Impact of 2 generational improvements in colonoscopes on adenoma miss rates: results of a prospective randomized multicenter tandem study

Effect of real-time computer-aided detection of colorectal adenoma in routine colonoscopy (COLO-GENIUS): a single-centre randomised controlled trial

BACKGROUND

Artificial intelligence systems have been developed to improve polyp detection. We aimed to evaluate the effect of real-time computer-aided detection (CADe) on the adenoma detection rate (ADR) in routine colonoscopy.

METHODS

This single-centre randomised controlled trial (COLO-GENIUS) was done at the Digestive Endoscopy Unit, Pôle Digestif Paris-Bercy, Clinique Paris-Bercy, Charenton-le-Pont, France. All consecutive individuals aged 18 years or older who were scheduled for a total colonoscopy and had an American Society of Anesthesiologists score of 1-3 were screened for inclusion. After the caecum was reached and the colonic preparation was appropriate, eligible participants were randomly assigned (1:1; computer-generated random numbers list) to either standard colonoscopy or CADe-assisted colonoscopy (GI Genius 2.0.2; Medtronic). Participants and cytopathologists were masked to study assignment, whereas endoscopists were not. The primary outcome was ADR, which was assessed in the modified intention-to-treat population (all randomly assigned participants except those with misplaced consent forms). Safety was analysed in all included patients. According to statistical calculations, 20 endoscopists from the Clinique Paris-Bercy had to include approximately 2100 participants with 1:1 randomisation. The trial is complete and registered with ClinicalTrials.gov, NCT04440865.

FINDINGS

Between May 1, 2021, and May 1, 2022, 2592 participants were assessed for eligibility, of whom 2039 were randomly assigned to standard colonoscopy (n=1026) or CADe-assisted colonoscopy (n=1013). 14 participants in the standard group and ten participants in the CADe group were then excluded due to misplaced consent forms, leaving 2015 participants (979 [48·6%] men and 1036 [51·4%] women) in the modified intention-to-treat analysis. ADR was 33·7% (341 of 1012 colonoscopies) in the standard group and 37·5% (376 of 1003 colonoscopies) in the CADe group (estimated mean absolute difference 4·1 percentage points [95% CI 0·0-8·1]; p=0·051). One bleeding event without deglobulisation occurred in the CADe group after a large (>2 cm) polyp resection and resolved after a haemostasis clip was placed during a second colonoscopy.

INTERPRETATION

Our findings support the benefits of CADe, even in a non-academic centre. Systematic use of CADe in routine colonoscopy should be considered.

FUNDING

None.

Second-generation distal attachment cuff for adenoma detection in screening colonoscopy: a randomized multicenter study

BACKGROUND AND AIMS

Randomized studies have demonstrated that a distal attachment cap with rubber side arms, the Endocuff Vision (ECV; Olympus America, Center Valley, Pa, USA), increased colonoscopic adenoma detection rate (ADR) in various mixed patient collectives. This is the first study to evaluate its use in a primary colonoscopic screening program.

METHODS

Patients over age 55 years undergoing screening colonoscopy in 9 German private offices in Berlin and Hamburg were randomized to either the study group using ECV or the control group using high-definition colonoscopies (standard of care). The main outcome parameter was ADR, whereas secondary outcomes were detection rates of all adenomas per colonoscopy (APCs), of adenoma subgroups, and of hyperplastic polyps.

RESULTS

Of 1416 patients (mean age, 61.1 years; 51.8% women), with a median of 41 examinations per examiner (n = 23; interquartile range, 12-81), 700 were examined with ECV and 716 without. Adjusting for the effects of the colonoscopies, ADR was 39.5% (95% confidence interval [CI], 32.6%-46.3%) in the ECV group versus 32.2% (95% CI, 25.9%-38.6%) in the control group, which resulted in an increase of 7.2% (95% CI, 2.3%-12.2%; P = .004). The increase in ADR was mainly because of small polyps, with adjusted ADRs for adenomas <10 mm of 33.3% (95% CI, 26.5%-40.2%) for study patients versus 24.0% (95% CI, 18.2%-29.8%) for control patients (P < .001). APC was also significantly increased (.57 ECV vs .51 control subjects, P = .045).

CONCLUSIONS

A distal attachment cap with side arms significantly increased the ADR in patients undergoing primary colonoscopic screening. Because of the correlation of ADR and interval cancer, its use should be encouraged, especially in this setting. (Clinical trial registration number: NCT03442738.).

Factors Associated with Polyp Detection Rate in European Colonoscopy Practice: Findings of The European Colonoscopy Quality Investigation (ECQI) Group

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.

Enhancing polyp detection: technological advances in colonoscopy imaging

The detection and removal of polyps at colonoscopy is core to the current colorectal cancer (CRC) prevention strategy. However, colonoscopy is flawed with a well described miss rate and variability in detection rates associated with incomplete protection from CRC. Consequently, there is significant interest in techniques and technologies which increase polyp detection with the aim to remedy colonoscopy's ills. Technologic advances in colonoscope imaging are numerous and include; increased definition of imaging, widening field of view, virtual technologies to supplant conventional chromocolonoscopy (CC) and now computer assisted detection. However, despite nearly two decades of technologic advances, data on gains in detection from individual technologies have been modest at best and heterogenous and conflicted as a rule. This state of detection technology science is exacerbated by use of relatively blunt metrics of improvement without consensus, the myopic search for gains over single generations of technology improvement and an unhealthy focus on adenomatous lesions. Yet there remains cause for optimism as detection gains from new technology, while small, may still improve CRC prevention. The technologies are also readily available in current generation colonoscopes and have roles beyond simply detection such as lesion characterization, further improving their worth. Coupled with the imminent expansion of computer assisted detection the detection future from colonoscope imaging advances looks bright. This review aims to cover the major imaging advances and evidence for improvement in polyp detection.

Diagnostic Ability of High-definition Imaging Using Ultraslim Endoscopes in Early Gastric Cancer

Purpose

It is unclear whether high-definition (HD) imaging improves visibility and diagnostic ability in early gastric cancer (EGC) compared with standard-definition (SD) imaging. We aimed to compare the diagnostic performance and visibility scores of HD and SD ultraslim endoscopes in EGC.

Materials and Methods

We used HD and SD ultraslim endoscopes to obtain 60 images with similar compositions of gastric environments. Of the 60 images, 30 showed EGC (15 images for each modality) and 30 showed no EGC (15 images for each modality). Seventeen endoscopists evaluated the presence and location of the lesions in each image. Diagnostic ability was compared between modalities. The color difference between a lesion and the surrounding mucosa (ΔE) was measured and compared between the modalities.

Results

The ability of HD to detect EGC was significantly higher than that of SD (accuracy: 80.8% vs. 71.6%, P=0.017; sensitivity: 94.9% vs. 76.5%, P<0.001; positive predictive value, 76.2% vs. 55.3%, P<0.001; and negative predictive value (NPV), 94.1% vs. 73.5%, P<0.001). The ability of HD to determine the horizontal extent of EGC was significantly higher than that of SD (accuracy: 71.0% vs. 57.8%, P=0.004; sensitivity: 75.3% vs. 49.0%, P<0.001; NPV, 72.9% vs. 55.9%, P<0.001; and area under the curve: 0.891 vs. 0.631, P=0.038). The mean ΔE was significantly higher for HD than for SD (10.3 vs. 5.9, P=0.011).

Conclusions

The HD ultraslim endoscope showed a higher diagnostic performance in EGC than the SD endoscope because it provided good color contrast.

Latest Generation High-Definition Colonoscopy Increases Adenoma Detection Rate by Trainee Endoscopists

BACKGROUND

Adenoma detection rate (ADR) is an important quality indicator of colonoscopy. High-definition (HD) colonoscopy has been reported to increase ADR compared to standard-definition (SD) colonoscopy. Although there are few reports comparing the latest generation and the previous generation of HD colonoscopy equipment, there are reports that the latest generation colonoscopy equipment improves ADR. However, there are no reports on the impact of the latest generation HD colonoscopy on the ADR of trainee endoscopists.

AIMS

The aim of this study was to investigate whether the latest generation HD colonoscopy increases the ADR of trainee endoscopists compared with the previous generation HD colonoscopy.

METHOD

We conducted a retrospective review of medical records of patients aged 40-79 years old, who underwent screening or surveillance colonoscopy performed by nine gastroenterology fellows at Dong-A University Hospital from March 2019 to February 2020. We calculated the overall ratios of the ADR: the ADRs of the group using the older generation HD colonoscopy equipment and the group using the latest HD colonoscopy equipment. Polyp detection rate (PDR), sessile serrated polyp detection rate (SSPDR), and advanced neoplasia detection rate (ANDR) were calculated for each group. Factors related to adenoma detection were identified using logistic regression analysis.

RESULTS

Altogether, 2189 patients were included in the study (the older HD colonoscopy group comprising 1183 and the latest HD colonoscopy group comprising 1006). We found that PDR (45.98 vs. 51.69%, p = 0.008) and ADR (35.67 vs. 40.85%, p = 0.013) were significantly higher in the latest generation HD colonoscopy group. The generational differences were not statistically significant for SSPDR (1.94 vs. 2.78%, p = 0.195) or ANDR (4.65 vs. 4.97%, p = 0.726). In the multivariate regression analysis, age, male sex, the latest generation HD colonoscopy, and long withdrawal time were the most significant factors affecting adenoma detection.

CONCLUSIONS

The latest generation HD colonoscopy improved PDR and ADR by trainee endoscopists. These findings suggest that latest generation, higher-resolution colonoscopy equipment can improve the quality of colonoscopy for less experienced endoscopists.

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

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.

New insights on missed colonic lesions during colonoscopy through artificial intelligence-assisted real-time detection (with video)

BACKGROUND AND AIMS

Meta-analysis shows that up to 26% of adenomas could be missed during colonoscopy. We investigated whether the use of artificial intelligence (AI)-assisted real-time detection could provide new insights into mechanisms underlying missed lesions during colonoscopy.

METHODS

A validated real-time deep-learning AI model for the detection of colonic polyps was first tested in videos of tandem colonoscopy of the proximal colon for missed lesions. The real-time AI model was then prospectively validated in a total colonoscopy in which the endoscopist was blinded to real-time AI findings. Segmental unblinding of the AI findings were provided, and the colonic segment was then re-examined when missed lesions were detected by AI but not the endoscopist. All polyps were removed for histologic examination as the criterion standard.

RESULTS

Sixty-five videos of tandem examination of the proximal colon were reviewed by AI. AI detected 79.1% (19/24) of missed proximal adenomas in the video of the first-pass examination. In 52 prospective colonoscopies, real-time AI detection detected at least 1 missed adenoma in 14 patients (26.9%) and increased the total number of adenomas detected by 23.6%. Multivariable analysis showed that a missed adenoma(s) was more likely when there were multiple polyps (adjusted odds ratio, 1.05; 95% confidence interval, 1.02-1.09; P < .0001) or colonoscopy was performed by less-experienced endoscopists (adjusted odds ratio, 1.30; 95% confidence interval, 1.05-1.62; P = .02).

CONCLUSIONS

Our findings provide new insights on the prominent role of human factors, including inexperience and distraction, on missed colonic lesions. With the use of real-time AI assistance, up to 80% of missed adenomas could be prevented. (Clinical trial registration number: NCT04227795.).

Comparative evaluation of two colorectal cancer screening campaigns using different faecal occult blood tests in a French area

OBJECTIVE

The aim of this study was to compare quality performance of the first colorectal cancer (CRC) screening campaigns (C) with the OC Sensor® Faecal Immunological Test (FIT) (C7 from 2016 to 2017) and the Hemoccult® guaiac-based test (C1 from 2004 to 2006).

METHODS

The participation rate of the eligible population, screening fecal occult blood test (FOBT) performance indices, CRC and adenoma detection rate and time interval between test positivity and colonoscopy were studied.

RESULTS

In C7, 35.9 % of the eligible population completed the screening process versus 47.6 % in C1 (p < 0.0001). The positivity rate was of 4.3 % for OC Sensor® FIT and 2.3 % for Hemoccult® test (p < 0.0001). A total of 3,252 colonoscopies were performed in C7 versus 2,005 in C1; 246 CRCs and 1,160 advanced adenomas (AA) were detected in C7 compared to 140 CRCs and 491 AA in C1 (p < 0.0001). The FOBT cancer detection rate increased significantly from 1.4 ‰ to 2.9 ‰ between the two campaigns, as did the FOBT AA detection rate, from 5.7 ‰ to 13.7 ‰. During C7, the mean time for colonoscopy after a positive FIT result was 84.3 days [95 % CI: 77.9-90.7]. There was no significant difference between the stages at diagnosis according to the time for colonoscopy within the first 6 months.

CONCLUSIONS

CRC and AA detection rates increased significantly between the two campaigns. Longer follow-up will be required to show a potential decrease in the incidence of invasive CRCs.

Inspection and polypectomy during both insertion and withdrawal or only during withdrawal of colonoscopy?: A protocol for systematic review and meta analysis

INTRODUCTION

Current evidence supporting additional inspection and polypectomy during insertion of colonoscopy is limited. We plan to provide a systematic review and meta-analysis to compare the yield of inspection and polypectomy during both insertion and withdrawal versus the traditional practice of inspection and polypectomy during withdrawal only.

METHODS AND ANALYSIS

Randomised controlled trials evaluating inspection and polypectomy during both insertion and withdrawal versus inspection and polypectomy during withdrawal only will be searched in MEDLINE, EMBASE, Web of Science, the Cochrane Library, ClinicalTrials.gov, and Google Scholar, from database inception to 31 May 2020. Data on study design, participant characteristics, and outcomes will be extracted. Primary outcomes to be assessed are adenoma detection rate. Secondary outcomes include polyp detection rate, advanced adenoma detection rate, the mean number of adenomas per patient, polyp miss rate, the mean number of adenomas per colonoscopy, procedure duration, cecal intubation rate, procedure difficulty, patient discomfort, sedation dose, and adverse events. Study quality will be assessed using the Cochrane Risk of Bias Tool. Meta-analysis will be performed using RevMan V.5.3 statistical software. Data will be combined with random effect model. The results will be presented as a risk ratio (RR) for dichotomous data, and weighted/standard mean difference for continuous data. Publication bias will be visualized using funnel plots.

ETHICS AND DISSEMINATION

This study will not use primary data, and therefore formal ethical approval is not required. The findings will be disseminated through peer-reviewed journals and committee conferences.

PROTOCOL REGISTRATION NUMBER

INPLASY202050051.

High-definition colonoscopy for improving adenoma detection: a systematic review and meta-analysis of randomized controlled studies

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.

Colorectal polyp prevalence and aspirational detection targets determined using high definition colonoscopy and a high level detector in 2017

BACKGROUND

Colorectal adenoma prevalence can be determined by autopsy studies, or imaging studies such as colonoscopy. We describe the prevalence of colorectal adenomas determined by a single high detecting colonoscopist using high definition colonoscopes.

METHODS

We conducted a cross-sectional study of consecutive patients aged ≥18 years undergoing colonoscopy with a high level detector for the indications of screening, surveillance, and diagnostic reasons from December 29, 2016 to January 12, 2018.

RESULTS

During the study period, 1172 eligible patients underwent colonoscopy. Women comprised 55% (n = 646) and the majority (89%, n = 1038) were aged ≥50 years (mean age, 62.1 years). In persons aged ≥50 years undergoing screening, the prevalence of ≥1 conventional adenoma was 48.5% and ≥1 sessile serrated polyp was 15.3%. Diminutive polyps (1-5 mm in size) comprised three-quarters of all resected polyps (2236/2986). Among 246 patients (21%), 1050 hyperplastic appearing polyps were not resected from the recto-sigmoid. Adenoma prevalence was strongly associated with age and indication but serrated lesion prevalence was not.

CONCLUSIONS

The true prevalence of precancerous lesions in the colorectum determined by modern colonoscopy exceeds determination by autopsy studies. These data help define aspirational detection targets for colonoscopy. The economic burden associated with colonoscopic resection of tiny lesions is substantial.

Optimizing the Quality of Colorectal Cancer Screening Worldwide

Screening, followed by colonoscopic polypectomy (or surgery for malignant lesions), prevents incident colorectal cancer and mortality. However, there are variations in effective application of nearly every aspect of the screening process. Screening is a multistep process, and failure in any single step could result in unnecessary morbidity and mortality. Awareness of variations in operator- and system-dependent performance has led to detailed, comprehensive recommendations in the United States and Europe on how colonoscopy screening should be performed and measured. Likewise, guidance has been provided on quality assurance for nonprimary colonoscopy-based screening programs, including strategies to maximize adherence. Quality improvement is now a validated science, and there is clear evidence that higher quality prevents incident cancer and cancer death. Quality must be addressed at the levels of the system, provider, and individuals, to maximize the benefits of screening for any population. We review the important aspects of measuring and improving the quality of colorectal cancer screening.

Right-Sided Location Not Associated With Missed Colorectal Adenomas in an Individual-Level Reanalysis of Tandem Colonoscopy Studies

BACKGROUND & AIMS

Interval cancers occur more frequently in the right colon. One reason could be that right-sided adenomas are frequently missed in colonoscopy examinations. We reanalyzed data from tandem colonoscopies to assess adenoma miss rates in relation to location and other factors.

METHODS

We pooled data from 8 randomized tandem trials comprising 2218 patients who had diagnostic or screening colonoscopies (adenomas detected in 49.8% of patients). We performed a mixed-effects logistic regression with patients as cluster effects with different independent parameters. Factors analyzed included location (left vs right, splenic flexure as cutoff), adenoma size, form, and histologic features. Analyses were controlled for potential confounding factors such as patient sex and age, colonoscopy indication, and bowel cleanliness.

RESULTS

Right-side location was not an independent risk factor for missed adenomas (odds ratio [OR] compared with the left side, 0.94; 95% CI, 0.75-1.17). However, compared with adenomas ≤5 mm, the OR for missing adenomas of 6-9 mm was 0.62 (95% CI, 0.44-0.87), and the OR for missing adenomas of ≥10 mm was 0.51 (95% CI, 0.33-0.77). Compared with pedunculated adenomas, sessile (OR, 1.82; 95% CI, 1.16-2.85) and flat adenomas (OR, 2.47; 95% CI, 1.49-4.10) were more likely to be missed. Histologic features were not significant risk factors for missed adenomas (OR for adenomas with high-grade intraepithelial neoplasia, 0.68; 95% CI, 0.34-1.37 and OR for sessile serrated adenomas, 0.87; 95% CI, 0.47-1.64 compared with low-grade adenomas). Men had a higher number of adenomas per colonoscopy (1.27; 95% CI, 1.21-1.33) than women (0.86; 95% CI, 0.80-0.93). Men were less likely to have missed adenomas than women (OR for missed adenomas in men, 0.73; 95% CI, 0.57-0.94).

CONCLUSIONS

In an analysis of data from 8 randomized trials, we found that right-side location of an adenoma does not increase its odds for being missed during colonoscopy but that adenoma size and histologic features do increase risk. Further studies are needed to determine why adenomas are more frequently missed during colonoscopies in women than men.

Diagnostic yield and miss rate of EndoRings in an organized colorectal cancer screening program: the SMART (Study Methodology for ADR-Related Technology) trial

BACKGROUND AND AIMS

The EndoRings add-on has been claimed to improve adenoma detection at colonoscopy, but available data are inconsistent. When testing a new technology, parallel and crossover methodologies measure different outcomes, leaving uncertainty about their correspondence. The aims of this study were to compare the diagnostic yield and miss rate of the EndoRings for colorectal neoplasia.

METHODS

Consecutive patients undergoing colonoscopy after a positive fecal immunochemical test (FIT) within an organized screening program in 7 Italian centers were randomized between a parallel (EndoRings or standard) or a crossover (EndoRings/standard or standard/EndoRings) methodology. Outcomes measures were the adenoma detection rate (ADR) and advanced adenoma detection rate (AADR) in the parallel arms and the miss rate of adenomas in the crossover arms.

RESULTS

Of 958 eligible patients, 927 (317 EndoRings; 317 standard; 142 EndoRings/standard; 151 standard/Endo-Rings) were included in the final analysis. In the parallel arms (mean ADR, 51.3%; mean AADR, 25.4%), no difference between standard and EndoRings was found for both ADR (relative risk [RR], 1.10; 95% confidence interval [CI], 0.95-1.28) and AADR (RR, 1.16; 95% CI, 0.88-1.51), as well as for the mean number of adenomas and advanced adenomas per patient (EndoRings, 1.9 ± 1.3 and 1.0 ± 1.2; standard, 2.1 ± 1.5 and 1.0 ± 1.2; P = not significant for both comparisons). In the crossover arms, no difference in the miss rate for adenomas between EndoRings and standard was found at per polyp (RR, 1.43; 95% CI, 0.97-2.10) or per-patient analysis (24% vs 26%; P = .76).

CONCLUSIONS

No statistically significant difference in diagnostic yield and miss rate between EndoRings and standard colonoscopy was detected in patients with a positive FIT result. A clinically relevant correspondence between miss and detection rates was shown, supporting a cause-effect relationship. (ISRCTN registry: ISRCTN10357435.).

A motivational phone call improves participation to screening colonoscopy for those with a positive FIT in a national screening programme (NCT 03276091)

BACKGROUND

A large proportion of individuals with a positive faecal immunologic test (FIT) will never undergo the recommended colonoscopy despite a full sequence of reminders.

AIMS

This prospective study aimed to recruit refractory individuals by a motivational personalised phone call given by a screening physician.

METHODS

We evaluated the impact of a motivational phone call given by a physician of the screening organisation in order to convince patients with positive FIT to undergo a colonoscopy.

RESULTS

115 individuals with a positive FIT were targeted. After GP phone call, it was ascertained that 15 had had a colonoscopy, one died, one moved outside the region, and the GP refused the study phone call for 13. Finally, we attempted to call 85 individuals; 24 could not be reached, 5 colonoscopies had been performed, and thus 56 individuals were included. The main reason for colonoscopy refusal (33.9%) was wrong advice from the GP or the gastroenterologist. Among those included, 33.9% (19/56) underwent the colonoscopy within 22.7 months after FIT; 1 invasive cancer, 18 adenomas and 9 serrated sessile lesions were found.

CONCLUSION

Motivational phone call performed by a physician from the screening organisation is effective to recruit a third of refractory individuals. Education for GPs and gastroenterologists is necessary to increase participation to colonoscopy and to avoid the performance of an inappropriate secondary FIT.

TRIAL REGISTRATION

NCT 03276091.

Complete polypectomy and early detection and management of residual disease to reduce the risk of interval colorectal cancers

Advances in colorectal polyp detection and resection methods aim to reduce interval cancer rates. Complete polypectomy is essential to reduce the risk of early recurrence and the development of interval cancers. To achieve this, polyps must first be correctly identified and then completely excised. This article reviews current adenoma detection methods in use and the management of residual disease.