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

Abstract

This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e146. Learning Objective-Upon completion of this activity, successful learners will be able to list the endoscopic techniques that have been shown to increase colon adenoma detection rate; list the endoscopic techniques that have been shown to increase mean adenoma per patient compared with standard colonoscopy; and list the endoscopic techniques that have not been shown to improve colon adenoma detection rate. 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 (fullspectrum 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.

Distal attachments for adenoma detection go head‐to‐head: Cap or cuff?

“…Further research is needed to assess the impact of distal colonoscope attachments on patient comfort, their role in tip stabilization to support effective polypectomy and whether the small increment in ADR at the higher end of the spectrum has any impact upon interval cancer rates and mortality. It further remains to be seen whether adjunct devices such as EAC or TAC (as compared with inexpensive measures such as NBI, longer withdrawal times, second look or retroflexion in the right colon or use of anti‐spasmodics) have a role in improving ADRs in day‐to‐day practice . Nevertheless head‐to‐head studies as presented here should be the new standard for novel device assessment in endoscopic clinical care.…”

“…It further remains to be seen whether adjunct devices such as EAC or TAC (as compared with inexpensive measures such as NBI, longer withdrawal times, second look or retroflexion in the right colon or use of anti-spasmodics) have a role in improving ADRs in day-to-day practice. 8 Nevertheless head-to-head studies as presented here should be the new standard for novel device assessment in endoscopic clinical care.…”

Covid-19 pandemic impact on colonoscopy service and suggestions for managing recovery

“…Perhaps this is a good time to consider adopting low-cost interventions to minimize risk of transmission of the Covid-19 virus, decrease the number of incomplete or low-quality procedures that require rescheduling, and minimize the need for anesthesia medication and support. Low-cost interventions have been proven effective [11].…”

How to increase proximal adenoma detection rate: a meta-analysis comparing water exchange, water immersion and air/CO2 insufflation methods for colonoscopy

“…Fuccio et al compared the WE, WI and ACI methods in a comparative meta-analysis and demonstrated the superiority of the WE method over both WI and ACI in terms of overall adenoma detection rate and right colon adenoma detection rate (RADR) [8]. Another network meta-analysis by Facciorusso et al supported the use of water techniques for improving overall ADR [9]. Critically, the authors of this study did not perform an analysis of the proximal adenoma detection rate (PADR).…”