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Full-Spectrum Endoscopy Improves Adenoma Detection Compared to Conventional Colonoscopy PLUS Right-Colon Examination With Scope Retroflexion: A Randomized,

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Presentation on theme: "Full-Spectrum Endoscopy Improves Adenoma Detection Compared to Conventional Colonoscopy PLUS Right-Colon Examination With Scope Retroflexion: A Randomized,"— Presentation transcript:

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


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