Difference In Polyp Detection Rate Research Articles

Long-term impact of artificial intelligence on colorectal adenoma detection in high-risk colonoscopy.

Improved adenoma detection rate (ADR) has been demonstrated with artificial intelligence (AI)-assisted colonoscopy. However, data on the real-world application of AI and its effect on colorectal cancer (CRC) screening outcomes is limited. To analyze the long-term impact of AI on a diverse at-risk patient population undergoing diagnostic colonoscopy for positive CRC screening tests or symptoms. AI software (GI Genius, Medtronic) was implemented into the standard procedure protocol in November 2022. Data was collected on patient demographics, procedure indication, polyp size, location, and pathology. CRC screening outcomes were evaluated before and at different intervals after AI introduction with one year of follow-up. We evaluated 1008 colonoscopies (278 pre-AI, 255 early post-AI, 285 established post-AI, and 190 late post-AI). The ADR was 38.1% pre-AI, 42.0% early post-AI (P = 0.77), 40.0% established post-AI (P = 0.44), and 39.5% late post-AI (P = 0.77). There were no significant differences in polyp detection rate (PDR, baseline 59.7%), advanced ADR (baseline 16.2%), and non-neoplastic PDR (baseline 30.0%) before and after AI introduction. In patients with an increased pre-test probability of having an abnormal colonoscopy, the current generation of AI did not yield enhanced CRC screening metrics over high-quality colonoscopy. Although the potential of AI in colonoscopy is undisputed, current AI technology may not universally elevate screening metrics across all situations and patient populations. Future studies that analyze different AI systems across various patient populations are needed to determine the most effective role of AI in optimizing CRC screening in clinical practice.

Colorectal adenoma detection rate using texture and color enhancement imaging versus white light imaging with chromoendoscopy: a propensity score matching study.

Few studies have evaluated the adenoma detection rate (ADR) of colonoscopy with texture and color enhancement imaging (TXI), a novel image-enhancing technology. This study compares the detection of colorectal polyps using TXI to that using white light imaging (WLI). This single-center retrospective study used propensity-matched scoring based on the patients' baseline characteristics (age, sex, indication, bowel preparation, endoscopist, colonoscope type, and withdrawal time) to compare the results of patients who underwent chromoendoscopy using WLI or TXI at the Toyoshima Endoscopy Clinic. The differences in polyp detection rates and the mean number of detected polyps per colonoscopy were determined between the TXI and WLI groups. After propensity score matching, 1970 patients were enrolled into each imaging modality group. The mean patient age was 57.2±12.5years, and 44.5% of the cohort were men. The ADR was higher in the TXI group than in the WLI group (55.0% vs 49.4%, odds ratio: 1.25). High-risk ADR were more common in the TXI group than in the WLI group (17.6% vs 12.8%; OR: 1.45). The mean number of adenomas per colonoscopy (APC) was higher in the TXI group than in the WLI group (1.187 vs 0.943, OR: 1.12). APC with a flat morphology (1.093 vs 0.848, OR: 1.14) and APC of <6mm (0.992 vs 0.757, OR: 1.16) were higher in the TXI group than in the WLI group. Compared to WLI, TXI improved the ADR in patients who underwent chromoendoscopy based on actual clinical data.

The impact of EndoCuff-assisted colonoscopy on the polyp detection rate: A cross-over randomized back-to-back study

Background and study aimsColorectal cancer (CRC) is one of the most common cancers worldwide, and most CRCs develop from polyps with malignant potential. We aimed to study the difference in polyp detection rate between EndoCuff-assisted colonoscopies (EAC) and standard colonoscopy (SC). Patients and methodsThis study was conducted at Cairo University Hospitals on patients referred for screening or diagnostic colonoscopy from July 2018 to August 2020. All included patients underwent back-to-back standard colonoscopy (SC) and ENDOCUFF VISION-assisted colonoscopies (EAC). Results214 patients were included in this study. In comparison between EAC and SC, EAC increased the polyp detection rate (69 (32.24 %) vs. 57(26.64 %) (p < 0.05), EAC increased the detection of diminutive polyps ≤ 5 mm (104 vs. 81) (p < 0.05), and small polyps 6–9 mm (12 vs. 10) while there was no difference in large polyps ≥ 10 mm. EAC increased the adenoma detection rate (ADR) (37 (17.2 %) vs. 32(14.9 %) (p < 0.05). The findings detected by EAC shortened the interval of surveillance determined by SC findings. EndoCuff caused six mucosal erosions (2.8 %) in patients. ConclusionEAC increases the number of detected colonic polyps, primarily small polyps on the left and right sides of the colon.

Influencing factors of different bowel preparation regimens on the quality of colonoscopy

Objective To explore the influencing factors of different bowel preparation before colonoscopy on the intestinal cleanliness and polyp detection rate. Methods From March to August in 2018, at the Center of Endoscopy of Huashan Hospital Affiliated to Fudan University, the patients who underwent colonoscopy were selected and their general data of bowel preparation regimens were collected. Self-factors of the patients, different bowel preparation regimens, bowel preparation quality and polyp detection rate were observed. The quality of bowel preparation was evaluated by Boston bowel preparation scale (BBPS). T test, and analysis of variance and chi-square test were used for statistical analysis. Results Among 1 008 patients who underwent colonoscopy, there were 506 males and 502 females, and average age was (57.3±13.7) years. There were statistically significant differences in BBPS score of patients with different body mass index (BMI), Parkinson disease and history of abdominal surgery (F=3.319, t=-2.060 and -2.544; all P<0.05). The BBPS score of patients with three-day low residue diet before examination was higher than that of those without preparation before examination (6.04±2.50 vs. 5.54±2.73), and the difference was statistically significant (t=2.514, P=0.010). The BBPS scores of 2 000 mL polyethylene glycol electrolyte lavage solution (PEG) taken once, 2 000 mL PEG taken separately, 3 000 mL PEG taken once and 3 000 mL PEG taken separately were 5.06±2.88, 6.11±2.44, 5.94±2.32 and 6.10±2.47, respectively, and the difference was statistically significant (F=7.242, P<0.01). There were significant differences in polyp detection rates among the patients with different age, gender, BMI, and with history of constipation, hypertension and diabetes mellitus (χ2=33.170, 8.489, 12.024, 4.034, 26.790, 10.381; all P<0.05). The polyp detection rate of patients with oral methyl silicone oil was higher than that of patients without oral methyl silicone oil (52.6%, 30/57 vs. 29.7%, 221/744), and the difference was statistically significant (χ2=12.934, P<0.01). Age (odds ratio (OR)=1.328, 95% confidence interval (CI) 1.162 to 1.517) and BMI (OR=1.412, 95%CI1.115 to 1.787) were independent risk factors for polyp detection rate. Conclusions Parkinson disease, history of abdominal surgery and BMI are the related factors affecting the quality of bowel preparation before colonoscopy. Age and BMI are independent risk factors for polyp detection rate. Key words: Colonoscopes; Polyethylene glycols; Bowel preparation; Simethicone

Polyp detection rate: does length matter?

IntroductionPolyp detection rate is a surrogate marker for adenoma detection rate and therefore a surrogate marker of quality colonoscopy. To our knowledge, this is the first study that compares distance...

Cirrhotic Patients Have Worse Bowel Preparation at Screening Colonoscopy than Chronic Liver Disease Patients without Cirrhosis

Cirrhosis has been shown in small studies to be a predictor of suboptimal bowel preparation at screening colonoscopy. It has yet to be established whether patients with chronic liver disease in the absence of cirrhosis experience equally poor colon cleansing. Intestinal dysmotility related to cirrhosis might impair bowel preparation in this population more than those with chronic liver disease without cirrhosis. This study compared the quality of bowel preparation in cirrhotic and non-cirrhotic patients with chronic liver disease and determined whether this influenced polyp detection rate. A retrospective study of patients with chronic liver disease, both cirrhotic and non-cirrhotic, who underwent screening colonoscopy was performed. Patient characteristics, concomitant medication use, adequacy of bowel preparation, and the total number and types of polyps found were compared between cirrhotic and non-cirrhotic groups. 330 patients fulfilled inclusion criteria; 36% (n=120) were cirrhotic. Cirrhotic patients had significantly worse bowel preparation scores compared with non-cirrhotics (mean 3.4±1.1 vs. 3.7±0.9, P=0.003). Worse bowel preparation scores in cirrhotics vs. non-cirrhotics persisted despite controlling for age, sex, and concomitant diabetes mellitus (DM) (P=0.0027). Among the cirrhotics, 48% had the lowest preparation scores compared with 30% of non-cirrhotics. No difference in polyp detection rate was found between cirrhotics and non-cirrhotics. Severity of cirrhosis as assessed by the MELD score did not predict worse bowel preparation. Cirrhotics have significantly worse bowel preparation scores compared to non-cirrhotics with chronic liver disease. No correlation between MELD score and bowel preparation score was observed in the cirrhotic cohort.

The efficacy of a short transparent hood attached to the tip of the colonoscope: a single-center, randomized, controlled study

Objective This prospective randomized controlled trial was to assess efficacy of the cap-fitted colonoscopy (CFC). Methods A total of 160 patients who underwent colonoscopic examinations at Digestive Endoscopy Center of Drum Tower Hospital met the criteria and were randomized to CFC group (n=80) and regular control group (n=80). All colonoscopies were performed by two middle-level endoscopists without anesthesia. BMI, surgery history, starting time, time to access the cecum, ending time, bowel preparation, conclusions, attempts to pass the ileocecal valves, and patient discomfort were recorded after the examinations. Results Among 80 patients in the CFC group, the cecum was not intubated in 7 patients due to narrow bowel with the mean cecal intubation time being 7.5±4.0 minutes. Cecum intubation was not achieved in 4 of the 80 patients in the control group with the mean cecal intubation time being 9.8±4.5 minutes. There was significant difference in the mean cecal intubation time (P=0.011). The terminal ileum was not accessed in 3 patients in the CFC group. The average attempts for passing the ileocecal valves were 1.32 for the rest of 70 patients. The terminal ileum was not accessed in 8 patients in the control group. The average attempts for passing the ileocecal valves were 1.96 for the rest of 68 patients (P=0.001 compared with CFC group). There was no significant difference in polyp detection rate between the CFC group (32.88%, 24/73) and the control group (28.95%, 27/76, P>0.05). Conclusion For middle-level colonoscopists, CFC shortens cecal intubation time, facilitates passing the ileocecal valves, and improves polyp detection rate. This technique is promising for wider use in clinic. Key words: Endoscopy; Colonoscopes; Polyp detection rate; Cecal intubation time; Cap-fitted colonoscopy

PTH-013 Is polyp detection rate altered by the number of procedures performed during a bowel scope screening list?: Abstract PTH-013 Table 1

<h3>Introduction</h3> A one-off screening flexible sigmoidoscopy at the age of 55 has been shown to significantly decrease incidence and mortality from bowel cancer.¹As a result “bowel scope” screening was offered in 6 pilot centres from March 2013 and is now beginning to be rolled out nationwide. The delivery of this service varies between sites with no consensus on the optimum number of procedures per lists. At the Norfolk and Norwich University Hospital 2 rooms run simultaneously with initially 12 patients per endoscopist scheduled based on a turn around time of 20 mins. Due to a higher than expected polypectomy rates this was reduced to 10 in order to complete sessions in time. 23 patients are currently invited to a 2 room session in order to achieve an attendance of 10 patients per room. This has resulted in a wide variation in the number of people attending a bowel scope list. If more patients attend then there is the possibility that polyp detection rates may fall due to added pressure to complete the endoscopy in a set time, endoscopist fatigue and distance of bowel examined. The aim of this study is to detect any differences in polyp detection rates if 10 or more endoscopies are performed in an evening session. <h3>Method</h3> Bowel Scope screening lists performed between 1st January 2015 and the 14th February 2015 at the Norfolk and Norwich University Hospital were retrospectively analysed. The number of procedures per list and polyp detection rates were recorded. Endoscopies were performed by 8 accredited bowel scope endoscopists under gold standard conditions. A student’s T-test was used to test for difference in polyp detection rates between lists with 10 or more endoscopies and those with less than 10. <h3>Results</h3> A total of 87 endoscopy lists were performed. 40 of these had 10 or morw procedures per list, 47 had 9 or less. The average number of procedures per list in each group was 10.5 and 8.2 respectively. The polyp detection rate in the 10 or more group was 17.8% whilst in the 9 or fewer groups is was 23.3% (<i>p </i>value 0.035). <h3>Conclusion</h3> There is a significant fall in the polyp detection rate if more than 10 endoscopies are performed in a single session, meaning some lesions are being missed. This finding could be important for new centres planning bowel scope screening especially as trusts are considering up to 12 procedures per list or all day bowel scope sessions. <h3>Disclosure of interest</h3> None Declared. <h3>Reference</h3> Atkin WS <i>et al</i>. Once-only flexible sigmoidoscopy in prevention of colorectal cancer: a multi-centre randomised controlled trial. <i>Lancet</i>. 2010 May 8;375(9726):1624–33

If You Have a Low Adenoma Detection Rate, Don’t Blame Your Fellows

Quality measures in colonoscopy are at the forefront in the field of gastroenterology, particularly in light of the current emphasis on ‘‘accountable’’ care. Colonoscopy quality measures include cecal intubation rate, complication rate, adenoma detection rate (ADR), and appropriate screening and surveillance intervals. For screening and surveillance colonoscopy, ADR is emerging as perhaps the most important quality indicator, since identification and removal of adenomas is the primary goal. Factors that improve ADR include adequacy of bowel preparation, cecal withdrawal time, time of day that colonoscopy is performed, type of sedation regimen used, and use of techniques such as cap-assisted colonoscopy and retroflexion in the right colon [1, 2]. Whether fellow involvement in colonoscopy affects ADR, the subject of the paper by Oh et al. [3] in this issue of Digestive Diseases and Sciences, has been less well studied. Most endoscopists who train fellows to perform colonoscopy probably have an opinion, based on personal experience, about whether fellow involvement increases or decreases ADR. Oh et al. looked at the issue more objectively by performing a meta-analysis of relevant studies to determine if a difference in polyp detection rate (PDR) or ADR occurs when a fellow is involved in colonoscopy. On the one hand, it might seem intuitive that PDRs and ADRs would be higher with a fellow and attending both observing the same procedure, as dual observers increase ADR [4]. Additionally, since fellows tend to take longer to complete a colonoscopy, one might infer that increased cecal withdrawal time by a fellow is associated with an increased ADR, similar to the data showing increased ADR with increased cecal withdrawal time amongst attending endoscopists. On the other hand, one might predict a lower ADR with fellows due to other factors, such as rapid withdrawal through colon segments when the fellow is having difficulty managing the colonoscope, a less thorough examination of the back surfaces of colonic folds, and inability to retroflex the colonoscope in the right colon. The impact, if any, of fellow participation on the PDR and ADR is important information for clinicians who regularly train fellows, particularly if ADR is recorded and/ or reported as a quality indicator. Although PDR is not relevant for determining screening and surveillance intervals, calculating PDR is much simpler since polyp histology is not required. If PDR correlates with ADR, some programs may choose to monitor PDR as a useful metric as fellows progress through training, allowing an objective assessment of fellow proficiency. Additionally, there may be patients who receive care at training institutions who want to know whether having a trainee involved affects the quality of their medical care. To determine if fellow involvement in colonoscopy affects ADR, Oh et al. [3] performed a comprehensive literature search, identifying articles in which the ADR, as well as the percent of colonoscopies, involving fellows was reported. From this information, they applied a modified Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool to the data to determine the impact of fellow participation in colonoscopy on ADR. A total of 14 studies met inclusion criteria, accounting for 21,504 colonoscopies. Based on the combined data, the RR (95 % CI) for detecting polyps when a fellow was present was 1.04 (0.94, 1.15), and for detecting adenomas was 1.03 (0.93, 1.14) suggesting that fellow involvement has no impact on D. S. Early (&) Department of Medicine, Washington University in St. Louis, 660 South Euclid Avenue, Campus Box 8124, St. Louis, MO 63110, USA e-mail: dearly@dom.wustl.edu

PWE-102 Is there a difference in polyp detection rates by time of day?

IntroductionThe endoscopy literature1 2 has raised concerns regarding variations in polyp detection rates during the day. One mechanism for this is thought to be operator fatigue which increases as the...

Meta-analysis of narrow-band imaging versus conventional colonoscopy for adenoma detection

At colonoscopy, missed adenomas have been well documented at approximately 22%. The challenge is in reducing this miss rate. Narrow-band imaging (NBI) has been extensively evaluated in prospective, randomized, controlled studies for polyp detection. Sample-size calculations show us that these studies may be underpowered, and hence a meta-analysis is required. Our aim was to determine whether use of NBI enhances the detection of adenomas. Meta-analyses were conducted of 7 studies using NBI for adenoma detection rate. MEDLINE, Embase, PubMed, and Cochrane databases were searched by using a combination of the following terms: "colonoscopy," "NBI," and "electronic chromoendoscopy." There was a total of 2936 patients in the NBI studies. Prospective, randomized trials of NBI versus standard white-light colonoscopy (WLC) were conducted. We excluded spray chromoendoscopy studies and studies of inflammatory bowel disease and polyposis syndromes. Adenoma and polyp detection rates and the number of polyps and adenomas detected per person. There was no statistically significant difference in the overall adenoma detection rate with the use of NBI or WLC (36% vs 34%; P = .413 [relative risk 1.06; 95% CI, 0.97-1.16]), and there was no statistically significant difference in polyp detection rate by using NBI or WLC (37% vs 35%; P = .289 [relative risk 1.22; 95% CI, 0.85-1.76]). When the number of adenomas and polyps per patient was analyzed, no significant difference was found between NBI and WLC (0.645 vs 0.59; P = .105 and 0.373 vs 0.348; P = .139 [weighted mean difference 0.19; 95% CI, ∞0.06 to 0.44], respectively). Variability in NBI studies can reduce the accuracy of this analysis. NBI did not increase adenoma or polyp detection rates.

Does Polyp Detection Rate During Screening Colonoscopy Drop as the Day Progresses? An Urban Community Hospital Experience

Purpose: Reduction in polyp detection rate (PDR) as the day progresses has been demonstrated in some recent studies. Endoscopist fatigue and duration of colonoscopy have been attributed to the decline in PDR. This study analyzed data at our urban community based teaching hospital. Colonoscopies were performed from 8AM to 5PM at a standard endoscopist to patient ratio. This study looked at outcome analysis regarding PDR in the 8AM to 12N block (AM Block) and 12N to 5PM block (PM Block). Methods: In this retrospective study, 1000 outpatient colonoscopies over 6 months were reviewed. Colonoscopies with indications other than screening and with incomplete data were excluded. PDR (colonoscopies with 1 or more polyps divided by total number of colonoscopies) was used as the primary outcome measure. Results: 1000 colonoscopies were reviewed. 563 were performed for screening and met inclusion criteria. 438 [77.7%] had good bowel preparation (GPG) and 125 (22.2%) had fair to poor preparation (PPG). In the GPG, 271 [61%] were performed during the AM Block and 167 (39%) were performed during the PM Block. 40% of subjects were male in AM Block and 38% male in the PM Block. Ethnicity was equally distributed in both blocks — 66% African Americans, 25% Hispanics and 10% Other (Caucasian and Asian). PDR in AM Block was 47.6% and 39.5% in PM Block. The difference was not statistically significant. Additionally, PDR in the poor prep group was 32.4% in AM Block and 24% in PM Block. This result was also not statistically significant. PDR in GPG was 44% and PDR in PPG was 28% and was statistically significant (P Value 0.001). PDR in GPG was 47% versus 32% in PPG in the AM Block (P Value 0.01). PDR in GPG was 39.5% versus 24% in PPG in the PM Block (P Value 0.06). Conclusion: This study did not show statistically significant differences in polyp detection rates (PDR) for screening colonoscopy performed during AM Block (8AM-12N) versus PM Block (12N to 5PM). As expected, there was a statistically significant reduction in PDR if the prep was suboptimal.

A Comparison of High-Definition Versus Conventional Colonoscopes for Polyp Detection

High-resolution, high-definition colonoscopes (HD) with 170 degrees angle of view providing brighter images, sharper resolution, and a 30 degrees wider field of view than conventional colonoscopes (CC) are available. The impact of these innovations on enhancing the detection of clinically important colonic lesions or over detection of clinically insignificant colonic lesions is not well established. To compare the difference in the detection of individuals with polyps, adenomas, or high-risk adenoma features between HD and CC. We also compared the difference in detection of individuals with clinically insignificant colonic lesions, >or=2, <6-mm hyperplastic polyps between HD and CC. Endoscopic findings from 426 individuals who underwent HD were compared to a cohort of 426 individuals who underwent CC after matching by gender, age (+/-5 years), and indication for colonoscopy based on propensity score. Conditional logistic regression was used to assess for differences in polyp detection rates and risk classification between the two groups. HD affords no increase over CC in the detection of individuals with polyps, 39.9 vs. 36.9% (P = 0.34) or adenomas, 24.7 vs. 21.9% (P = 0.36). The proportion of subjects classified as high risk did not differ between the groups, 5.7% in the HD group and 4.5% in the CC group (P = 0.43) and 5.6% of each cohort was found to have >or=2, <6-mm hyperplastic polyps (P = 0.99). HD colonoscopy does not increase the detection of individuals with polyps, adenomas, or high-risk adenoma features. HD does not increase the detection of individuals with clinically insignificant colonic lesions.