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

Abstract

BackgroundRecent meta-analyses have demonstrated a higher adenoma detection rate using the water exchange method (WE), compared to water immersion (WI) and air/CO 2 insufflation (ACI). Proximal adenomas have a high miss rate owing to their location and appearance. We performed a systematic review and meta-analysis of studies comparing the WE and WI methods to the ACI method, with a primary focus on proximal adenoma detection rate. MethodsThe following databases were searched for our systematic review: Medline, Embase, Cochrane Library, CINAHL, and Web of Sciences. We included both randomized controlled trials and cohort studies. The primary outcome was proximal adenoma detection rate, and secondary outcomes were right adenoma detection rate and cecal intubation rate.Results A total of 12 studies (17 arms) with 5660 patients (2260 ACI, 2281 WE, and 1119 WI) were included. A higher proximal adenoma detection rate (risk ratio [RR] 1.30, 95% confidence interval [CI] 1.11-1.53; P=0.001) and right adenoma detection rate (RR 1.43, 95%CI 1.19-1.71; P≤0.001; I 2 =0%) were noted for the WE group compared to the ACI group. The WI group did not demonstrate a better detection rate of proximal or right adenomas. ConclusionsThe water exchange method for colonoscopy holds promise and should be encouraged in the clinical setting to increase proximal and right adenoma detection rates. This will in turn decrease the incidence of colorectal cancer.

Impact of real-time use of artificial intelligence in improving adenoma detection during colonoscopy: A systematic review and meta-analysis

“…Various newer modalities have been studied to help increase ADR. Some of these interventions include changes in procedure techniques like water immersion and water exchange, add-on devices like Endo-Cuff, cap-assisted colonoscopy, image enhancement with narrow-band imaging (NBI) or chromoendoscopy 29 30 31 32 and DNN based computer learning capabilities. While AIAC has shown promising results in improving ADR in the recent RCTs, it is unclear if the impact is significant enough to warrant changes in clinical practice.…”

The impact of deep convolutional neural network‐based artificial intelligence on colonoscopy outcomes: A systematic review with meta‐analysis

“…Numerous interventions have been introduced to improve the ADR of colonoscopy. These include the use of add‐on devices (endocap, endoring, endocuff, G‐EYE, and amplifEYE), electronic chromoendoscopy (narrow band imaging, linked color imaging, blue laser imaging, and flexible spectral imaging color enhancement), water‐aided techniques (water immersion and water exchange), use of second observer, antispasmodic administration, retroflexion in the right colon or second forward view, quality control initiatives, and improved bowel preparation . However, there are still a number of adenomas that are missed during colonoscopy, and current efforts are being directed to prevent this.…”

Does i-scan improve adenoma detection rate compared to high-definition colonoscopy? A systematic review and meta-analysis

“…The U.S. Multi-Society Task Force set ADR benchmarks of ≥ 25 % overall (≥ 20 % in women and ≥ 30 % in men) among colonoscopists to achieve high-quality examinations [29]. Numerous interventions and techniques including use of distal attachments (cap, cuff, rings), virtual chromoendoscopy, water-based techniques, having a second observer, premedication with peppermint oil, optimizing bowel prep and ensuring good examination techniques have been proposed previously to improve ADR during colonoscopy [12,13,[30][31][32][33][34]. Our study demonstrated the potential use of i-scan with surface and CE as an additional modality that can be employed to improve the ADR [22,35].…”