New endoscopes and add-on devices to improve colonoscopy performance

Endocuff-Assisted Colonoscopy for Identifying Sessile Serrated Polyps and Adenomas During Routine Colorectal Cancer Screening: A Retrospective Cohort Study

Background and Aims

Polyps located in less accessible areas of the colon, such as inner curves of flexures, are often difficult to visualize. Colonoscope attachments such as the Endocuff have been developed to improve the visualization of these polyps. We aimed to assess the utility of Endocuff-assisted colonoscopy (EAC) in the detection of tubular adenomas and sessile serrated polyps (SSP) compared to conventional colonoscopy during routine colorectal cancer screening.

Patients and Methods

This retrospective cohort study included patients who underwent colorectal cancer screening with either conventional colonoscopy or EAC between November 2022 and March 2023. The primary outcomes were SSP and tubular adenoma detection rates. Secondary outcomes included total procedure time, cecal intubation time, and ileal intubation rates.

Results

Of the 435 patients included, 189 (43%) underwent EAC, and 246 (57%) underwent conventional colonoscopy. The mean ± standard deviation number of polyps detected was 1.7 ± 2.2, the mean procedure time was 18.7 ± 7.5 min, and the mean cecal intubation time was 4.4 ± 3.3 min, with no significant differences between groups. A smaller proportion of patients in the EAC group had successful ileal intubation (14% vs. 55%; p < 0.01). The tubular adenoma detection rate was similar between EAC and conventional colonoscopy (41% vs. 39%; p = 0.70), but the SSP detection rate was significantly higher with EAC (16% vs. 8.5%; p < 0.01).

Conclusion

EAC may enhance the detection of difficult-to-visualize SSPs during screening colonoscopies without affecting overall procedure time. However, physicians should consider the examination indication when selecting EAC, as ileal intubation may be more challenging.

Polyp detection with colonoscopy assisted by the GI Genius artificial intelligence endoscopy module compared with standard colonoscopy in routine colonoscopy practice (COLO-DETECT): a multicentre, open-label, parallel-arm, pragmatic randomised controlled trial

BACKGROUND

Increased polyp detection during colonoscopy is associated with decreased post-colonoscopy colorectal cancer incidence and mortality. The COLO-DETECT trial aimed to assess the clinical effectiveness of the GI Genius intelligent endoscopy module for polyp detection, comparing colonoscopy assisted by GI Genius (computer-aided detection [CADe]-assisted colonoscopy) with standard colonoscopy in routine practice.

METHODS

We did a multicentre, open-label, parallel-arm, pragmatic randomised controlled trial in 12 National Health Service (NHS) hospitals (ten NHS Trusts) in England, among adults (aged ≥18 years) undergoing planned colonoscopy for gastrointestinal symptoms or for surveillance due to personal or family history (ie, symptomatic indications), or colorectal cancer screening. Randomisation (1:1) to CADe-assisted colonoscopy or standard colonoscopy was done with a web-based dynamic adaptive algorithm, immediately before colonoscopy, with stratification by age group, sex, colonoscopy indication (screening or symptomatic), and NHS Trust. Recruiting staff, participants, and colonoscopists were unmasked to trial allocation; histopathologists, co-chief investigators, and trial statisticians were masked. CADe-assisted colonoscopy consisted of standard colonoscopy plus the GI Genius module active for at least the entire inspection phase of colonoscope withdrawal. The primary outcome was mean adenomas per procedure (total number of adenomas detected divided by total number of procedures); the key secondary outcome was adenoma detection rate (proportion of colonoscopies with at least one adenoma). Analysis was by intention to treat (ITT), with outcomes compared between groups by mixed-effects regression modelling, in which effect estimates were adjusted for randomisation stratification variables. Data were imputed for outcome measures with more than 5% missing values. All participants who underwent colonoscopy were assessed for safety. The trial is registered on ISRCTN (ISRCTN10451355) and ClinicalTrials.gov (NCT04723758), and is complete.

FINDINGS

Between March 29, 2021, and April 6, 2023, 2032 participants (1132 [55·7%] male, 900 [44·3%] female; mean age 62·4 years [SD 10·8]) were recruited and randomly assigned: 1015 to CADe-assisted colonoscopy and 1017 to standard colonoscopy. 1231 (60·6%) participants were undergoing screening and 801 (39·4%) had symptomatic indications. Mean adenomas per procedure was 1·56 (SD 2·82; n=1001 participants with available data) in the CADe-assisted colonoscopy group versus 1·21 (1·91; n=1009) in the standard colonoscopy group, representing an adjusted mean difference of 0·36 (95% CI 0·14-0·57; adjusted incidence rate ratio 1·30 [95% CI 1·15-1·47], p<0·0001). Adenomas were detected in 555 (56·6%) of 980 participants in the CADe-assisted colonoscopy group versus 477 (48·4%) of 986 in the standard colonoscopy group, representing a proportion difference of 8·3% (95% CI 3·9-12·7; adjusted odds ratio 1·47 [95% CI 1·21-1·78], p<0·0001). Numbers of adverse events were similar between the CADe-assisted colonoscopy and standard colonoscopy groups (adverse events: 25 vs 19; serious adverse events: four vs six), and no adverse events in the CADe-assisted colonoscopy group were deemed to be related to GI Genius use on independent review.

INTERPRETATION

Results of the COLO-DETECT trial support the use of GI Genius to increase detection of premalignant colorectal polyps in routine colonoscopy practice.

FUNDING

Medtronic.

Factors affecting the quality of bowel preparation for colonoscopy in hard-to-prepare patients: Evidence from the literature

Adequate bowel cleansing is critical for a high-quality colonoscopy because it affects diagnostic accuracy and adenoma detection. Nevertheless, almost a quarter of procedures are still carried out with suboptimal preparation, resulting in longer procedure times, higher risk of complications, and higher likelihood of missing lesions. Current guidelines recommend high-volume or low-volume polyethylene glycol (PEG)/non-PEG-based split-dose regimens. In patients who have had insufficient bowel cleansing, the colonoscopy should be repeated the same day or the next day with additional bowel cleansing as a salvage option. A strategy that includes a prolonged low-fiber diet, a split preparation regimen, and a colonoscopy within 5 h of the end of preparation may increase cleansing success rates in the elderly. Furthermore, even though no specific product is specifically recommended in the other cases for difficult-to-prepare patients, clinical evidence suggests that 1-L PEG plus ascorbic acid preparation are associated with higher cleansing success in hospitalized and inflammatory bowel disease patients. Patients with severe renal insufficiency (creatinine clearance < 30 mL/min) should be prepared with isotonic high volume PEG solutions. Few data on cirrhotic patients are currently available, and no trials have been conducted in this population. An accurate characterization of procedural and patient variables may lead to a more personalized approach to bowel preparation, especially in patients undergoing resection of left colon lesions, where intestinal preparation has a poor outcome. The purpose of this review was to summarize the evidence on the risk factors influencing the quality of bowel cleansing in difficult-to-prepare patients, as well as strategies to improve colonoscopy preparation in these patients.

Clinical Characteristics and Main Findings of Colonoscopy in Tripoli Central Hospital: A Cross-Sectional Study of 1858 Patients

Introduction Colonoscopy is used to detect colorectal abnormalities, including inflammatory bowel disease, polyps, cancers, and other colorectal lesions. We aimed to analyze the demographic and clinical characteristics, main findings, and indications of patients who underwent colonoscopy in the Surgery department of Tripoli Central Hospital in Libya. Methods The study data were retrospectively extracted from the medical in and out-patient records of individuals who underwent colonoscopy procedures between December 2009 and December 2016 in the general surgery department of Tripoli General Hospital. Results A total of 1858 patients underwent colonoscopy during the study period with a mean age of 51.7 ± 18.5 years. Hematochezia was the most common patient complaint (530; 28.5%), followed by constipation (354; 19.1%), and weight loss (178; 9.6%), respectively. Seven-hundred sixty-five (765; 41.2%) participants completed the procedure, 420 (22.6%) did not, and 673 (36.2%) participants failed the colonoscopy. The most common reasons for procedure failure were failed preparation (609; 55.7%), followed by patient intolerance (251; 23.0%), and obstructive lesions (229; 21.0%). The most common finding was colonic masses, followed by polyps (29.0% and 20.8%, respectively). Conclusion This study describes the characteristics of colonoscopy patients in the largest surgical center in Libya over seven years. Hematochezia and chronic constipation were the most common complaints among the participants with reported complaints. Half of the colonoscopy procedures are incomplete or failed due to the lack of patient preparation. Colonic masses and polyps were the most common among the reported colonoscopic findings. Future research to increase the quality of colonoscopy service and patient preparations in Libya is required.

Safety, Efficacy and High-Quality Standards of Gastrointestinal Endoscopy Procedures in Personalized Sedoanalgesia Managed by the Gastroenterologist: A Retrospective Study

Performing GI endoscopy under sedoanalgesia improves the quality-indices of the examination, in particular for cecal intubation and adenoma detection rates during colonoscopy. The implementation of procedural sedoanalgesia in GI endoscopy is also strongly recommended by the guidelines of the major international scientific societies. Nevertheless, there are regional barriers that prevent the widespread adoption of this good practice. A retrospective monocentric analytic study was performed on a cohort of 529 patients who underwent EGDS/Colonoscopy in sedoanalgesia, with personalized dosage of Fentanyl and Midazolam. ASA class, age and weight were collected for each patient. The vital parameters were recorded during, pre- and post-procedure. The rates of cecal intubation and of procedure-related complications were entered. The VAS scale was used to evaluate the efficacy of sedoanalgesia, and the Aldrete score was used for patient discharge criteria. No clinically significant differences were found between vital signs pre- and post-procedure. Both anesthesia and endoscopic-related complications occurring were few and successfully managed. At the end of examination, both the mean Aldrete score (89.56), and the VAS score (<4 in 99.1%) were suitable for discharge. For the colonoscopies, the cumulative adenoma detection rate (25%) and the cecal intubation rate in the general group (98%) and in the colorectal cancer screening group (100%) were satisfying. Pain control management is an ethical and medical issue aimed at increasing both patient compliance and the quality of the procedures. The findings of this work underscore that in selected patients personalized sedoanalgesia in GI endoscopy can be safely managed by gastroenterologists.

Endocuff-assisted colonoscopy versus cap-assisted colonoscopy for adenoma detection rate: A meta-analysis of randomized controlled trials

BACKGROUND AND AIMS

Add-on devices have been widely used in clinical practice. The aim of this meta-analysis was to compare the adenoma detection rate between Endocuff-assisted colonoscopy (EAC) and cap-assisted colonoscopy (CAC).

METHODS

PubMed, EMBASE, SCOPUS, and Cochrane databases were searched. Outcomes included adenoma detection rate, cecal intubation rate, cecal intubation time, and withdrawal time. Dichotomous data were pooled to obtain the odds ratio or risk ratio. Continuous data were pooled using the mean difference.

RESULTS

Of the 240 articles reviewed, six randomized controlled trials were included, with a total of 1994 patients. In the meta-analysis, no statistical difference in adenoma detection rate was detected between EAC and CAC (47.0% vs 45.1%; P = 0.33). EAC significantly improved detection rate of diminutive adenomas/polyps compared with CAC (P = 0.01). Cecal intubation was achieved in 96.5% in EAC group and 97.9% in CAC group (P = 0.04). Besides, no statistical difference was found in cecal intubation time (P = 0.86), withdrawal time (P = 0.88), small adenomas/polyps (P = 0.60), or large adenomas/polyps (P = 0.95).

CONCLUSION

EAC and CAC have their respective merits. EAC significantly improve the detection of diminutive adenomas/polyps. CAC was better in cecal intubation rate.

LINC01413/hnRNP-K/ZEB1 Axis Accelerates Cell Proliferation and EMT in Colorectal Cancer via Inducing YAP1/TAZ1 Translocation

Long non-coding RNAs (lncRNAs) are crucial molecules in tumorigenesis and tumor growth in various human cancers, including colorectal cancer (CRC). Studies have revealed that lncRNAs can regulate cellular processes in cancers by interacting with proteins, for example RNA-binding proteins (RBPs). In this study, we recognize a novel lncRNA called LINC01413 that is upregulated in CRC tissues through lncRNAs microarray. Subsequently, we confirmed that an elevated level of LINC01413 expression in CRC tissues was strongly correlated to clinicopathological features, such as tumor size, tumor stage, lymph node metastasis, and distant metastasis, and its association with poor overall survival was also revealed. Additionally, LINC01413 facilitates cell proliferation, migration, invasion, and epithelial-mesenchymal transition (EMT) in vitro. Also, silenced LINC01413 restrains tumor growth in vivo. Moreover, LINC01413 binds with hnRNP-K and induces YAP1 (yes-associated protein 1)/TAZ1 (tafazzin) nuclear translocation to regulate the expression of ZEB1 in CRC cells. Taken together, this research suggested LINC01413 as a positive regulator in CRC progression through the LINC01413/hnRNP-K/TAZ1/YAP1/ZEB1 axis, broadening a new view on CRC treatment.

The Use of Attachment Devices to Aid in Adenoma Detection

PURPOSE OF REVIEW

With the intent of maximizing adenoma detection rate (ADR), different devices and colonoscopic innovations have been introduced over the past few years. There are a variety of attachment devices available for use in colonoscopy, all intended to improve ADR. In this review, we evaluate the evidence surrounding the available attachment devices and their impact on ADR.

RECENT FINDINGS

Endocuff, Endoring, Transparent cap, G-EYE balloon, and Third Eye Retroscope were all included in this review. Three of the devices, Endocuff, Endoring, and transparent hood or cap, have been shown to increase ADR without significantly altering the use of the colonoscope. Although balloon-assisted colonoscopy is not currently FDA-approved, it has the potential to increase ADR as well.

SUMMARY

Mechanical enhancement has been shown to complement the current forward-viewing colonoscope, and Endocuff appears to be the most beneficial attachment to improve ADR.

Advanced endoscopy technologies to improve the detection and characterisation of colorrectal polyps

Colorectal cancer is a major health problem. An improvement to its survival has been demonstrated by performing colonoscopy screenings and removing its precursor lesions: polyps. However, colonoscopy is not infallible and multiple strategies have been proposed aimed at improving the quality thereof. This report describes the endoscopic systems available to improve the detection and characterization of polyps, the different classifications for histological prediction and the current indications of advanced endoscopic diagnostic techniques.

Compared Abilities of Endoscopic Techniques to Increase Colon Adenoma Detection Rates: A Network Meta-analysis

BACKGROUND AND AIMS

Adenoma detection rate (ADR) is a quality metric for colorectal cancer screening. We performed a systematic review and network meta-analysis to assess the overall and comparative efficacies of different endoscopic techniques in adenoma detection.

METHODS

We performed a systematic review of published articles and abstracts, through March 15, 2018, to identify randomized controlled trials of adults undergoing colonoscopy that compared the efficacy of different devices in detection of adenomas. Our final analysis included 74 2-arm trials that comprised 44948 patients. These studies compared efficacies of add-on devices (cap, endocuff, endo-rings, G-EYE), enhanced imaging techniques (chromoendoscopy, narrow-band imaging, flexible spectral imaging color enhancement, blue laser imaging), new scopes (full-spectrum endoscopy, extra-wide-angle-view colonoscopy, dual focus), and low-cost optimizing existing resources (water-aided colonoscopy, second observer, dynamic position change), alone or in combination with high-definition colonoscopy or each other. Primary outcome was increase in ADR. We performed pairwise and network meta-analyses, and appraised quality of evidence using GRADE.

RESULTS

Low-cost optimizing existing resources (odds ratio [OR], 1.29; 95% CI,1.17-1.43), enhanced imaging techniques (OR,1.21; 95% CI, 1.09-1.35), and add-on devices (OR,1.18; 95% CI, 1.07-1.29) were associated with a moderate increase in ADR compared with high-definition colonoscopy; there was low to moderate confidence in estimates. Use of newer scopes was not associated with significant increases in ADR compared with high-definition colonoscopy (OR, 0.98; 95% CI, 0.79-1.21). In our comparative efficacy analysis, no specific technology for increasing ADR was superior to others. We did not find significant differences between technologies in detection of advanced ADR, polyp detection rate, or mean number of adenomas/patient.

CONCLUSIONS

In a network meta-analysis of published trials, we found that low-cost optimization of existing resources to be as effective as enhanced endoscopic imaging, or add-on devices, in increasing ADR during high-definition colonoscopy.

Effect of fellow involvement on colonoscopy outcomes: A systematic review and meta-analysis

BACKGROUND AND AIMS

The effect of fellow involvement on colonoscopy outcomes is controversial. Thus, we evaluated this effect on adenoma detection rate (ADR) and on other colonoscopy quality indicators.

METHODS

MEDLINE and Cochrane central register of controlled trials were searched up to September 2018 for studies evaluating fellow-involved colonoscopies vs. attending physicians-only examinations in terms of colonoscopy outcomes. Primary outcome was ADR, while advanced ADR (AADR), mean number of adenomas per colonoscopy (MAC), cecum intubation rate (CIR) and adverse events rate comprised the secondary outcomes. The effect size on study outcomes was calculated using random-effects model and it is presented as Odds Ratio (OR) or Mean Difference (MD) with 95% confidence interval (CI).

RESULTS

Nineteen observational studies involving 34,059 patients (fellow-involved 16,875, attending physician-only 17,184) were included. Compared to the attending physician-only group, fellow involvement marginally increased ADR [OR (95%CI) = 1.12 (1.00-1.26); p = 0.06, I2 = 76%]. Attending physicians with low-to-moderate ADR (<35%) benefited most from fellow's participation [OR (95%CI): 1.26 (1.13-1.40) vs. 1.12 (1.00-1.26); p = 0.03 when ADR < 35% and OR (95%CI): 1.29 (1.13-1.46) vs. 0.95 (0.78-1.16); p = 0.01 when ADR < 30%, respectively]. Moreover, fellow-involved group had higher MAC compared to attending-only group [MD (95%CI) = 0.12 (0.04-0.20); p = 0.002, I2 = 53%]. No benefit from fellow involvement was detected either for AADR, CIR or adverse events rate.

CONCLUSIONS

Fellow involvement during colonoscopy is associated with more adenomas detected per procedure and with higher ADR when the attending physician-only group ADR is less than 35%.

Strategies to Improve Inpatients' Quality of Bowel Preparation for Colonoscopy: A Systematic Review and Meta-Analysis

BACKGROUND AND AIMS

Inpatients' bowel preparation before colonoscopy is frequently inadequate, and various interventions have been investigated to improve it, so far. We aimed to evaluate the efficacy of various interventions to improve inpatients' colon preparation quality.

METHODS

We systematically reviewed the literature for publications on interventions aiming to improve the quality of inpatients' colon preparation until June, 2018. Significant heterogeneity-measured with I 2-was detected at the level of P < 0.1. Adequacy rates were measured using inverse variance, and the size effect of different interventions was calculated using random effects model and expressed as odds ratio (OR).

RESULTS

Seventeen studies enrolling 2733 inpatients were included. Overall, 67% (60-75%) of the participants achieved adequate colon cleansing (I 2 = 97%; P < 0.001). In six studies assessing the impact of educational interventions to patient/physician/nurse vs. no intervention, adequate bowel preparation was achieved in 77% (62-91%) vs. 50% (32-68%) of the patients (OR (95%CI) = 3.49 (1.67-7.28), P = 0.0009; I 2 = 74%; P = 0.002). Ten studies examined variations (qualitative and/or quantitative) in bowel preparation regimens with adequate preparation detected in 71% (60-81%) of the participants, and a single study examined the administration of preparation through an esophagogastroduodenoscope, resulting in adequate prep in 71% of the patients.

CONCLUSIONS

Despite several interventions, only two-thirds of inpatients achieve adequate colon preparation before colonoscopy. Educational interventions significantly improve inpatients' bowel preparation quality.

Establishing a model to measure and predict the quality of gastrointestinal endoscopy

BACKGROUND

Tens of millions of gastrointestinal endoscopic procedures are performed every year in China, but the quality varies significantly and related factors are complex. Individual endoscopist- and endoscopy division-related factors may be useful to establish a model to measure and predict the quality of endoscopy.

AIM

To establish a model to measure and predict the quality of gastrointestinal endoscopic procedures in mainland China.

METHODS

Selected data on endoscopy experience, equipment, facility, qualification of endoscopists, and other relevant variables were collected from the National Database of Digestive Endoscopy of China. The multivariable logistic regression analysis was used to identify the potential predictive variables for occurrence of medical malpractice and patient disturbance. Linear and nonlinear regressions were used to establish models to predict incidence of endoscopic complications.

RESULTS

In 2012, gastroscopy/colonoscopy-related complications in mainland China included bleeding in 4,359 cases (0.02%) and perforation in 914 (0.003%). Endoscopic-retrograde-cholangiopancreatography-related complications included severe acute pancreatitis in 593 cases (0.3%), bleeding in 2,151 (1.10%), perforation in 257 (0.13%) and biliary infection in 4,125 (2.11%). Moreover, 1,313 (5.0%) endoscopists encountered with medical malpractice, and 5,243 (20.0%) encountered with the disturbance from patients. The length of endoscopy experience, weekly working hours, weekly night shifts, annual vacation days and job satisfaction were predictors for the occurrence of medical malpractice and patient disturbance. However, the length of endoscopy experience and the ratio of endoscopists to nurses were not adequate to establish an effective predictive model for endoscopy complications.

CONCLUSION

The workload and job satisfaction of endoscopists are valuable predictors for medical malpractice or patient disturbance. More comprehensive data are needed to establish quality-predictive models for endoscopic complications.

To cap/cuff or ring: do distal attachment devices improve the adenoma detection?

Colonoscopy reduces the risk of colorectal cancer, by interrupting the adenoma-carcinoma sequence enabling the detection and removal of adenomas before they turn into colorectal cancer. Colonoscopy has its limitations as adenoma miss rates as high as 25% have been reported. The reasons for missed pathology are complicated and multi-factorial. The recent drive to improve adenoma detection rates has led to a plethora of new technologies. Areas covered: An increasing number of advanced endoscopes and distal attachment devices have appeared in the market. Advanced endoscopes aim to improve mucosal visualization by widening the field of view. Distal attachment devices aim to increase adenoma detection behind folds by flattening folds on withdrawal. In this review article, we discuss the three following distal attachment devices: the transparent cap, the Endocuff, and the Endoring. Expert commentary: The authors believe that the distal attachment devices will have a greater benefit for endoscopists with low baseline adenoma detection rates.

Meta-analysis indicates that add-on devices and new endoscopes reduce colonoscopy adenoma miss rate

INTRODUCTION

A variety of add-on devices and new-generation endoscopes have the potential to detect lesions 'hidden' behind colonic folds. We measured the effect of these new modalities on colonoscopy's lesions miss rates by a meta-analysis of data from individual studies.

MATERIALS AND METHODS

We performed literature searches in Medline and Cochrane Library for back-to-back randomized-controlled trials evaluating colonoscope add-on devices and new endoscopes in terms of lesions miss rates. The effect size on study outcomes is shown as relative risk (95% confidence interval).

RESULTS

We identified nine tandem studies with 1594 patients: seven evaluating add-on devices (one with cap, two with Endocuff, one with Endorings, one with Third-Eye Retroscope, two with G-EYE endoscope) and two evaluating the full-spectrum endoscopy system (FUSE) in comparison with conventional colonoscopy (CC). Overall, adenoma miss rate (AMR) was significantly lower with add-on devices/FUSE [0.33 (0.22-0.50), P<0.00001] compared with CC, the effect being similar among the add-on devices [0.35 (0.22-0.57), P<0.0001] and the FUSE [0.26 (0.15-0.46), P<0.00001] studies, respectively. Advanced AMR and polyp miss rate (PMR) were also significantly lower using add-on devices/FUSE [0.30 (0.21-0.44), P<0.0001 and 0.31 (0.13-0.79), P=0.01, respectively]. Use of add-on devices/FUSE scope was associated with significantly lower AMR and PMR in the proximal colon and it was associated with shortening of the colonoscopy surveillance interval.

CONCLUSION

Our meta-analysis provides evidence that AMR, advanced AMR, and PMR are significantly lower using add-on to colonoscope devices and the full-spectrum endoscopy systems compared with CC. Heterogeneity among the included studies and the small number of detected advanced adenomas call for cautious interpretation of the results.

Development and validation of a deep-learning algorithm for the detection of polyps during colonoscopy

The detection and removal of precancerous polyps via colonoscopy is the gold standard for the prevention of colon cancer. However, the detection rate of adenomatous polyps can vary significantly among endoscopists. Here, we show that a machine-learning algorithm can detect polyps in clinical colonoscopies, in real time and with high sensitivity and specificity. We developed the deep-learning algorithm by using data from 1,290 patients, and validated it on newly collected 27,113 colonoscopy images from 1,138 patients with at least one detected polyp (per-image-sensitivity, 94.38%; per-image-specificity, 95.92%; area under the receiver operating characteristic curve, 0.984), on a public database of 612 polyp-containing images (per-image-sensitivity, 88.24%), on 138 colonoscopy videos with histologically confirmed polyps (per-image-sensitivity of 91.64%; per-polyp-sensitivity, 100%), and on 54 unaltered full-range colonoscopy videos without polyps (per-image-specificity, 95.40%). By using a multi-threaded processing system, the algorithm can process at least 25 frames per second with a latency of 76.80 ± 5.60 ms in real-time video analysis. The software may aid endoscopists while performing colonoscopies, and help assess differences in polyp and adenoma detection performance among endoscopists.

Colonoscopy attachments for the detection of precancerous lesions during colonoscopy: A review of the literature

Although colonoscopy has been proven effective in reducing the incidence of colorectal cancer through the detection and removal of precancerous lesions, it remains an imperfect examination, as it can fail in detecting up to almost one fourth of existing adenomas. Among reasons accounting for such failures, is the inability to meticulously visualize the colonic mucosa located either proximal to haustral folds or anatomic curves, including the hepatic and splenic flexures. In order to overcome these limitations, various colonoscope attachments aiming to improve mucosal visualization have been developed. All of them - transparent cap, Endocuff, Endocuff Vision and Endorings - are simply mounted onto the distal tip of the scope. In this review article, we introduce the rationale of their development, present their mode of action and discuss in detail the effect of their implementation in the detection of lesions during colonoscopy.

Full spectrum endoscopy for an easy and adequate visualization of Vater's papilla

Patients with classical familial adenomatous polyposis (FAP) are at high risk for developing colorectal cancer (CRC) and duodenal adenomas. Current guidelines recommend to start duodenal screening at the age of 25-30 years and standard upper gastrointestinal (GI) endoscopy is considered inadequate for an optimal visualization of the duodenum. We used the Full-Spectrum Endoscopy^® (FUSE^®; EndoChoice Inc., Atlanta, GA, USA) esophagogastroduodenoscope (FUSE-EGD) for an upper GI screening procedure of a 20-year-old Caucasian male with classical FAP. The pioneer design of the FUSE-EGD allowed an easy and accurate examination of the ampulla with standard scope manipulation maneuvers.

New technologies improve adenoma detection rate, adenoma miss rate, and polyp detection rate: a systematic review and meta-analysis

BACKGROUND AND AIMS

The need to increase the adenoma detection rate (ADR) for colorectal cancer screening has ushered in devices that mechanically or optically improve conventional colonoscopy. Recently, new technology devices (NTDs) have become available. We aimed to compare the ADR, polyp detection rate (PDR), and adenoma miss rate (AMR) between NTDs and conventional colonoscopy and between mechanical and optical NTDs.

METHODS

MEDLINE and Embase databases were searched from inception through September 2017 for articles or abstracts reporting ADR, PDR, and AMR with NTDs. Randomized controlled trials and case-control studies with >10 subjects were included. Primary outcomes included ADR, PDR, and AMR odds ratio (OR) between conventional colonoscopy and NTDs. Secondary outcomes included cecal intubation rates, adverse events, cecal intubation time, and total colonoscopy time.

RESULTS

From 141 citations, 45 studies with 20,887 subjects were eligible for ≥1 analyses. Overall, the ORs for ADR (1.35; 95% confidence interval [CI] 1.24-1.47; P < .01) and PDR (1.51; 95% CI, 1.37-1.67; P < .01) were higher with NTDs. Higher ADR (OR, 1.52 vs 1.25; P = .035) and PDR (OR, 1.63 vs 1.10; P ≤ .01) were observed with mechanical NTDs. The overall AMR with NTDs was lower compared with conventional colonoscopy (OR, .19; 95% CI, .14-.26; P < .01). Mechanical NTDs had lower AMRs compared with optical NTDs (OR, .10 vs .33; P < .01). No differences in cecal intubation rates, cecal intubation time, or total colonoscopy time were found.

CONCLUSIONS

Newer endoscopic technologies are an effective option to improve ADR and PDR and decrease AMR, particularly with mechanical NTDs. No differences in operability and safety were found.

Is there a difference in adenoma detection rates between gastroenterologists and surgeons?

AIM

To compare the adenoma detection rate (ADR) between gastroenterologists and colorectal surgeons at Box Hill Hospital, Melbourne, Australia.

METHODS

A total of 300 colonoscopies performed by gastroenterologists and colorectal surgeons at Box Hill Hospital were retrospectively reviewed from May 2016 to June 2017. Exclusion criteria were: Patients ≤ 50 years old, colonoscopies with failure of caecal intubation, patients who previously had colon cancer and/or a colonic resection, history of polyposis syndromes or inflammatory bowel disease, or a colonoscopy within the last 10 years. Patient demographics, indications, symptoms and procedural-related outcomes were measured.

RESULTS

The ADR was not significantly different between gastroenterologists and colorectal surgeons (34% vs 34.67%; P = 0.90). The adjusted odds ratio correcting for gender, age, 1^st degree relative with colorectal cancer, previous colonoscopy, trainee involvement and caecal or terminal ileum intubation rate was 1.19 (0.69-2.05).

CONCLUSION

Both specialties at our institution exceed benchmark standards suggested by published Australian and American guidelines. An association between endoscopist specialty and ADR was not observed.