Full Spectrum (FUSE®) Colonoscopy Is Associated With Longer Cecal Insertion Time and Higher Sedative Requirement

Abstract

Introduction: Wide-angle endoscopy is an emerging technique that aims to improve lesion detection through better visualization with a trend toward improved adenoma detection rate (ADR). We sought to evaluate the procedural characteristics of the Full-Spectrum Endoscopy (Fuse®) system. Methods: This single-center retrospective cohort study reviews 974 colonoscopies performed since January 2015. The type of colonoscope used was randomly determined for a given endoscopy block on the day of the procedure by the nursing staff. Data were collected on age, gender, indication for colonoscopy, and bowel preparation quality. Insertion and withdrawal time (WT), as well as sedative doses (midazolam, fentanyl, diphenhydramine), and reversal agent use (naloxone, flumazenil) were recorded. The primary outcomes of insertion time and sedative requirements were compared between the Fuse® and conventional (Olympus 190) colonoscope exams.Table: Table. Colonoscopy Descriptive AnalysisTable: Table. Standard Colonoscopy vs Fuse Colonoscopy Baseline Data Comparison:Results: Of the total 974 patients, 770 underwent standard colonoscopy while 204 underwent Fuse® colonoscopy. Mean age was 59.4 years and majority were female (56.9%). Colorectal cancer screening or surveillance was the most common indication (50.9%), followed by gastrointestinal bleeding (19.4%). Cecal intubation rate was 98.4% while mean WT was 13.5 minutes. There were no significant differences in demographics, preparation quality, or cecal intubation rate between both groups. Adenoma Detection Rate (ADR), calculated on a subset of patients who underwent screening colonoscopy with two endoscopists, was higher with Fuse® colonoscopy compared to standard colonoscopy however this did not meet statistical significance (32.5% vs 25.1%, p=0.146). There was no difference in mean WT (Fuse® 13.9 min vs standard 13.4 min, P=0.36) however mean insertion time was longer for Fuse® colonoscopies (12.3 mins vs 9.2 mins, P= < 0.01). Adjunctive sedative use (diphenhydramine) was more often required with Fuse® (33.5%) than standard colonoscopy (27.3%, p = 0.008). The mean fentanyl dose administered was higher in the Fuse® group (111.7 mcg vs 101.4 mcg, P= < 0.01). No difference existed between midazolam dose or the use of reversal agents. Conclusion: Insertion time was significantly longer for Fuse® cases, with higher sedative requirements. It is unclear if the increased insertion time was related to patient's discomfort and increased sedative requirements. Further prospective studies are needed to evaluate the technical performance of the Fuse® colonoscope.