Full-spectrum Endoscopy Research Articles

Su1721 Full-Spectrum Endoscopy Improves Adenoma Detection Compared to Conventional Colonoscopy PLUS Right-Colon Examination With Scope Retroflexion: A Randomized, Back-to-Back Study

Su1721 Full-Spectrum Endoscopy Improves Adenoma Detection Compared to Conventional Colonoscopy PLUS Right-Colon Examination With Scope Retroflexion: A Randomized, Back-to-Back Study

“Evaluation of the EndoChoice full spectrum endoscopy (Fuse) platform for upper endoscopy and colonoscopy”

ABSTRACTTraditional forward-viewing (TFV) flexible gastrointestinal endoscopes currently used to perform esophagogastroduodenoscopy (EGD) and colonoscopy have changed relatively little in the past two decades. While considered the standard of care, TFV endoscopes only allow between a 140-170° field of view (FOV). A revolutionary new endoscopic technology, “full spectrum endoscopy (Fuse)”, now allows a panoramic 245o (gastroscope) to 330° (colonoscope) FOV. With this new endoscopic platform, physicians are able to view formerly difficult- or impossible-to-view areas within the gastrointestinal (GI) tract, such as behind the pylorus/within the duodenal bulb or the proximal side of colonic folds/flexures.

Feasibility of full-spectrum endoscopy: Korea’s first full-spectrum endoscopy colonoscopic trial

To evaluate the full-spectrum endoscopy (FUSE) colonoscopy system as the first report on the utility thereof in a Korean population. We explored the efficacy of the FUSE colonoscopy in a retrospective, single-center feasibility study performed between February 1 and July 20, 2015. A total of 262 subjects (age range: 22-80) underwent the FUSE colonoscopy for colorectal cancer screening, polyp surveillance, or diagnostic evaluation. The cecal intubation success rate, the polyp detection rate (PDR), the adenoma detection rate (ADR), and the diverticulum detection rate (DDR), were calculated. Also, the success rates of therapeutic interventions were evaluated with biopsy confirmation. All patients completed the study and the success rates of cecal and terminal ileal intubation were 100% with the FUSE colonoscope; we found 313 polyps in 142 patients and 173 adenomas in 95. The overall PDR, ADR and DDR were 54.2%, 36.3%, and 25.2%, respectively, and were higher in males, and increased with age. The endoscopists and nurses involved considered that the full-spectrum colonoscope improved navigation and orientation within the colon. No colonoscopy was aborted because of colonoscope malfunction. The FUSE colonoscopy yielded a higher PDR, ADR, DDR than did traditional colonoscopy, without therapeutic failure or complications, showing feasible, effective, and safe in this first Korean trial.

Preliminary Experience Using Full-Spectrum Endoscopy for Colorectal Cancer Screening: Matched Case Controlled Study.

Background/Aim. High-quality colonoscopy is needed to reduce the morbidity and mortality of colorectal cancer. Full-spectrum endoscopy (FUSE) has recently shown potential in improving adenoma detection during colonoscopy. This study aimed to evaluate the feasibility and utility of FUSE colonoscopy. Methods. From April 2015 to February 2016, 130 patients underwent FUSE colonoscopy for screening at a tertiary cancer center. Cecal intubation rate (CIR), procedure time, polyp/adenoma detection rate (PDR/ADR), and mean number of adenomas per colonoscopy (APC) were compared in matched-control patients (n = 260) who underwent standard colonoscopy (SC). Accordingly, endoscopists subjectively evaluated the utility of FUSE colonoscopy. Results. The CIR of FUSE colonoscopy was 94.6%. Cecal intubation time (8.8 min versus 5.1 min, P < 0.001) and total procedure time (21.6 min versus 17.3 min, P < 0.001) in the FUSE group were significantly longer than those in the SC group. PDR (68.3 versus 71.2%, P = 0.567), ADR (63.4% versus 58.5%, P = 0.355), and APC (1.4 versus 1.4, P = 0.917) were not significantly different between the two groups. The wide view of FUSE colonoscopy was superior to that of SC based on the questionnaires. Conclusions. FUSE colonoscopy did not demonstrate superiority to SC in a clinical setting.

New Colonoscopy Devices to Improve Colon Neoplasm Detection

Early detection and removal of adenomatous polyps can prevent the development of colorectal cancer. However, it is fairly common-up to 20%-for polyps to be undetected in a colonoscopy due to poor visualization of the proximal aspect of colonic folds and anatomical flexures. To overcome these limitations, many new endoscopes and accessories have been developed. A wide-angle colonoscopy did not improve the detection of adenoma compared with the standard colonoscopy. An extra-wide angle and Retroview colonoscopies showed a significantly lower miss rate of polyps in the colon model. However, clinical trials are mandatory in the future. The recently introduced full spectrum endoscopy system showed a significantly higher adenoma detection rate than the standard forward-viewing colonoscopy. In accessories, The cap-assisted colonoscopy showed only a marginal or no benefit on the detection of polyps and adenomas. In contrast, a colonoscopy with Endocuff, EndoRings, and G-eye have showed significantly lower adenoma miss rates. The Third Eye, which provides additional retrograde viewing, has revealed a significant improvement in the detection of adenoma and polyp. However, the Third Eye Retroscope was limited by its deployment through the working channel of the scope. Recently, the Third Eye Panoramic cap, which was designed to overcome the limitation of the Third Eye Retroscope, was introduced. In the future, this would be needed to evaluate the effectiveness, efficiency and safety for these new colonoscopies and accessories.

Light and sound - emerging imaging techniques for inflammatory bowel disease.

Patients with inflammatory bowel disease are known to have a high demand of recurrent evaluation for therapy and disease activity. Further, the risk of developing cancer during the disease progression is increasing from year to year. New, mostly non-radiant, quick to perform and quantitative methods are challenging, conventional endoscopy with biopsy as gold standard. Especially, new physical imaging approaches utilizing light and sound waves have facilitated the development of advanced functional and molecular modalities. Besides these advantages they hold the promise to predict personalized therapeutic responses and to spare frequent invasive procedures. Within this article we highlight their potential for initial diagnosis, assessment of disease activity and surveillance of cancer development in established techniques and recent advances such as wide-view full-spectrum endoscopy, chromoendoscopy, autofluorescence endoscopy, endocytoscopy, confocal laser endoscopy, multiphoton endoscopy, molecular imaging endoscopy, B-mode and Doppler ultrasound, contrast-enhanced ultrasound, ultrasound molecular imaging, and elastography.

Advanced technology for the improvement of adenoma and polyp detection during colonoscopy.

Early detection and removal of adenomatous polyps reduces colorectal cancer death. However, many studies have reported that up to 20% of adenomas can be missed during colonoscopy. To improve visualization and reduce the blind spot of the colonic mucosa for an increase in the adenoma detection rate, many endoscopic techniques and technologies have been developed. The benefit of the high-definition endoscope for improving adenoma and polyp detection is marginal. Wide-angle colonoscope has failed to improve adenoma detection compared to standard colonoscopy. Although the cap-assisted colonoscope can reduce cecal intubation times, it does not seem to improve adenoma and polyp detection. The diagnostic accuracy of the colon capsule endoscope is low compared to the conventional colonoscope. Third Eye(®) retroscope(®) , which provides additional retrograde viewing, has revealed significant improvement in adenoma and polyp detection compared to standard colonoscopy. However, this device increases procedural times. Recently developed full-spectrum endoscopy colonoscope and extra-wide-angle-view colonoscope have demonstrated a significantly lower miss rate of polyps. However, clinical trials are mandatory to determine the efficacy of these novel technologies for cancer screening. In addition, education and training for these novel techniques and technologies should seriously be considered to improve adenoma and polyp detection.

Cost-effectiveness of “full spectrum endoscopy” colonoscopy for colorectal cancer screening

BackgroundCompared to standard forward viewing colonoscopy, we aimed to assess the cost-effectiveness of full spectrum endoscopy colonoscopy in a population-based colorectal cancer screening and surveillance program. MethodsA Markov model was constructed to simulate the occurrence of colorectal neoplasia in a cohort of 100,000 subjects aged 50–100 years. The cost-effectiveness of full spectrum endoscopy was compared with that of standard forwarding viewing colonoscopy. Sensitivity for adenomatous and hyperplastic polyps <5mm, 6–9mm, and high-risk polyps were derived from the recent randomized tandem Fuse colonoscopy study. ResultsThe significantly higher sensitivity of full spectrum endoscopy in detecting additional adenomas resulted in an increase in cancer prevention from 58% to 74%, corresponding to a gain of 9 days per person. This 14% increase led to an absolute reduction in the cost of cancer care from $90 million to $57 million. This cost savings was only minimally impacted by the higher cost of more frequent post-polypectomy colonoscopy surveillance rates, leading to full spectrum endoscopy being associated with a savings of $145 per person. Thus, standard colonoscopy appeared to be “dominated” by the full spectrum endoscopy. ConclusionsCompared to standard colonoscopy, full spectrum endoscopy appears to be more cost-effective for colon cancer screening and surveillance.

Emerging technological advancements in colonoscopy: Third Eye® Retroscope® and Third Eye® Panoramic(TM) , Fuse® Full Spectrum Endoscopy® colonoscopy platform, Extra-Wide-Angle-View colonoscope, and NaviAid(TM) G-EYE(TM) balloon colonoscope.

Colonoscopy is the criterion standard for detecting colorectal adenomas and cancers. However, multiple studies have reported a significant percentage of adenomas are missed during standard, forward-viewing colonoscopy. Missed adenomas can lead to interval colorectal cancers. Aside from inadequate colon preparation, incomplete examinations (e.g. failure to intubate the cecum), short withdrawal times, and patient-related factors, the primary reason for missing colorectal adenomas and early cancers is poor visualization of the proximal aspect of colonic folds, at anatomical flexures, and in the ileocecal valve area. These anatomical sites tend to be hidden from the standard forward-viewing colonoscope (170-degree angle of view) and can often only be seen through manipulation of the colonoscope by the endoscopist. Thus, there is mounting evidence supporting the need to reduce the adenoma 'miss rate' of standard forward-viewing colonoscopy by improving upon current colonoscope technology and its current visualization/optics limitations. Recently, there are a number of emerging technologies that may help revolutionize how colonoscopy is carried out and that will significantly reduce adenoma miss rates. These include the Third Eye® Retroscope® and Third Eye® Panoramic(TM) (Avantis Medical Systems, Sunnyvale, CA, USA); Fuse® Full Spectrum Endoscopy® colonoscopy platform (EndoChoice Inc., Alpharetta, GA, USA); Extra-Wide-Angle-View colonoscope (Olympus, Tokyo, Japan), and the NaviAid(TM) G-EYE(TM) balloon colonoscope (SMART Medical Systems Ltd, Ra'anana, Israel).

Tu1553 Performance Characteristics of Colorectal Full Spectrum Endoscopy (Fuse) - Prospective, Parallel, Randomized Study From Europe

Full Spectrum Endoscopy (FUSE) has recently been introduced. FUSE provides a 330° field of view, thereby potentially allowing the endoscopists to see more anatomy in comparison to standard forward viewing endoscopes (FVE). Recent data has already shown that FUSE is feasible to significantly reduce adenoma miss rates.

Tu1468 "Full Spectrum Endoscopy (Fuse)" Colonoscopy Is Cost Effective for Colorectal Cancer Screening and Surveillance

As compared with Standard Forward Viewing (SFV) colonoscopy, Full Spectrum Endoscopy (Fuse) colonoscopy significantly increases the adenoma detection rate and thereby impacts the recommended post-polypectomy surveillance intervals per current US guidelines. As compared to SFV colonoscopy, we aimed to assess the cost effectiveness of Fuse colonoscopy in a CRC screening and surveillance program.

Standard forward-viewing colonoscopy versus full-spectrum endoscopy: an international, multicentre, randomised, tandem colonoscopy trial

Although colonoscopy is the accepted standard for detection of colorectal adenomas and cancers, many adenomas and some cancers are missed. To avoid interval colorectal cancer, the adenoma miss rate of colonoscopy needs to be reduced by improvement of colonoscopy technique and imaging capability. We aimed to compare the adenoma miss rates of full-spectrum endoscopy colonoscopy with those of standard forward-viewing colonoscopy. We did an international, multicentre, randomised trial at three sites in Israel, one site in the Netherlands, and two sites in the USA between Feb 1, 2012, and March 31, 2013. Patients aged 18-70 years referred for colorectal cancer screening, polyp surveillance, or diagnostic assessment underwent same-day, back-to-back tandem colonoscopy with standard forward-viewing colonoscope and the full-spectrum endoscopy colonoscope. The patients were randomly assigned (1:1), via computer-generated randomisation with block size of 20, to which procedure was done first. The endoscopist was masked to group allocation until immediately before the start of colonoscopy examinations; patients were not masked. The primary endpoint was adenoma miss rates. We did per-protocol analyses. This trial is registered with ClinicalTrials.gov, number NCT01549535. 197 participants were enrolled. 185 participants were included in the per-protocol analyses: 88 (48%) were randomly assigned to receive standard forward-viewing colonoscopy first, and 97 (52%) to receive full-spectrum endoscopy colonoscopy first. By per-lesion analysis, the adenoma miss rate was significantly lower in patients in the full-spectrum endoscopy group than in those in the standard forward-viewing procedure group: five (7%) of 67 vs 20 (41%) of 49 adenomas were missed (p<0·0001). Standard forward-viewing colonoscopy missed 20 adenomas in 15 patients; of those, three (15%) were advanced adenomas. Full-spectrum endoscopy missed five adenomas in five patients in whom an adenoma had already been detected with first-pass standard forward-viewing colonoscopy; none of these missed adenomas were advanced. One patient was admitted to hospital for colitis detected at colonoscopy, whereas five minor adverse events were reported including vomiting, diarrhoea, cystitis, gastroenteritis, and bleeding. Full-spectrum endoscopy represents a technology advancement for colonoscopy and could improve the efficacy of colorectal cancer screening and surveillance. EndoChoice.

What is the effect of more sensitive diagnostic technology?

What is the probable effect of more sensitive diagnostic technology? Is an improved ability to visualise lesions at colonoscopy always better? Or are there downsides to consider? In The Lancet Oncology, Ian Gralnek and colleagues1 report findings from their randomised tandem comparison trial of standard forward-viewing colonoscopy versus full-spectrum endoscopy with a 330° field of view. In the 185 study participants, the proportion of adenomas missed was lower in patients in the full-spectrum endoscopy group than in those in the standard forward-viewing procedure group: five (7%) of 67 versus 20 (41%) of 49 adenomas missed (p<0·0001).

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

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.

Full-spectrum endoscopy—three lenses are better than one

Full-spectrum endoscopy—three lenses are better than one

A prospective cohort study evaluating a novel colonoscopy platform featuring full-spectrum endoscopy

Although colonoscopy is the criterion standard for detecting colorectal adenomas and cancers, a significant percentage of adenomas are missed with this technique. We aimed to establish the feasibility, usability, and safety of a novel colonoscopy platform featuring full-spectrum endoscopy (FUSE). This was a prospective, single-center pilot and feasibility study. In total, 50 individuals, ages 18 - 70 years, underwent colonoscopy featuring FUSE (up to 330° field of view) for colorectal cancer screening, polyp surveillance, or diagnostic evaluation. Study end points included success of cecal intubation, time to cecal intubation, withdrawal time, total procedure time, success of therapeutic interventions, adverse events, and endoscopists' subjective evaluation of FUSE. Cecal intubation was achieved in 50/50 individuals (100 %). Time to cecum (minutes, mean ± SD) was 3.1 ± 1.5 minutes, withdrawal time 12.7 ± 4.4 minutes, and total procedure time 15.3 ± 4.6 minutes. In 22/50 cases (44 %), 26 therapeutic interventions were performed: 19 (73.1 %) biopsies and 7 (26.9 %) polypectomies. No acute or delayed adverse events were observed. Patient satisfaction and endoscopist subjective evaluation were high. A colonoscopy platform featuring full-spectrum endoscopy appears feasible, usable, and safe. These results represent an important advance in colonoscopy imaging technology and should be further pursued in comparative human studies.