Sessile serrated adenoma/polyp detection rate of water exchange, Endocuff, and cap colonoscopy: A network meta‐analysis

Abstract

Background and Aim: Sessile serrated adenoma/polyp (SSA/P) may contribute to interval cancer. In a recent meta-analysis, water exchange (WE) was shown to be superior to Endocuff and cap colonoscopy at adenoma and advanced adenoma detection. The strong positive correlation between adenoma detection rate (ADR), advanced adenoma detection rate (AADR), and sessile serrated adenoma/polyp detection rate (SSA/PDR) prompted us to hypothesize that WE could significantly improve SSA/PDR compared with Endocuff and cap colonoscopy. Methods: The literature was searched for all randomized controlled trials (RCTs) that reported SSA/PDR as an outcome and included the keywords colonoscopy, and water exchange, Endocuff, or cap. We performed traditional network meta-analyses with random effect models comparing SSA/PDR of each method using air insufflation as the control and reported the odds ratios (ORs) with 95% confidence interval (CI). Performances were ranked based on P-score. Results: A total of 531 articles resulted from initial keywords search. Eleven RCTs were included in the analysis. A total of 7856 patients underwent air insufflation, WE, Endocuff, or cap colonoscopy. WE significantly increased SSA/PDR (OR 2.04; 95% CI 1.33-3.13). Endocuff (OR 1.15; 95% CI 0.94-1.41) and cap (OR 1.08; 95% CI 0.42-2.74) did not significantly impact SSA/P detection. P-scores for WE (0.96), Endocuff (0.49), cap (0.37), and air insufflation (0.17) suggested that WE had the highest SSA/PDR. The results did not change after adjusting for mean withdrawal time and indication for colonoscopy. Conclusion: Water exchange significantly increases SSA/PDR and is superior to Endocuff and cap colonoscopy at detecting SSA/P.

A survey of colonoscopists with and without in‐depth knowledge of water‐aided colonoscopy

“…WE produced significantly higher ADR than WI 8 . Network meta‐analyses showed WE colonoscopy had the highest ADR, 9 advanced ADR 9 and serrated adenoma/polyp detection rate 10 compared with cap‐ and Endocuff‐assisted colonoscopy when gas insufflation was used as the common comparator. In a study of video recordings of an RCT, artificial intelligence (computer‐aided detection) showed a significantly higher additional polyp detection rate and a lower number of false positives per colonoscopy (related to feces and bubbles) in the WE group compared with the air‐insufflation group.…”

“…In the discussion, we will review the most recent WAC reports published after the cutoff date of literature search for the MDCR to add additional insights. [5][6][7][8][9][10][11][12][13]…”

“…In this context, it is important to explore how WE could benefit screening colonoscopy practice during pandemic recovery. In the discussion, we will review the most recent WAC reports published after the cutoff date of literature search for the MDCR to add additional insights 5–13 …”

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

“…Facciorusso et al (24) en su metanálisis de 6 ECA, comparó el EC con el Cap, encontrando que la TD ASS fueron similares en los 2 grupos (9,6% vs 6,8%, RR:1,36, IC de 95%: 0,72-2,59). Shao et al (25) compararon EC, Cap y colonoscopia con intercambio de agua, encontrando que EC no mejoró la TD ASS (OR 1,15, ic 95%: 0,94-1,41). Aziz et al (15) en su metanálisis publicado en Gastrointest.…”

“…(15) y en Eur J Gastroenterol Hepatol. (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).…”