, 3059 subjects were randomized to AI-assisted colonoscopy (n = 1519) and conventional colonoscopy (n = 1540). Baseline characteristics and bowel preparation quality between the 2 groups were similar. The overall ADR (39.9% vs 32.4%; P < .001), advanced ADR (6.6% vs 4.9%; P = .041), ADR of expert (42.3% vs 32.8%; P < .001) and nonexpert endoscopists (37.5% vs 32.1%; P = .023), and adenomas per colonoscopy (0.59 ± 0.97 vs 0.45 ± 0.81; P < .001) were all significantly higher in the AI-assisted colonoscopy. The median withdrawal time (8.3 minutes vs 7.8 minutes; P = .004) was slightly longer in the AI-assisted colonoscopy group. CONCLUSIONS In this multicenter RCT in asymptomatic patients, AI-assisted colonoscopy improved overall ADR, advanced ADR, and ADR of both expert and nonexpert attending endoscopists. (ClinicalTrials.gov, Number: NCT04422548).
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Affiliation(s)
- Hong Xu
- Department of Gastroenterology and Endoscopy Center, First Hospital of Jilin University, Jilin, China
| | - Raymond S Y Tang
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China; Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Thomas Y T Lam
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China; JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong SAR, China; Stanley Ho Big Data Decision Analytics Research Centre, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Guijun Zhao
- Department of Endoscopy Center, Inner Mongolia Key Laboratory of Endoscopic Digestive Diseases, Inner Mongolia People's Hospital, Hohhot, China
| | - James Y W Lau
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China; Department of Surgery, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yunpeng Liu
- Department of Gastroenterology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China
| | - Qi Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Endoscopy Center, Peking University Cancer Hospital and Institute, Beijing, China
| | - Long Rong
- Endoscopy Center, Peking University First Hospital, Beijing, China
| | - Weiran Xu
- Department of Gastroenterology and Endoscopy Center, First Hospital of Jilin University, Jilin, China
| | - Xue Li
- Department of Endoscopy Center, Inner Mongolia Key Laboratory of Endoscopic Digestive Diseases, Inner Mongolia People's Hospital, Hohhot, China
| | - Sunny H Wong
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China; Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Shuntian Cai
- Department of Gastroenterology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China
| | - Jing Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Endoscopy Center, Peking University Cancer Hospital and Institute, Beijing, China
| | - Guanyi Liu
- Endoscopy Center, Peking University First Hospital, Beijing, China
| | - Tantan Ma
- Department of Gastroenterology and Endoscopy Center, First Hospital of Jilin University, Jilin, China
| | - Xiong Liang
- Department of Endoscopy Center, Inner Mongolia Key Laboratory of Endoscopic Digestive Diseases, Inner Mongolia People's Hospital, Hohhot, China
| | - Joyce W Y Mak
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China; Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hongzhi Xu
- Department of Gastroenterology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China
| | - Peng Yuan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Endoscopy Center, Peking University Cancer Hospital and Institute, Beijing, China
| | - Tingting Cao
- Department of Gastroenterology and Endoscopy Center, First Hospital of Jilin University, Jilin, China
| | - Fudong Li
- Department of Gastroenterology and Endoscopy Center, First Hospital of Jilin University, Jilin, China
| | - Zhenshi Ye
- Department of Gastroenterology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China
| | - Zhang Shutian
- Department of Gastroenterology and Hepatology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Joseph J Y Sung
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China; Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China; Stanley Ho Big Data Decision Analytics Research Centre, Chinese University of Hong Kong, Hong Kong SAR, China; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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Reduced Adenoma Miss Rate With 9-Minute vs 6-Minute Withdrawal Times for Screening Colonoscopy: A Multicenter Randomized Tandem Trial. Am J Gastroenterol 2022; 118:802-811. [PMID: 36219172 PMCID: PMC10144327 DOI: 10.14309/ajg.0000000000002055] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 09/02/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Although the 9-minute mean withdrawal time (m-WT) is often reported to be associated with the optimal adenoma detection rate (ADR), no randomized trials of screening colonoscopy have confirmed the impact of a 9-minute m-WT on adenoma miss rate (AMR) and ADR. METHODS A multicenter tandem trial was conducted in 11 centers. Seven hundred thirty-three asymptomatic participants were randomized to receive segmental tandem screening colonoscopy with a 9-minute withdrawal, followed by a 6-minute withdrawal (9-minute-first group, 9MF, n = 366) or vice versa (6-minute-first group, 6MF, n = 367). The primary outcome was the lesion-level AMR. RESULTS The intention-to-treat analysis revealed that 9MF significantly reduced the lesion-level (14.5% vs 36.6%, P < 0.001) and participant-level AMR (10.9% vs 25.9%, P < 0.001), advanced adenoma miss rate (AAMR, 5.3% vs 46.9%, P = 0.002), multiple adenomas miss rate (20.7% vs 56.5%, P = 0.01), and high-risk adenomas miss rate (14.6% vs 39.5%, P = 0.01) of 6MF without compromising detection efficiency ( P = 0.79). In addition, a lower false-negative rate for adenomas ( P = 0.002) and high-risk adenomas ( P < 0.05), and a lower rate of shortening surveillance schedule ( P < 0.001) were also found in 9MF, accompanying with an improved ADR in the 9-minute vs 6-minute m-WT (42.3% vs 33.5%, P = 0.02). The independent inverse association between m-WT and AMR remained significant even after adjusting ADR, and meanwhile, 9-minute m-WT was identified as an independent protector for AMR and AAMR. DISCUSSION In addition to increasing ADR, 9-minute m-WT also significantly reduces the AMR and AAMR of screening colonoscopy without compromising detection efficiency.
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Kamal F, Khan MA, Lee-Smith W, Sharma S, Acharya A, Imam Z, Farooq U, Hanson J, Pulous V, Aziz M, Chandan S, Kouanda A, Dai SC, Munroe CA, Howden CW. Second exam of right colon improves adenoma detection rate: Systematic review and meta-analysis of randomized controlled trials. Endosc Int Open 2022; 10:E1391-E1398. [PMID: 36262512 PMCID: PMC9576333 DOI: 10.1055/a-1896-4499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 07/08/2022] [Indexed: 11/06/2022] Open
Abstract
Background and study aims A second examination of the right colon, either as a second forward view (SFV) or as retroflexion (RF) in the cecum, can increase adenoma detection rate (ADR) in the right colon. In this meta-analysis, we have evaluated the role of a second examination of the right colon in improving ADR. Methods We reviewed several databases to identify randomized controlled trials that compared right colon SFV with no SFV, and RCTs that compared SFV with RF in the right colon, and reported data on ADR. Our outcomes of interest were ADR and polyp detection rate (PDR) with SFV vs no SFV, right colon and total withdrawal times, and additional ADR and PDR with SFV vs RF. For categorical variables, we calculated pooled risk ratios (RRs) with 95 % confidence intervals (CIs); for continuous variables, we calculated standardized mean difference (SMD) with 95 % CI. Data were analyzed using random effects model. Results We included six studies with 3901 patients. Comparing SFV with no SFV, right colon ADR and PDR were significantly higher in the SFV group: ADR (RR [95 % CI] 1.39 [1.22,1.58]) and PDR (RR [95 % CI] 1.47 [1.30, 1.65]). We found no significant difference in right colon withdrawal time (SMD [95 % CI] 1.54 [-0.20,3.28]) or total withdrawal time (SMD (95 % CI) 0.37 [-0.39,1.13]) with and without SFV. We found no significant difference in additional ADR between SFV and RF. Conclusions SFV of the right colon significantly increases right-sided and overall ADR.
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Affiliation(s)
- Faisal Kamal
- Division of Gastroenterology, University of California-San Francisco, California, United States
| | - Muhammad Ali Khan
- Division of Gastroenterology, Hepatology and Nutrition, University of Texas MD
| | - Wade Lee-Smith
- Mulford Health Sciences Library, University of Toledo, Toledo, Ohio, United States
| | - Sachit Sharma
- Department of Medicine, University of Toledo, Toledo, Ohio, United States,Division of Gastroenterology, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Ashu Acharya
- Department of Medicine, University of Toledo, Toledo, Ohio, United States
| | - Zaid Imam
- Division of Gastroenterology, William Beaumont Hospital, Royal Oak, Michigan, United States
| | - Umer Farooq
- Department of Medicine, Loyola Medicine/MacNeal Hospital, Berwyn, Illinois, United States
| | - John Hanson
- Department of Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States
| | - Vian Pulous
- Department of Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States
| | - Muhammad Aziz
- Division of Gastroenterology, University of Toledo, Toledo, Ohio, United States
| | - Saurabh Chandan
- Division of Gastroenterology, Creighton University Medical Center, Omaha, Nebraska, United States
| | - Abdul Kouanda
- Division of Gastroenterology, University of California-San Francisco, California, United States
| | - Sun-Chuan Dai
- Division of Gastroenterology, University of California-San Francisco, California, United States
| | - Craig A. Munroe
- Division of Gastroenterology, University of California-San Francisco, California, United States
| | - Colin W. Howden
- Division of Gastroenterology, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States
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Gubbiotti A, Spadaccini M, Badalamenti M, Hassan C, Repici A. Key factors for improving adenoma detection rate. Expert Rev Gastroenterol Hepatol 2022; 16:819-833. [PMID: 36151898 DOI: 10.1080/17474124.2022.2128761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Colonoscopy is a fundamental tool in colorectal cancer (CRC) prevention. Nevertheless, one-fourth of colorectal neoplasms are still missed during colonoscopy, potentially being the main reason for post-colonoscopy colorectal cancer (PCCRC). Adenoma detection rate (ADR) is currently known as the best quality indicator correlating with PCCRC incidence. AREAS COVERED We performed a literature review in order to summarize evidences investigating key factors affecting ADR: endoscopists education and training, patient management, endoscopic techniques, improved navigation (exposition defect), and enhanced lesions recognition (vision defect) were considered. EXPERT OPINION 'Traditional' factors, such as split dose bowel preparation, adequate withdrawal time, and right colon second view, held a significant impact on ADR. Several devices and technologies have been developed to promote high-quality colonoscopy, however artificial intelligence may be considered the most promising tool for ADR improvement, provided that endoscopists education and recording are guaranteed.
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Affiliation(s)
- Alessandro Gubbiotti
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Italy
| | - Marco Spadaccini
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Italy
| | - Matteo Badalamenti
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Italy
| | - Cesare Hassan
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Italy
| | - Alessandro Repici
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Italy
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Shaukat A, Tuskey A, Rao VL, Dominitz JA, Murad MH, Keswani RN, Bazerbachi F, Day LW. Interventions to improve adenoma detection rates for colonoscopy. Gastrointest Endosc 2022; 96:171-183. [PMID: 35680469 DOI: 10.1016/j.gie.2022.03.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/25/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Aasma Shaukat
- Division of Gastroenterology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Anne Tuskey
- Division of Gastroenterology, Department of Medicine, University of Virginia, Arlington, Virginia, USA
| | - Vijaya L Rao
- Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Jason A Dominitz
- Division of Gastroenterology, Department of Medicine, Puget Sound Veterans Affairs Medical Center and University of Washington, Seattle, Washington, USA
| | - M Hassan Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rajesh N Keswani
- Division of Gastroenterology, Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Fateh Bazerbachi
- Division of Gastroenterology, CentraCare, Interventional Endoscopy Program, St Cloud, Minnesota, USA
| | - Lukejohn W Day
- Division of Gastroenterology, Department of Medicine, Zuckerberg San Francisco General Hospital and University of San Francisco, San Francisco, California, USA
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Abstract
Colorectal cancer (CRC) continues to be the third leading cause of cancer-related deaths in the US. Colonoscopy remains the best preventative tool against the development of CRC. As a result, high-quality colonoscopy is becoming increasingly important. Specifically, recent guidelines have highlighted pre-procedural, peri-procedural, and post-procedural practices, which promise to improve patient outcomes and reduce the mortality and interval cancer rates in patients undergoing colonoscopies. Despite the guidelines and advances in modern endoscopy, the procedure remains provider-dependent, which results in differences in outcomes. As a result, incorporating high-quality colonoscopy approaches early in training is key to improving patient outcomes. Additionally, ensuring that high-quality colonoscopy is practiced widely by endoscopists can lead to the most cost-effective care.
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9
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Imai K. Reappraisal of a second examination after standard colonoscopy withdrawal in the proximal colon: Retroflex or forward view? Dig Endosc 2022; 34:741-743. [PMID: 35301765 DOI: 10.1111/den.14272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Kenichiro Imai
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
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10
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Schrader C, Wallstabe I, Schiefke I. Künstliche Intelligenz in der Vorsorgekoloskopie. COLOPROCTOLOGY 2022. [DOI: 10.1007/s00053-022-00593-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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11
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Kerdsirichairat T, Shin EJ. Important Quality Metrics and Standardization in Endoscopy. Gastrointest Endosc Clin N Am 2021; 31:727-742. [PMID: 34538412 DOI: 10.1016/j.giec.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Quality metrics and standardization has become critical as the Affordable Care Act mandates that the Center for Medicare and Medicaid Services change reimbursement from volume to a value-based system. While the most commonly used quality indicators are related to that of colonoscopy, quality metrics for other procedures and endoscopy units have been developed mainly by the American College of Gastroenterology and the American Society of Gastrointestinal Endoscopy. Data to show that these quality metrics, especially in the field of advanced endoscopy as well as in the era of COVID-19 pandemic, can improve patient outcomes, are anticipated.
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Affiliation(s)
- Tossapol Kerdsirichairat
- Digestive Disease Center, Bumrungrad International Hospital, Bangkok, Thailand 33 Soi Sukhumvit 3, Wattana, Bangkok 10110 Thailand
| | - Eun Ji Shin
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins Medical Institutions, 1800 Orleans Street, Sheikh Zayed Tower, Suite 7125H, Baltimore, MD 21287, USA.
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12
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Keswani RN, Crockett SD, Calderwood AH. AGA Clinical Practice Update on Strategies to Improve Quality of Screening and Surveillance Colonoscopy: Expert Review. Gastroenterology 2021; 161:701-711. [PMID: 34334168 DOI: 10.1053/j.gastro.2021.05.041] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/27/2021] [Accepted: 05/06/2021] [Indexed: 12/23/2022]
Abstract
The purpose of this American Gastroenterological Association Institute Clinical Practice Update was to review the available evidence and provide best practice advice regarding strategies to improve the quality of screening and surveillance colonoscopy. This review is framed around 15 best practice advice statements regarding colonoscopy quality that were agreed upon by the authors, based on a review of the available evidence and published guidelines. This is not a formal systematic review and thus no formal rating of the quality of evidence or strength of recommendation has been carried out.
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Affiliation(s)
- Rajesh N Keswani
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Seth D Crockett
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Audrey H Calderwood
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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