Magnetic endoscopic imaging as an adjuvant to elective colonoscopy: a systematic review and meta-analysis of randomized controlled trials

Mark‐Christensen, Anders; Brandsborg, Søren; Iversen, Lene Hjerrild

doi:10.1055/s-0034-1390767

Cited by 26 publications

(30 citation statements)

References 20 publications

(84 reference statements)

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“…Magnetic endoscope imaging is an established useful adjunct for assisting with loop identification and reduction during colonoscopy, and for reducing patient discomfort in unsedated or minimally sedated colonoscopy 16 17 18 19 , although it is less useful for reducing cecal intubation time 20. However, the role of magnetic endoscope imaging as an adjunctive tool for colonoscopic lesion localization has not be well studied.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of polyp localization at colonoscopy

et al. 2016

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Background and study aims: Accurate documentation of lesion localization at the time of colonoscopic polypectomy is important for future surveillance, management of complications such as delayed bleeding, and for guiding surgical resection. We aimed to assess the accuracy of endoscopic localization of polyps during colonoscopy and examine variables that may influence this accuracy. Patients and methods: We conducted a prospective observational study in consecutive patients presenting for elective, outpatient colonoscopy. All procedures were performed by Australian certified colonoscopists. The endoscopic location of each polyp was reported by the colonoscopist at the time of resection and prospectively recorded. Magnetic endoscope imaging was used to determine polyp location, and colonoscopists were blinded to this image. Three experienced colonoscopists, blinded to the endoscopist’s assessment of polyp location, independently scored the magnetic endoscope images to obtain a reference standard for polyp location (Cronbach alpha 0.98). The accuracy of colonoscopist polyp localization using this reference standard was assessed, and colonoscopist, procedural and patient variables affecting accuracy were evaluated. Results: A total of 155 patients were enrolled and 282 polyps were resected in 95 patients by 14 colonoscopists. The overall accuracy of polyp localization was 85 % (95 % confidence interval, CI; 60 – 96 %). Accuracy varied significantly (P < 0.001) by colonic segment: caecum 100 %, ascending 77 % (CI;65 – 90), transverse 84 % (CI;75 – 92), descending 56 % (CI;32 – 81), sigmoid 88 % (CI;79 – 97), rectum 96 % (CI;90 – 101). There were significant differences in accuracy between colonoscopists (P < 0.001), and colonoscopist experience was a significant independent predictor of accuracy (OR 3.5, P = 0.028) after adjustment for patient and procedural variables. Conclusions: Accuracy of localization of polyps is imprecise and affected by position within the colon and colonoscopist, including their level of experience. Magnetic endoscope imaging may improve the localization of lesions during colonoscopy.

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Section: Discussionmentioning

confidence: 99%

Accuracy of polyp localization at colonoscopy

et al. 2016

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“…A recent meta-analysis of all RCTs. which included a total of 4470 patients, found that MEI was associated with a significantly lower risk of failed caecal intubation (a risk difference of 4%, 95 %CI 0 % -7 %; P = 0.03), lower caecal intubation times (mean difference of 0.58 minutes, 95 %CI 0.28 -0.88; P < 0.001) and lower pain scores as estimated by visual analogue scale (mean difference 0.45 cm, 95 %CI 0.03-0.86; P = 0.03) compared with conventional colonoscopy [10]. However, there was considerable heterogeneity amongst the trials and it is arguable whether such difference in caecal intubation times and pain scores are clinically significant.…”

Section: Mei Use In Clinical Practicementioning

confidence: 94%

Magnetic Endoscopic Imaging: A Useful Ally in Colonoscopy

Pelitari¹,

Patel²

2015

J Gastrointest Dig Syst

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Magnetic endoscopic imaging (MEI) allows the configuration of the endoscope shaft to be visualised during colonoscopy. In particular, it allows the operator to confidentally recognise loop formation and subsequent loop resolution which is vital for colonoscope tip advancement and thus complete visualisation of the colon. Although generally accepted as a useful aid during colonoscopy, it is not universally available either due to cost or this facility is not available or compatible with all manufactured endoscopes. The data on its utility with regards colonoscopy performance outcome measures is mixed but overall likely to be beneficial. Its main value probably relates to colonoscopy training and its value may be realised with the large expansion in workforce required with the recent introduction of bowel cancer screening. Further work in this area is required. The manufacturer suggests some minor limitations in use because of potential interference with implanted electronic device, but its safety overall is well recognised.

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“…Other techniques include cap‐assisted colonoscopy (CAC), x‐ray imaging and magnetic endoscopic imaging (MEI), which may be useful especially for inexperienced endoscopists. CAC keeps mucosa away from the lens, maximizing visualization, and allowing for anticipation of sharp turns, leading to less looping, while x‐ray and MEI may be useful to identify difficult anatomy, recognize and overcome loops, and apply specific abdominal pressure in the appropriate location . While fluoroscopy is two‐dimensional, MEI provides three‐dimensional endoscopic configuration and is radiation free; however, none of these techniques is available in most endoscopic departments.…”

Section: Methodsmentioning

confidence: 99%

“…CAC keeps mucosa away from the lens, maximizing visualization, and allowing for anticipation of sharp turns, leading to less looping, 19 while x-ray and MEI may be useful to identify difficult anatomy, recognize and overcome loops, and apply specific abdominal pressure in the appropriate location. 20 While fluoroscopy is two-dimensional, MEI provides threedimensional endoscopic configuration and is radiation free; however, none of these techniques is available in most endoscopic departments. They may be useful teaching tools for colonoscopy, especially whenever difficulties arise with intubation.…”

Section: A Natomically Difficult Colonoscopiesmentioning

confidence: 99%

(Technically) Difficult colonoscope insertion – Tips and tricks

Rodrigues‐Pinto

Ferreira‐Silva

Macedo

et al. 2019

Digestive Endoscopy

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Cecal intubation is a critical aspect of effective, complete colonoscopy. Difficult colonoscopy is most often considered as one in which it is challenging or impossible to reach the cecum. It may be a common occurrence due to patient and/or endoscopist factors. Incomplete colonoscopies should be avoided, since patients in this context present an important prevalence of lesions that escape examination. The approach to successful cecal intubation should depend on characterization of the problem as redundant colon or difficult sigmoid colon. Most patients with a prior incomplete colonoscopy can be colonoscoped successfully, if careful attention is paid to technique, using a variety of scopes, colonoscopy methods and additional equipment. Sufficient time should be allotted to make the attempt.

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Magnetic endoscopic imaging as an adjuvant to elective colonoscopy: a systematic review and meta-analysis of randomized controlled trials

Abstract: Adjuvant MEI is associated with a lower failure risk and shorter time to cecal intubation during elective colonoscopy compared with conventional colonoscopy.

Cited by 26 publications

References 20 publications

Accuracy of polyp localization at colonoscopy

Accuracy of polyp localization at colonoscopy

Magnetic Endoscopic Imaging: A Useful Ally in Colonoscopy

(Technically) Difficult colonoscope insertion – Tips and tricks

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