Douglas K Rex1, Alessandro Repici2, Seth A Gross3, Cesare Hassan4, Prasanna L Ponugoti1, Jonathan R Garcia1, Heather M Broadley1, Jack C Thygesen1, Andrew W Sullivan1, William W Tippins1, Samuel A Main1, George J Eckert5, Krishna C Vemulapalli6. 1. Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA. 2. Department of Gastroenterology, Humanitas Research Hospital & Humanitas University via Manzoni, Milan, Italy. 3. Department of Gastroenterology, Tisch Hospital, NYU Langone Medical Center, New York, New York, USA. 4. Department of Gastroenterology, Nuovo Regina Margherita Hospital, Rome, Italy. 5. Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA. 6. Department of Public Health and Preventative Medicine, St. George's University, Grenada, West Indies.
Abstract
BACKGROUND AND AIMS: Devices used to improve polyp detection during colonoscopy have seldom been compared with each other. METHODS: We performed a 3-center prospective randomized trial comparing high-definition (HD) forward-viewing colonoscopy alone to HD with Endocuff to HD with EndoRings to the full spectrum endoscopy (FUSE) system. Patients were age ≥50 years and had routine indications and intact colons. The study colonoscopists were all proven high-level detectors. The primary endpoint was adenomas per colonoscopy (APC). RESULTS: Among 1188 patients who completed the study, APC with Endocuff (APC mean ± standard deviation: 1.82 ± 2.58), EndoRings (1.55 ± 2.42), and standard HD colonoscopy (1.53 ± 2.33) were all higher than FUSE (1.30 ± 1.96; P < .001 for APC). The APC for Endocuff was higher than standard HD colonoscopy (P = .014). Mean cecal insertion times with FUSE (468 ± 311 seconds) and EndoRings (403 ± 263 seconds) were both longer than with Endocuff (354 ± 216 seconds; P = .006 and .018, respectively). CONCLUSIONS: For high-level detectors at colonoscopy, forward-viewing HD instruments dominate the FUSE system, indicating that for these examiners image resolution trumps angle of view. Further, Endocuff is a dominant strategy over EndoRings and no mucosal exposure device on a forward-viewing HD colonoscope. (Clinical trial registration number: NCT02345889.).
RCT Entities:
BACKGROUND AND AIMS: Devices used to improve polyp detection during colonoscopy have seldom been compared with each other. METHODS: We performed a 3-center prospective randomized trial comparing high-definition (HD) forward-viewing colonoscopy alone to HD with Endocuff to HD with EndoRings to the full spectrum endoscopy (FUSE) system. Patients were age ≥50 years and had routine indications and intact colons. The study colonoscopists were all proven high-level detectors. The primary endpoint was adenomas per colonoscopy (APC). RESULTS: Among 1188 patients who completed the study, APC with Endocuff (APC mean ± standard deviation: 1.82 ± 2.58), EndoRings (1.55 ± 2.42), and standard HD colonoscopy (1.53 ± 2.33) were all higher than FUSE (1.30 ± 1.96; P < .001 for APC). The APC for Endocuff was higher than standard HD colonoscopy (P = .014). Mean cecal insertion times with FUSE (468 ± 311 seconds) and EndoRings (403 ± 263 seconds) were both longer than with Endocuff (354 ± 216 seconds; P = .006 and .018, respectively). CONCLUSIONS: For high-level detectors at colonoscopy, forward-viewing HD instruments dominate the FUSE system, indicating that for these examiners image resolution trumps angle of view. Further, Endocuff is a dominant strategy over EndoRings and no mucosal exposure device on a forward-viewing HD colonoscope. (Clinical trial registration number: NCT02345889.).
Authors: Nancy E Aguilar-Olivos; Ricardo Balanzá; Fernando Rojas-Mendoza; Rodrigo Soto-Solis; Mario A Ballesteros-Amozurrutia; Norma González-Uribe; Justo A Fernández-Rivero Journal: Endosc Int Open Date: 2021-05-27