1. Full-Spectrum Endoscopy Improves Adenoma Detection Compared to Conventional Colonoscopy PLUS Right-Colon Examination With Scope Retroflexion: A Randomized, Back to-Back Study
I.S. Papanikolaou1, P. Apostolopoulos2, G. Tziatzios1, E. Vlachou2, A.D. Sioulas1, D. Polymeros1,
A. Karameris3, I. Panayiotides4, G. Alexandrakis2, G.D. Dimitriadis1, K. Triantafyllou1
Please export the Keynote document as a PDF (File – Save as – PDF – Image Quality – Best) and upload the PDF into the system. Please use the font in the document or a similar one and do not use a font size smaller than 16.
1Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University, Attikon University
General Hospital, Athens, 2Department of Gastroenterology, 417 Army Veterans Hospital, Athens 3Laboratory of Pathology, 417 Army Veterans Hospital, Athens
42nd Department of Pathology, Medical School, National and Kapodistrian University, Attikon University General Hospital, Athens, GRECE
Introduction
Study endpoints
Results
Secondary Endpoints:
Advanced adenoma miss-rates (overall/proximal colon)
Changes in surveillance intervals indicated by the second modality
Estimation of false negative (adenomas) index examinations
Measurement of performance of individual endoscopists
Cancer miss-rate
Occurrence of serious adverse events
Various colonoscopic techniques and technical advancements have been suggested to improve the diagnostic yield of colonoscopy and assist in avoiding occurrence of interval CRC.
Colonoscope retroflexion in the right colon is a relatively simple and safe technique, which adds a diagnostic yield similar to that of a second forward-viewing examination.
Full-spectrum colonoscopy (FC) platform (FUSE® system, EndoChoice Inc., Atlanta, GA, USA) promises to increase adenoma detection by providing a 330°- field of view.
Per - lesion analysis : Lesions detected and missed with FUSE and colonoscopy with scope retroflexion (CC/R)
Index colonoscopy arm
 Significance
FUSE, n=107
CC/R, n=108
Adenomas detected at index, n 65 53
Adenomas detected at second exam, n
Adenoma miss-rate, %
8 by CC/R
10.9 ( )
27 by FC
33.7 ( )
OR=4.28 (95%CI= )
Proximal adenomas detected at index, n 31 26
Proximal adenomas with the second exam, n
Proximal adenoma miss-rate, %
5 by CC/R
13.9 ( )
19 by FC
42.2 ( )
OR=4.70 (95%CI= )
Advanced adenomas detected at index, n 22 20
Advanced adenomas at second exam, n
Advanced adenoma miss-rate, %
1 by CC/R
4.3 ( )
7 by FC
25.9 ( )
OR=7.82 (95%CI= )
Proximal advanced adenomas detected at index, n 9 6
Proximal advanced adenomas at second exam, n
Proximal advanced adenoma miss-rate, %
10.0 ( )
5 by FC
45.5 ( )
OR=5.54 (95%CI= )
Results
Participants’ baseline characteristics
Index colonoscopy arm p
FUSE, n=107
CC/R, n=108
Study site, n (%)
Attikon Hospital
Army Veterans Hospital
83 (75.4)
27 (24.6)
84 (76.4)
26 (23.6)
0.87
Male/female gender, n (%)
49 (44.5) / 61 (55.5)
52 (47.2) / 58 (52.8)
0.68
Age, years (SD)
62.1 (10.12)
63.8 (9.5)
0.20
Indication, n (%)
CRC screen/surveillance
Symptomatic
Polypectomy
76 (69.1)
29 (26.4)
5 (4.5)
74 (67.3)
33 (30.0)
3 (2.7)
0.67
ASA score, n (%) I II
82 (74.5)
28 (25.5)
83 (74.6)
27 (25.4)
0.88
Overall bowel preparation
Right colon preparation
9 (8-9)
3 (2-3)
0.64
Objective
To compare the adenoma miss-rates between FC and conventional colonoscopy with additional right-colon examination with scope retroflexion (CC/R)
Methods
Study type: prospective, randomized cross-over study
Inclusion Criteria:
Patients with indication for total colonoscopy
Exclusion Criteria:
Recent abdominal surgery, IBD, colectomy, polyposis syndrome
Randomization and concealed allocation:
Randomly assigned (1:1), by computer-generated randomization
with block design (10 patients per block) participants
Same-day, back-to-back tandem colonoscopy with either FC or
CC/R first, followed immediately by the other procedure
Study coordinator opened concealed allocation card to reveal
group allocation just before colonoscopies
Procedures:
Colonoscopies performed by five endoscopists with documented adenoma detection rates (ADR) >35%, in two tertiary facilities.
Bowel cleansing with 4 liters of polyethylene glycol solution in
split doses. Colonoscopies were performed under
conscious sedation. Boston Bowel Preparation Scale rated quality
of bowel preparation
Per - patient analysis : False negative index examinations and surveillance schedule modification
Index colonoscopy arm
 Significance
FUSE, n=107
CC/R , n=108
False negative (no adenomas) first colonoscopy, n/N; %
2/68; 2.9 ( )
15/75; 21.1 ( )
OR=8.25 (95%CI: )
Change in CRC surveillance schedule with the second exam, n; % (American Guidelines)
4; 3.8 ( )
16; 16.8 ( )
OR=5.11 (95%CI: )
Change in CRC surveillance schedule with the second exam, n; % (European Guidelines)
2; 1.9 ( )
6; 6.3 ( )
OR=3.47 (95%CI= )
Incremental benefit of FUSE compared to that of CC/R
Conclusion
Full-spectrum colonoscopy outperforms conventional colonoscopy complemented by examination of the right colon with scope retroflexion to detect missed adenomas -overall and in the proximal colon- by more than four times, even performed by endoscopists with high ADR