Full Spectrum Endoscopy versus Forward Viewing Colonoscopy for Adenoma/dysplasia Detection: A Meta-Analysis of Randomized Trials

Abstract

Introduction: Colonoscopy is still considered the best tool for colon cancer screening; however, 25% of adenomas and polyps are still missed during conventional colonoscopy. Full spectrum endoscopy (FUSE) has one central camera and two lateral cameras that provide 330 degree view, which eliminate the blind spots and allow visualization behind folds. We performed this meta-analysis to compare FUSE with forward viewing colonoscopy (FVC) for adenoma and or dysplasia detection and missing rate. Methods: Two independent reviewers conducted a comprehensive search of PubMed, Cochrane library and Embase databases for randomized crossover tandem studies using special search criteria. Odd ratio (OR) and 95% confidence intervals (Cl) computed using the Mantel Haenszel random effect model. Sensitivity and cumulative analysis was performed for each outcome. Results: We identified a total of 3 randomized crossover tandem studies with 452 patients which were included in the analysis. The adenoma/dysplasia detection rate of FUSE and FVC were 89.5% (136/152) and 60.1% (86/143) respectively. The adenoma/dysplasia miss rate of FUSE and FVC were 10.5% (16/152) and 39.9% (57/143) respectively. Compared to FVC, FUSE has greater adenoma/dysplasia detection rate (OR 5.74; 95% Cl 3.06-10.77, P = 0.0000, I2 = 0%) and lower adenoma/dysplasia miss rate (OR 0.17; 95% Cl 0.09-0.33, P = 0.0000, I2 = 0%). Conclusion: Adenoma/dysplasia detection rate is higher with FUSE compared to FVC. However, the size of the polyps/ adenoma missed on FVC was not reported. Future studies should examine this observation and whether this translates to better cancer detection rate.