FuseTM Colonoscopy Shortens Colonoscopy Surveillance Intervals While Significantly Reducing Adenoma Miss Rates

Abstract

Purpose: To evaluate the impact of the new “full spectrum endoscopy” (FuseTM) colonoscope on colonoscopy surveillance recommendations. Methods: The Fuse colonoscope (EndoChoice, Alpharetta, Georgia, U.S.A.) provides a wider angle of view (330°) than traditional forward viewing (TFV) colonoscopes (170°). In a prospective, multicenter study (3 sites Israel, 1 site the Netherlands, 2 sites U.S.A.), subjects (ages 18-70 years) were randomly assigned to undergo tandem colonoscopy starting with either a TFV colonoscope or the Fuse colonoscope. The same endoscopist performed both examinations. All identified polyps were removed. Patient level data including adenoma quantity, size, morphology, and histologic subtype were recorded and colonoscopy surveillance intervals were recommended per current guidelines (Gastroenterology 2012;143:844-857). We previously reported that Fuse colonoscopy significantly increases the adenoma find rate by 71% (DDW 2013). Results: From Jan 2012 to Mar 2013, 197 subjects enrolled, 12 subjects were excluded due to inability to reach the cecum, poor prep, or protocol violation. In total, 185 subjects (101 female [54.6%]; mean age 55.8 ± 9.7 years) completed back-to-back tandem colonoscopies and included for analysis. Indications for colonoscopy were: CRC screening n=103 (55.7%), polyp surveillance n=36 (19.5%), and diagnostic evaluation n=46 (24.9%). 88 subjects underwent colonoscopy first with a TFV colonoscope; 28 adenomas were detected while Fuse yielded 20 additional adenomas, an adenoma miss rate of 41.7% (20/48) by TFV colonoscopy. 97 subjects underwent Fuse first; 61 adenomas/cancers were detected, while TFV colonoscopy yielded five additional adenomas, an adenoma miss rate of 7.6% (p<0.0001). TFV missed the 20 adenomas in 15 patients. In 40% (6/15) the colonoscopy surveillance interval was shortened from 5-10 yrs to 3 yrs due to finding more adenomas. In 13.3% (2/15), the colonoscopy surveillance interval was shortened from 10 yrs to 5-10 yrs due to finding a single adenoma in patients in whom nothing was found on TFV colonoscopy. Conclusion: Fuse colonoscopy shortened the surveillance colonoscopy interval recommendations in 53.3% of the exams where TFV missed adenomas and in 9.1% (8/88) of the overall exams where TFV was first. TFV did not change any surveillance colonoscopy interval recommendation of exams done with Fuse first. Fuse led to better detection of high risk adenoma patients compared to TFV, and therefore could lead to improved protection against colorectal cancer. Disclosure - Blair Lewis - none Ian Gralnek - Endochoice, consultant Peter Siersema - none Ralph D'Agostino - Endochoice consultant Douglas Rex - none. This research was supported by an industry grant from Endochoice.