Lower adenoma miss rate with FUSE vs. conventional colonoscopy with proximal retroflexion: a randomized back-to-back trial

Abstract

Full-spectrum colonoscopy (FSC) promises to increase adenoma detection by providing a wider field of view. The aim of this study was to compare adenoma miss rates of FSC with those of conventional colonoscopy complemented by right-colon re-examination using scope retroflexion (CC/R). At two tertiary endoscopy facilities, patients who were scheduled for colonoscopy for the assessment of symptoms or for colorectal cancer screening/surveillance were randomized (1:1) to undergo same-day, back-to-back colonoscopies (FSC or CC/R first), performed by one of five endoscopists who had documented adenoma detection rates> 35 %. Per-protocol data were analyzed. We randomized 220 patients. There were five FSC technical failures (three air pump and two left screen); therefore, 107 and 108 cases were analyzed in the FSC and CC/R index procedure arms, respectively. Withdrawal times were similar for FSC and CC/R (7.7 minutes vs. 7.6 minutes). Overall, we detected 3 cancers and 153 adenomas (FSC = 92; CC/R = 61); 81 were detected in the proximal colon, 3 of which were detected by retroflexed examination. By per-lesion analysis, FSC showed a significantly lower adenoma miss rate compared with CC/R overall (10.9 % [95 % confidence interval (CI) 3.8 to 18.1] vs. 33.7 % [95 %CI 23.4 to 44.1]) and in the proximal colon (13.9 % [95 %CI 2.6 to 25.2] vs. 42.2 % [95 %CI 27.8 to 56.7]). The advanced adenoma miss rate was lower with FSC overall (4.3 % [95 %CI - 4.0 to 12.7] vs. 25.9 % [95 %CI 9.4 to 42.5]). There were no adverse events. FSC outperformed conventional colonoscopy with right-colon scope retroflexion in the detection of missed adenomas, both overall and in the proximal colon, even when performed by experienced endoscopists.Trial registered at ClinicalTrials.gov (NCT02117674).

The Role of Behind Folds Visualizing Techniques and Technologies in Improving Adenoma Detection Rate

“…This finding clearly conflicts with the results of two previous meta-analyses that reported a 19-35% reduction in overall AMR with BFTs [32,33]. However, both meta-analyses included studies that were excluded in our analysis either because they were published before 2013 [34,35], written in German [36•], and used a previous version of the Endocuff or EndoRings [37][38][39], or because they did not use CC as a comparator [40]. Similarly to the results on ADR, the Endocuff results were the most positive in these analyses.…”

Increased Risk of Synchronous Colorectal Lesions in Patients Referred for Endoscopic Mucosal Resection of Lateral Spreading Tumors

“…As a matter of fact, mucosal lesions -even polypoid adenomas -can be missed, which constitute a significant risk factor for interval CRC. Adenoma miss rate (12) is cumbersome to estimate: it has been better evaluated by means of back-to-back colonoscopies under experimental settings (13,14) .…”

New endoscopes and add-on devices to improve colonoscopy performance

“…The majority of the 20 adenomas that were missed during SFV examination and detected by the Fuse were sessile (90%), diminutive (70%) and RC sited (70%). In a similar design cross over study, Papanikolaou et al[26] showed that Fuse outperformed SFV complemented by examination of the right colon with scope retroflexion regarding adenoma (10.9% vs 33.7%, P < 0.001) and polyp (3.0% vs 33.5%, P < 0.001) miss rates. The same study showed that the incremental benefit of full-spectrum colonoscopy when performed, as a second examination, was 39% higher compared to that of conventional colonoscopy with retroflexion in the cecum, regarding-adenoma miss-rate overall (Figure 2).…”

“…Incremental benefit from full-spectrum colonoscopy compared to conventional colonoscopy complemented with proximal colon examination with scope retroflexion[26]. …”