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      Use of the Endocuff during routine colonoscopy examination improves adenoma detection: A meta-analysis

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          Abstract

          AIM

          To perform meta-analysis of the use of Endocuff during average risk screening colonoscopy.

          METHODS

          Scopus, Cochrane databases, MEDLINE/PubMed, and CINAHL were searched in April 2016. Abstracts from Digestive Disease Week, United European Gastroenterology, and the American College of Gastroenterology meeting were also searched from 2004-2015. Studies comparing EC-assisted colonoscopy (EAC) to standard colonoscopy, for any indication, were included in the analysis. The analysis was conducted by using the Mantel-Haenszel or DerSimonian and Laird models with the odds ratio (OR) to assess adenoma detection, cecal intubation rate, and complications performed.

          RESULTS

          Nine studies ( n = 5624 patients) were included in the analysis. Compared to standard colonoscopy, procedures performed with EC had higher frequencies for adenoma (OR = 1.49, 95%CI: 1.23-1.80; P = 0.03), and sessile serrated adenomas detection (OR = 2.34 95%CI: 1.63-3.36; P < 0.001). There was no significant difference in cecal intubation rates between the EAC group and standard colonoscopy (OR = 1.26, 95%CI: 0.70-2.27, I 2 = 0%; P = 0.44). EAC was associated with a higher risk of complications, most commonly being superficial mucosal injury without higher frequency for perforation.

          CONCLUSION

          The use of an EC on colonoscopy appears to improve pre-cancerous polyp detection without any difference in cecal intubation rates compared to standard colonoscopy.

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          Quality indicators for colonoscopy and the risk of interval cancer.

          Michal F Kaminski, Jaroslaw Regula, Ewa Kraszewska … (2010)
          Although rates of detection of adenomatous lesions (tumors or polyps) and cecal intubation are recommended for use as quality indicators for screening colonoscopy, these measurements have not been validated, and their importance remains uncertain. We used a multivariate Cox proportional-hazards regression model to evaluate the influence of quality indicators for colonoscopy on the risk of interval cancer. Data were collected from 186 endoscopists who were involved in a colonoscopy-based colorectal-cancer screening program involving 45,026 subjects. Interval cancer was defined as colorectal adenocarcinoma that was diagnosed between the time of screening colonoscopy and the scheduled time of surveillance colonoscopy. We derived data on quality indicators for colonoscopy from the screening program's database and data on interval cancers from cancer registries. The primary aim of the study was to assess the association between quality indicators for colonoscopy and the risk of interval cancer. A total of 42 interval colorectal cancers were identified during a period of 188,788 person-years. The endoscopist's rate of detection of adenomas was significantly associated with the risk of interval colorectal cancer (P=0.008), whereas the rate of cecal intubation was not significantly associated with this risk (P=0.50). The hazard ratios for adenoma detection rates of less than 11.0%, 11.0 to 14.9%, and 15.0 to 19.9%, as compared with a rate of 20.0% or higher, were 10.94 (95% confidence interval [CI], 1.37 to 87.01), 10.75 (95% CI, 1.36 to 85.06), and 12.50 (95% CI, 1.51 to 103.43), respectively (P=0.02 for all comparisons). The adenoma detection rate is an independent predictor of the risk of interval colorectal cancer after screening colonoscopy. 2010 Massachusetts Medical Society
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            Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies.

            G Lehman, G T Lemmel, D Helper … (1996)
            The miss rate of colonoscopy for neoplasms is poorly understood. The aim of this study was to determine the miss rate of colonoscopy by same day back-to-back colonoscopy. Two consecutive same day colonoscopies were performed in 183 patients. The patients were randomized to undergo the second colonoscopy by the same or a different endoscopist and in the same or different position. The overall miss rate for adenomas was 24%, 27% for adenomas or = 1 cm. Patients with two or more adenomas at the first examination were more likely than patients with no or one adenoma detected at the first examination to have one or more adenomas at the second examination (odds ratio, 3.3; 95% confidence interval, 1.69-6.46). Right colon adenomas were missed more often (27%) than left colon adenomas (21%), but the difference was not significant. There was evidence of variation in sensitivity between endoscopists, but significant miss rates for small adenomas were found among essentially all endoscopists. Using current colonoscopic technology, there are significant miss rates for adenomas or = 1 cm. The results suggest the need for improvements in colonoscopic technology.
            Article 0 comments Cited 106 times – based on 0 reviews     Review now
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              Longitudinal outcome study of sessile serrated adenomas of the colorectum: an increased risk for subsequent right-sided colorectal carcinoma.

              Fang Lu, Dmitry A Turbin, C. Owen … (2010)
              Sessile serrated adenomas (SSAs) are associated with colorectal carcinomas (CRCs) that demonstrate high microsatellite instability (MSI-H). Currently, SSAs are managed clinically in a similar fashion to adenomatous polyps (APs). We studied the natural history of SSA by analyzing the outcome of previously undiagnosed SSAs and comparing it with that of hyperplastic polyps (HPs) and APs. All colorectal polyps diagnosed between 1980 and 2001 as HP were selected for study. Polyps identified as possible SSAs were reviewed by 3 pathologists, and the diagnosis was confirmed. Clinical follow-up was obtained for each SSA patient and matched with control HP and AP patients. In total, 1402 colorectal polyps diagnosed as HP were examined and 81 polyps in 55 patients (5.8%) were rediagnosed as SSA. Of these, 40 SSA patients had no previous history of either CRC or AP with high-grade dysplasia (HGD). Of these 40 patients, 5 developed subsequent CRCs and 1 developed AP with HGD. The incidence of subsequent CRCs was significantly higher in SSA patients than in control patients with HP (12.5% vs. 1.8%) and AP (12.5% vs. 1.8%). All of the subsequent CRCs or APs with HGD developed in the proximal colon. Four of the 5 CRCs demonstrated a high microsatellite instability phenotype. We conclude that SSAs are high-risk lesions, with 15% of the SSA patients developing subsequent CRCs or APs with HGD. This incidence is higher than that of the control HP and AP patients, and would support close endoscopic follow-up in patients harboring SSAs.
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                Author and article information

                Journal
                Journal ID (nlm-ta): World J Gastroenterol
                Journal ID (iso-abbrev): World J. Gastroenterol
                Journal ID (publisher-id): WJG
                Title: World Journal of Gastroenterology
                Publisher: Baishideng Publishing Group Inc
                ISSN (Print): 1007-9327
                ISSN (Electronic): 2219-2840
                Publication date (Print): 21 November 2016
                Publication date (Electronic): 21 November 2016
                Volume: 22
                Issue: 43
                Pages: 9642-9649
                Affiliations
                Matthew Chin, William Karnes, John G Lee, Robert Lee, Jason Samarasena, Douglas L Nguyen, Division of Gastroenterology and Hepatology, University of California Irvine, Orange, CA 92868, United States
                M Mazen Jamal, Division of Gastroenterology, Long Beach Veterans Affairs Health System, Long Beach, CA 90822, United States
                Matthew L Bechtold, Division of Gastroenterology, University of Missouri Health, Columbia, MO 65201, United States
                Author notes

                Author contributions: Chin M and Nguyen DL contributed to conception, design and acquisition of data; Chin M, Bechtold ML and Nguyen DL contributed to analysis and interpretation of data; Chin M, Karnes W, Lee JG, Lee R, Samarasena J, Bechtold ML and Nguyen DL contributed to drafting of manuscript; Chin M, Karnes W, Lee JG, Lee R, Samarasena J, Bechtold ML and Nguyen DL contributed to critical revision of manuscript; Jamal MM, Bechtold ML and Nguyen DL were statistical expertise.

                Correspondence to: Douglas L Nguyen, MD, Division of Gastroenterology and Hepatology, University of California Irvine, Department of Medicine, 101 The City Drive, Orange, CA 92868, United States. douglaln@ 123456uci.edu

                Telephone: +1-949-8245011

                Article
                Other ID: jWJG.v22.i43.pg9642
                DOI: 10.3748/wjg.v22.i43.9642
                PMC ID: 5116608
                SO-VID: 695376cf-4bbe-4951-807e-9e6074fcfea6
                Copyright © ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
                License:

                This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

                History
                Date received : 22 July 2016
                Date revision received : 24 September 2016
                Date accepted : 19 October 2016
                Categories
                Subject: Meta-Analysis

                Keywords: colonoscopy,endocuff,adenoma detection
                Data availability:
                Keywords: colonoscopy, endocuff, adenoma detection

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