High-Definition Colonoscopy Compared With Cuff- and Cap-Assisted Colonoscopy: Results From a Multicenter, Prospective, Randomized Controlled Trial

Desai, Madhav; Rex, Douglas K.; Bohm, Matthew; DeWitt, John M.; Fischer, Monika; Faulx, Gregory; Heath, Ryan D.; Imler, Timothy D.; James-Stevenson, Toyia N.; Kahi, Charles J.; Kessler, William R.; Kohli, Divyanshoo R.; McHenry, Lee; Rai, Tarun; Rogers, Nicholas; Sagi, Sashidhar; Sathyamurthy, Anjana; Vennalaganti, Prashanth; Sundaram, Suneha; Patel, Harsh K.; Higbee, April D.; Kennedy, Kevin F.; Lahr, Rachel E.; Stojadinovikj, Gjorgie; Dasari, Chandra S.; Parasa, Sravanthi; Faulx, Ashley L.

doi:10.1016/j.cgh.2021.12.037

Cited by 11 publications

(6 citation statements)

References 19 publications

(25 reference statements)

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“…Several studies have demonstrated better performance of CADe over conventional colonoscopy with high-definition colonoscopes. This could be due to minimizing subjective component of endoscopist that is based on competence (low vs high ADR performers), fatigue, participation by endoscopy staff, and assigned time slots in a busy practice that cannot be applied to each case (25)(26)(27). We included only experienced endoscopists with ADR over recommended targets 25%-40%.…”

Section: Discussionmentioning

confidence: 99%

Use of a Novel Artificial Intelligence System Leads to the Detection of Significantly Higher Number of Adenomas During Screening and Surveillance Colonoscopy: Results From a Large, Prospective, US Multicenter, Randomized Clinical Trial

Desai,

Ausk,

Brannan

et al. 2024

Am J Gastroenterol

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Introduction: Adenoma per colonoscopy (APC) has recently been proposed as a quality measure for colonoscopy. We evaluated the impact of a novel AI system, compared to standard HD colonoscopy, for APC measurement. Methods: This was a U.S. based, multi-center, prospective randomized trial examining a novel AI detection system (EW10-EC02) that enables a real-time colorectal polyp detection enabled with the colonoscope (CAD-EYE™). Eligible average risk subjects (≥45 years) undergoing screening or surveillance colonoscopy were randomized to undergo either CAD-EYE-assisted colonoscopy (CAC) or conventional colonoscopy (CC). Modified Intention-to-treat (mITT) analysis was performed for all patients that completed colonoscopy with primary outcome of APC. Secondary outcomes included positive predictive value (PPV, total number of adenomas divided by total polyps removed) and adenoma detection rate (ADR). Results: In mITT analysis, of 1031 subjects (age: 59.1+/-9.8; 49.9% male), 510 underwent CAC vs. 523 underwent CC with no significant differences in age, gender, ethnicity, or colonoscopy indication between the 2 groups. CAC led to a significantly higher APC compared to CC: 0.99± 1.6 vs. 0.85±1.5, p=0.02, Incidence Rate Ratio 1.17 (1.03-1.33, p=0.02) with no significant difference in the withdrawal time: 11.28±4.59 min vs. 10.8±4.81 min; p=0.11 between the 2 groups. Difference in PPV of a polyp being an adenoma among CAC and CC was less than 10% threshold established: 48.6% vs 54%, 95% CI -9.56%, -1.48%. There were no significant differences in ADR (46.9% vs. 42.8%), advanced adenoma (6.5% vs. 6.3%), sessile serrated lesion detection rate (12.9% vs. 10.1%) and polyp detection rate (63.9% vs 59.3%) between the 2 groups. There was a higher polyp per colonoscopy with CAC compared to CC: 1.68 ± 2.1 vs. 1.33 ± 1.8 (incidence rate ratio 1.27; 1.15-1.4; p<0.01). Conclusion: Use of a novel AI detection system showed to a significantly higher number of adenomas per colonoscopy compared to conventional HD colonoscopy without any increase in colonoscopy withdrawal time, thus supporting use of AI-assisted colonoscopy to improve colonoscopy quality. (Clinicaltrials.gov NCT04979962)

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Section: Discussionmentioning

confidence: 99%

Use of a Novel Artificial Intelligence System Leads to the Detection of Significantly Higher Number of Adenomas During Screening and Surveillance Colonoscopy: Results From a Large, Prospective, US Multicenter, Randomized Clinical Trial

Desai,

Ausk,

Brannan

et al. 2024

Am J Gastroenterol

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“…Distal attachments facilitate mucosal exposure, which is the most time-consuming task of the careful examiner. We favor the Endocuff Vision (ECV) for routine examinations because it has extensive literature support (67,68) and on average speeds cecal intubation and allows faster withdrawal without compromising detection (69). ECV widens the distal tip of the colonoscope.…”

Section: Review Articlementioning

confidence: 99%

Performing High-Quality, Safe, Cost-Effective, and Efficient Basic Colonoscopy in 2023: Advice From Two Experts

Anderson

Rex

2023

Am J Gastroenterol

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Based on published evidence and our expert experience, we provide recommendations to maximize the efficacy, safety, efficiency and cost-effectiveness of routine colonoscopy. High quality colonoscopy (HQC) begins with colon preparation using a split or same day dose and preferably a low volume regimen for optimal patient tolerance and compliance. Successful cecal intubation can be achieved by choosing the correct colonoscope as well as using techniques to facilitate navigation through challenges such as severe angulations and redundant colons. Safety is a primary goal and complications such as perforation and splenic rupture can be prevented by avoiding pushing through fixed resistance and avoiding loops in proximal colon. Furthermore, barotrauma can be avoided by converting to water filling only (no gas insufflation) in every patient with a narrowed, angulated sigmoid. Optimal polyp detection relies primarily on compulsive attention to inspection as manifested by adequate inspection time, vigorous probing of the spaces between haustral folds, washing and removing residual debris, and achieving full distention. Achieving minimum recommended ADR thresholds (30% in men and 20% in women) is mandatory, and colonoscopists should aspire to ADRs approaching 50% in screening patients. Distal attachments can improve mucosal exposure and increase detection while shortening withdrawal times. Complete resection of polyps complements polyp detection in preventing colorectal cancer. Cold resection is the preferred method for all polyps < 10 mm. For effective cold resection, an adequate rim of normal tissue should be captured in the snare. Finally, cost-effective HQC requires the procedure not be overused, as demonstrated by following updated USMSTF post-polypectomy surveillance recommendations.

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“…Patel et al (26) llevan a cabo un metanálisis donde sólo evaluan el EC de segunda generación (EC Vision). Evaluando 5 ECA, la TD de lesiones serradas (LS) usando el EC Vision versus colonoscopia estándar fue de 8,8% (IC 95%: 3,1%-14,4%) y 6,1% (IC 95%:0,7%-11,5%), respectivamente, sin alcanzar diferencia significativa (RR, 1,21; IC 95%: 0,90-1,61; P=0,20 (28) , en un ECA que incluyó a 1203 pacientes, compararon el papel del EC Vision y del Cap en la detección de lesiones serradas, versus colonoscopia de HD. No encontraron diferencias significativas en los 3 grupos en la TD ASS (6,3%, 5,5% y 6,8%; p=0,775).…”

Section: Pregunta Pico: ¿Las Intervenciones Endoscópicas Pueden Aumen...unclassified

“…(16) , Weissman et al (21) , y Shao et al (25) no encontraron una mejora significativa en la detección de lesiones serradas con el uso de Cap. Un ECA reciente, tampoco encontró beneficio con el uso de endocap en la detección de ASS (28) , con TD ASS de 5,5% versus 6,3% para endocuff y 6,8% para colonoscopia de HD (p=0,775).…”

Section: B Capunclassified

Intervenciones endoscópicas para mejorar la tasa de detección de lesiones serradas durante la colonoscopia

Pérez

2023

Rev Gastroenterol Peru

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El cáncer colorrectal (CCR) es una de las causas más frecuentes de mortalidad por cáncer en el mundo. Las lesiones serradas son responsables de 10 a 20% de todos los CCR. Los pólipos serrados, en particular los adenomas serrados sésiles (ASS) y adenomas serrados tradicionales (AST), tienen una apariencia sutil y localización proximal, y por ello presentan una alta tasa de lesiones perdidas. El objetivo de la presente revisión fue evaluar la evidencia disponible sobre el uso de diversas intervenciones mejorar la tasa de detección de las lesiones serradas, para de esta forma, disminuir la mortalidad relacionada al CCR.

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High-Definition Colonoscopy Compared With Cuff- and Cap-Assisted Colonoscopy: Results From a Multicenter, Prospective, Randomized Controlled Trial

Cited by 11 publications

References 19 publications

Use of a Novel Artificial Intelligence System Leads to the Detection of Significantly Higher Number of Adenomas During Screening and Surveillance Colonoscopy: Results From a Large, Prospective, US Multicenter, Randomized Clinical Trial

Use of a Novel Artificial Intelligence System Leads to the Detection of Significantly Higher Number of Adenomas During Screening and Surveillance Colonoscopy: Results From a Large, Prospective, US Multicenter, Randomized Clinical Trial

Performing High-Quality, Safe, Cost-Effective, and Efficient Basic Colonoscopy in 2023: Advice From Two Experts

Intervenciones endoscópicas para mejorar la tasa de detección de lesiones serradas durante la colonoscopia

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