Yoji Takeuchi1, Manabu Sawaya2, Shiro Oka3, Naoto Tamai4, Takuji Kawamura5, Toshio Uraoka6, Hiroaki Ikematsu7, Tomohiko Moriyama8, Masamichi Arao1, Hideki Ishikawa9, Yuri Ito10, Takahisa Matsuda11. 1. Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan. 2. Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Japan. 3. Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Japan. 4. Department of Endoscopy, The Jikei University School of Medicine, Japan. 5. Department of Gastroenterology, Kyoto Second Red Cross Hospital, Japan. 6. Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Japan. 7. Endoscopy Division, National Cancer Center Hospital East, Japan. 8. Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Japan. 9. Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan. 10. Department of Cancer Epidemiology and Prevention, Center for Cancer Control and Statistics, Osaka International Cancer Institute, Osaka, Japan. 11. Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
Abstract
BACKGROUND AND AIMS: Colorectal flat (nonpolypoid) lesions can be overlooked during colonoscopy. This study evaluated the efficacy of updated autofluorescence imaging (AFI) for detecting colorectal flat neoplasms. METHODS: This was a prospective, multicenter, randomized controlled trial in 9 Japanese tertiary institutions. Patients undergoing colonoscopy because of positive fecal immunochemical tests, surveillance after polypectomy, or investigation of minor symptoms were enrolled and randomly assigned to either the white-light imaging (WLI) or the AFI group. Primary outcome measurement was number of flat neoplasms per patient. RESULTS:From November 2015 to June 2017, 817 patients were enrolled. After excluding 15 patients, 802 were finally analyzed (404, WLI; 398, AFI). Patients' backgrounds (sex, age, indication of colonoscopy, experience of endoscopists) and quality of colonoscopy (bowel preparation, sedative use, cecal insertion rate, insertion and withdrawal time) were not different between groups. Number of flat neoplasms in each patient was significantly higher in the AFI than in the WLI group (.87 [95% confidence interval [CI], .78-.97] vs .53 [95% CI, .46-.61]), whereas overall and polypoid neoplasm detection was not significantly different between the groups (1.33 [95% CI, 1.22-1.45] vs 1.14 [95% CI, 1.03-1.24], .46 [95% CI, .40-.53] vs .60 [95% CI, .53-.68]). Flat neoplasms were more frequently detected in the right-sided colon with AFI (.61 [95% CI, .54-.70] vs .30 [95% CI, .25-.36]) but not in the left-sided colon and rectum (.26 [95% CI, .21-.32] vs .23 [95% CI, .19-.28]). CONCLUSIONS: Updated AFI improves the detection of flat colorectal neoplasms in the right-sided colon compared with WLI. (Clinical trial registration number: UMIN000019355.).
RCT Entities:
BACKGROUND AND AIMS: Colorectal flat (nonpolypoid) lesions can be overlooked during colonoscopy. This study evaluated the efficacy of updated autofluorescence imaging (AFI) for detecting colorectal flat neoplasms. METHODS: This was a prospective, multicenter, randomized controlled trial in 9 Japanese tertiary institutions. Patients undergoing colonoscopy because of positive fecal immunochemical tests, surveillance after polypectomy, or investigation of minor symptoms were enrolled and randomly assigned to either the white-light imaging (WLI) or the AFI group. Primary outcome measurement was number of flat neoplasms per patient. RESULTS: From November 2015 to June 2017, 817 patients were enrolled. After excluding 15 patients, 802 were finally analyzed (404, WLI; 398, AFI). Patients' backgrounds (sex, age, indication of colonoscopy, experience of endoscopists) and quality of colonoscopy (bowel preparation, sedative use, cecal insertion rate, insertion and withdrawal time) were not different between groups. Number of flat neoplasms in each patient was significantly higher in the AFI than in the WLI group (.87 [95% confidence interval [CI], .78-.97] vs .53 [95% CI, .46-.61]), whereas overall and polypoid neoplasm detection was not significantly different between the groups (1.33 [95% CI, 1.22-1.45] vs 1.14 [95% CI, 1.03-1.24], .46 [95% CI, .40-.53] vs .60 [95% CI, .53-.68]). Flat neoplasms were more frequently detected in the right-sided colon with AFI (.61 [95% CI, .54-.70] vs .30 [95% CI, .25-.36]) but not in the left-sided colon and rectum (.26 [95% CI, .21-.32] vs .23 [95% CI, .19-.28]). CONCLUSIONS: Updated AFI improves the detection of flat colorectal neoplasms in the right-sided colon compared with WLI. (Clinical trial registration number: UMIN000019355.).
Authors: Judith A Stibbe; Petra Hoogland; Friso B Achterberg; Derek R Holman; Raoul S Sojwal; Jacobus Burggraaf; Alexander L Vahrmeijer; Wouter B Nagengast; Stephan Rogalla Journal: Mol Imaging Biol Date: 2022-06-28 Impact factor: 3.488
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