Improvement In Adenoma Detection Rate Research Articles

Long-Term Follow-Up of Colonoscopy Quality Monitoring.

High-quality colonoscopy is paramount for colorectal cancer prevention. Since 2009, endoscopists at our institution have received quarterly report cards summarizing individual colonoscopy quality indicators. We have previously shown that implementing this intervention was associated with short-term improvement in adenoma detection rate (ADR). However, the long-term effect of continued monitoring on colonoscopy quality is unclear. We conducted a retrospective study of prospectively administered quarterly colonoscopy quality report cards at the Roudebush Veteran's Affairs Medical Center between April 1, 2012, and August 31, 2019. The anonymized reports included individual endoscopists' ADRs, cecal intubation rates, and withdrawal times. Analyses were performed to determine slopes over time for each quality metric by physician and assess for differences based on whether ADRs were calculated quarterly or yearly. Data from the report cards of 17 endoscopists who had performed 24,361 colonoscopies were included. The mean quarterly ADR (±SD) was 51.7% (±11.7%) and mean yearly ADR was 47.2% (±13.8%). There was a small increase in overall ADR based on quarterly and yearly measurements (slope + 0.6%, P = 0.02; and slope +2.7%, P < 0.001, respectively), but no significant change in individual ADRs, cecal intubation rates, or withdrawal times. Analysis of SD of ADRs showed no significant difference between yearly and quarterly measurements ( P = 0.064). Individual endoscopists' ADR SD differences between yearly and quarterly measurements ranged from -4.7% to +6.8%. Long-term colonoscopy quality monitoring paralleled stable improvements in overall ADR. For endoscopists with baseline high ADR, frequent monitoring and reporting of colonoscopy quality metrics may not be necessary.

Evaluation of the Effectiveness of Patient’s Position Change during the Withdrawal Phase of Colonoscopy from Left Lateral Decubitus to Supine Position on Increasing Adenoma Detection Rate: A Randomized Controlled Trial

Background: Improvement in adenoma detection rate (ADR) reduces colorectal cancer incidence by increasing the colonoscopy quality. Using dynamic patient position changes during the withdrawal phase has shown promise in increasing ADR. We conducted this study to assess the effectiveness of the supine position on the improvement of ADR to improve its feasibility and avoid frequent patient position changes, particularly in sedated patients. Methods: This was a randomized, single-blind, parallel-group, single-center study implemented in the Mehregan private in Babol. Inclusion criteria were 40 to 85 years old, 4 L application of polyethylene glycol from the day before the procedure, no history of inflammatory bowel disease, bowel surgery, musculoskeletal problems, and negative familial history of colorectal cancer. Patients were allocated in a 1:1 ratio to the supine or left lateral positions during the withdrawal phase. All colonoscopies were performed by a single physician using a Fujifilm colonoscope. A P-value of &lt;0.005 was considered statistically significant. Results: A total of 880 patients were assessed for eligibility, of which 472 patients were included in the final analysis; 53.4% were female, the mean age of participants was 55.86±10.30 years old, 95.1% of patients had adequate bowel preparation, and adenomatous polyps were the most common histopathologic type (63.7%). Despite the intervention group’s higher rate of ADR and PDR (19.5% vs. 17.7% for ADR and 27.2% vs. 26.5% for PDR), no statistically significant difference in ADR or PDR was detected (P=0.613 and 0.866, respectively). Conclusion: No statistical significance was observed despite the increase in ADR when the supine position was used exclusively during the withdrawal phase. As a result, we recommend that the dynamic position change method be used if a position change is required. Nonetheless, additional research is required to determine a more effective alternative to dynamic position change in obese or heavily sedated patients.

Computer-aided Detection of Polyps Does Not Improve Colonoscopist Performance in a Pragmatic Implementation Trial

See editorial on page 332. Artificial Intelligence–Aided Colonoscopy for Characterizing and Detecting Colorectal Polyps: Required, Nice to Have, or Overhyped?GastroenterologyVol. 164Issue 3PreviewIn recent years, there has been a litany of publications assessing the potential benefits of emerging artificial intelligence (AI) applications in improving select aspects of colonoscopy quality. This has especially been the case for tools to assist in polyp characterization (computer-aided diagnosis [CADx]) and detection (computer-aided detection [CADe]).1,2 Several high-quality studies confirmed excellent accuracy in predicting polyp pathology when using CADx for optical diagnosis. The overwhelming evidence from published randomized trials of CADe suggests an improvement in adenoma detection rate (ADR) that may be greater than any other endoscopic intervention. Full-Text PDF

Comparative Performance of Artificial Intelligence Optical Diagnosis Systems for Leaving in Situ Colorectal Polyps

Comparative Performance of Artificial Intelligence Optical Diagnosis Systems for Leaving in Situ Colorectal Polyps

S288 Long-Term Follow-Up of Colonoscopy Quality Monitoring

Introduction: High-quality colonoscopy is paramount to effective prevention of colorectal cancer. A variety of interventions have been proposed to monitor and improve colonoscopy quality at operator and institutional levels. Since 2009, endoscopists at our university-affiliated, Veterans Affairs Medical Center (VAMC) have received a quarterly report card summarizing individual colonoscopy quality indicators. This intervention was associated with short-term improvement in adenoma detection rate (ADR). However, long-term effects of this monitoring on colonoscopy quality metrics, and appropriate monitoring frequency, are unclear. Methods: We conducted a retrospective study of prospectively administered quarterly colonoscopy quality report cards at a VAMC from April 1, 2012 to August 31, 2019. Anonymized reports included individual endoscopists’ ADR, cecal intubation rates, and withdrawal time. We included endoscopists who had contributed at least 50 colonoscopies per year, and at least 4 consecutive quarters during the study time frame. Linear regression models were used to determine and test slopes over time for each quality metric by physician, and to determine if slopes differed for data above vs below the median for each metric. Analyses were performed for quarterly and yearly data to assess whether there are significant differences based on monitoring frequency. Results: Data from the report cards of 17 endoscopists who had performed 24,361 colonoscopies were included. The mean quarterly ADR (±SD) was 51.7% (±11.7%), while the mean yearly ADR was 47.2% (±13.8%). Over the study time frame, there was a small increase in overall ADR based on both quarterly and yearly measurements (slope + 0.6%, p=0.02; and slope +2.7%, p < 0.001, respectively). However, most endoscopists had no significant change in their ADRs (Table). Overall cecal intubation rates and withdrawal times did not change significantly. Analysis of standard deviation of ADRs (to represent outcome variability over time within a physician) showed no significant difference between yearly and quarterly measurements (p=0.064). Individual endoscopists’ ADR standard deviation differences between yearly and quarterly measurement ranged from -4.7% to +6.8%. Conclusion: Long-term colonoscopy quality monitoring was paralleled with modest improvement in overall ADR, likely due to temporal trends. For endoscopists with baseline high ADR, intensive monitoring and reporting of colonoscopy quality metrics is not necessary and could be performed annually. Table 1. - Mean ADR and slopes of ADR for yearly and quarterly measurement Quarterly Yearly Physician Mean (± SD) Slope SE p-value Mean (± SD) Slope SE p-value All 51.7% (+ 11.7%) 0.6% 0.2% 0.021 47.2% (+ 13.8%) 2.7% 0.4% < .001 Physician A 48.5% (+ 7.8%) 1.1% 2.6% 0.689 49.3% (+ 5.7%) -3.0% 2.3% 0.314 Physician B 39.4% (+ 5.4%) 0.2% 0.5% 0.628 36.8% (+ 9.4%) 1.6% 1.4% 0.306 Physician C 66.3% (+ 6.0%) 1.6% 0.7% 0.022 64.1% (+ 7.6%) 2.3% 1.2% 0.113 Physician D 53.4% (+ 9.2%) 1.2% 0.8% 0.155 47.9% (+ 13.3%) 3.5% 1.7% 0.084 Physician E 33.8% (+ 11.5%) 4.7% 10.8% 0.692 21.0% (+ 15.0%) 13.6% 6.3% 0.275 Physician F 46.4% (+ 6.3%) 0.6% 2.0% 0.761 48.2% (+ 4.8%) 1.8% 2.3% 0.531 Physician G 48.0% (+ 11.5%) 0.1% 1.1% 0.948 39.6% (+ 9.1%) 1.9% 1.3% 0.201 Physician H 60.3% (+ 8.6%) 1.2% 0.8% 0.118 54.0% (+ 13.3%) 3.6% 1.6% 0.070 Physician I 55.1% (+ 6.2%) -1.3% 0.9% 0.167 53.2% (+ 9.1%) 1.4% 2.3% 0.589 Physician J 51.8% (+ 7.5%) 0.4% 1.5% 0.802 48.9% (+ 12.2%) 3.6% 3.9% 0.431 Physician K 38.5% (+ 11.0%) -1.4% 1.3% 0.290 35.5% (+ 12.2%) 1.6% 2.4% 0.533 Physician L 50.1% (+ 8.1%) 14.2% 3.4% 0.052 35.9% (+ 14.9%) -21.0% Physician M 48.2% (+ 11.3%) 11.8% 3.8% 0.026 38.6% (+ 15.3%) 7.1% 13.6% 0.692 Physician N 60.0% (+ 7.5%) 2.0% 2.9% 0.506 59.7% (+ 2.8%) 0.8% 2.7% 0.819 Physician O 52.9% (+ 6.4%) 1.3% 1.2% 0.277 52.1% (+ 5.2%) 1.9% 1.6% 0.302 Physician P 59.1% (+ 10.4%) 6.0% 2.5% 0.043 59.2% (+ 8.6%) 5.6% 2.6% 0.160 Physician Q 55.2% (+ 10.7%) 0.4% 1.1% 0.747 48.5% (+ 13.6%) 3.0% 1.9% 0.169

S312 Comparing the Adenoma Detection Rate of Endocuff-Assisted Colonoscopy (EAC) Against Combined Artificial Intelligence and Endocuff-Assisted Colonoscopy (AEAC)

Introduction: Colorectal cancer (CRC) is the second leading cause of cancer-related mortality in the world. While effective at preventing CRC, standard colonoscopy can miss precancerous polyps placing patients at risk for interval CRC. Endoscopic mechanical attachments and artificial intelligence (AI) are technologies that have independently shown improvement in adenoma detection rate (ADR). We sought to compare the performance of Endocuff-assisted colonoscopy (EAC) to combined AI and EAC (AEAC) in relation to ADR. Methods: This was a single-center study involving patients who underwent either AEAC or EAC between December 2021 and May 2022. Demographic (age, sex) and clinical (indication, Boston Bowel preparation scale (BBPS), withdrawal time, polyp location, histology and size) data on patients was obtained from the electronic health record. The primary outcome was ADR. Secondary outcomes were polyp detection rate (PDR), adenomas per colonoscopy (APC), polyps per colonoscopy (PPC), sessile serrated lesion rate (SSR) and sessile serrated lesions per colonoscopy (SSPC). Categorical variables were analyzed using a two-sided chi square test. Continuous variables were assessed using the student’s t-test or Mann-Whitney U-test. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using logistic regression. Results: 148 patients (50.7% men, mean age 60.9 years; 74 AEAC vs 74 EAC) were included. The AEAC group did not differ by age, sex, indication or BBPS from the EAC group (Table). ADR in the AEAC group was higher (71.6% vs 60.8%; OR 1.63; 95% CI 0.82-3.24; P = 0.17). SSR was 14.9% in the EAC group versus 24.3% in the AEAC group (P > 0.05) (Table). For adenomas >5-10mm in size, the AEAC group had a significantly higher ADR (28.4% vs 14.9%; OR 2.27; 95% CI 1.00-5.13; P = 0.05). Withdrawal time was longer in the AEAC group (8.0min vs 7.3min; P = 0.03). Subgroup analysis by indication revealed that ADR trended towards significance for patients in the AEAC group undergoing colonoscopy for CRC screening (70.3% vs 52.3%; OR 2.17; 95% CI 0.94-4.98; P = 0.068). Conclusion: Combining AI with Endocuff-assisted colonoscopy increased ADR, PDR, APC, PPC, SSR and SSPC when compared to EAC. ADR trended towards significance for patients in the AEAC group undergoing CRC screening. This study highlights the potential benefits of maximizing surface area exposure (mechanical enhancement) combined with enhanced mucosal inspection (AI). Future larger studies will be needed to further validate this combination. Table 1. - Patient Demographics and Per-Patient Lesion Analysis Caption Variable EAC (n=74) AEAC (n=74) P Mean age (SD), y 60.8 (9.7) 61.0 (9.9) 0.91 Sex, n (%) 0.87 Male 38 (51.4) 37 (50) Female 36 (48.6) 37 (50) Indication for colonoscopy, n (%) 0.08 Screening 44 (59.5) 54 (73) Surveillance 30 (40.5) 20 (27) Mean BBPS (SD) 8.6 (0.8) 8.5 (0.9) 0.55 Median withdrawal time (IQR), min* 7.3 (6.6-8.2) 8.0 (7.3-8.7) 0.03 Patients with >1 adenoma (ADR), n (%) 45 (60.8) 53 (71.6) 0.17 Adenomas per colonoscopy (APC), (range) 1.43 (0-12) 1.45 (0-5) 0.96 Patients with >1 polyp (PDR), n (%) 66 (89.2) 70 (94.6) 0.23 Polyps per colonoscopy (PPC), (range) 2.55 (0-13) 2.62 (0-16) 0.85 Patients with >1 sessile serrated lesion (SSR), n (%) 11 (14.9) 18 (24.3) 0.15 Sessile serrated lesions per colonoscopy (SSPC), (range) 0.23 (0-4) 0.27 (0-2) 0.67 Adenoma location, n (%)** Right colon 31 (41.9) 33 (44.6) 0.74 Transverse colon 16 (21.6) 17 (23) 0.84 Left colon 22 (29.7) 26 (35.1) 0.48 Adenoma size, n (%)** 1-5mm 40 (54.1) 39 (52.7) 0.87 >5-10mm 11 (14.9) 21 (28.4) 0.05 >10mm 8 (10.8) 11 (14.9) 0.46 Polyp location, n (%)** Right colon 34 (45.9) 42 (56.8) 0.19 Transverse colon 22 (29.7) 22 (29.7) 1.00 Left colon 49 (66.2) 51 (68.9) 0.73 Polyp size, n (%)** 1-5mm 62 (83.8) 55 (74.3) 0.16 >5-10mm 15 (20.3) 24 (32.4) 0.09 >10mm 8 (10.8) 12 (16.2) 0.34 Sessile serrated lesion location, n (%)** Right colon 3 (4.1) 10 (13.5) 0.08 Transverse colon 7 (9.5) 3 (4.1) 0.33 Left colon 5 (6.8) 6 (8.1) 1.00 Sessile serrated lesions size, n (%)** 1-5mm 5 (6.8) 5 (6.8) 1.00 >5-10mm 3 (4.1) 8 (10.8) 0.21 >10mm 4 (5.4) 6 (8.1) 0.75 EAC, Endocuff-assisted colonoscopy; AEAC, artificial intelligence and EAC; SD, standard deviation; BBPS, Boston Bowel Preparation scale; IQR, interquartile range; PDR, polyp detection rate; PPC, polyps per colonoscopy; ADR, adenoma detection rate; APC, adenomas per colonoscopy; SSR, sessile serrated lesion rate; SSPC, sessile serrated lesions per colonoscopy.*There was 1 case missing data in the EAC cohort.**Number of patients with >1 adenoma/polyp/sessile serrated lesion.

The Effect of Linked Color Imaging for Adenoma Detection. A Meta-analysis of Randomized Controlled Studies.

The effect of linked color imaging (LCI) compared with white light imaging (WLI) is conflicting. The aim of this meta-analysis is to compare the efficacy of LCI versus WLI for the adenoma detection. PubMed, Embase, Google Scholar and Cochrane Library were searched up to the end of Aug 18, 2021. All randomized controlled trials (RCTs) comparing LCI with WLI were included. Dichotomous data were pooled to obtain the relative risk (RR) with a 95% confidence interval (CI), whereas continuous data were pooled using a mean difference (MD) with 95%CI. A total of 10 RCTs involving 5,510 patients were included. The use of LCI was associated with a statistically significant improvement in adenoma detection rate (ADR), polyp detection rate (PDR), mean adenomas per patient (MAP) and mean polyp per patient (MPP) when compared to WLI (ADR: RR=1.15, 95%CI: 1.07-1.23, p=0.0001, PDR: RR=1.15, 95%CI: 1.08-1.22, p<0.0001; MAP: MD=0.18, 95%CI: 0.09- 0.28, p=0.0002; MPP: MD=0.13, 95%CI: 0.01, 0.25, p=0.03). When stratified by size, LCI group had a higher detection rate of small adenomas (<10 mm) than the WLI group. Besides, LCI showed a significant decrease in adenoma miss rate (AMR) when compared to WLI. There were no statistically significant differences between the two groups in advanced ADR (AADR), sessile serrated lesion detection rate (SDR), cecal intubation rate, insertion time, and withdrawal time. The pooled evidence suggests that LCI can significantly improve the detection of ADR, especially for small adenomas (<10 mm). Moreover, the AMR were significantly lower using LCI compared with WLI.

Artificial Intelligence in Colonoscopy: Improving Medical Diagnostic of Colorectal Cancer

Introduction- Colorectal cancer (CRC) is a development of abnormal cells either in colon or rectum. CRC considered being the 3rd leading cause of death in 2018 only behind lung and breast cancer. It first arises during pre-cancerous stages called as polyps. The detection and removal of polyp is important to increase the survival rate of patient. Various method of polyp detection are available. However, only colonoscopy remains the gold standard in detection and removal of polyps. Several studies showed how Artificial Intelligence (AI) used in colonoscopy area particularly in detecting polyps, assessing physicians and predicting patient with high risk of CRC. The aim of this study is to describe the involvement of AI in colonoscopy and its impact in reducing the Materials and methods– Search for journal articles conducted between May and June 2016 from various resources including PubMed and Google Scholar. 6 research journals were reviewed and all the advantages and limitations were discussed throughout this study. Results– Various study showed that AI able to improve medical diagnostic of CRC in several ways, including in the improvement of adenoma detection rate (ADR) in terms of medical diagnostic, finding physicians associated with high Adenoma Detection Rate (ADR) and predicting patients with high risk of CRC. In addition, the use of AI in colonoscopy also associated with limitations including require large amount of datasets and advance computational resources in order to generate accurate output. Conclusion– The utilization of AI in colonoscopy shows how it able to improve the diagnosis accuracy and survival rate of patients associated with CRC despite several limitations that were identified during the study. However in the future, instead of allowing it to fully automatically conducting diagnosis, it still needs to be accompanied by physicians conducting the operation as there is no hundred percent perfect algorithms.

Mo1036 THE ADDITIONAL EFFECTS WITH SIMETICONE IN THE BOWEL PREPARATION IN COLONOSCOPY MAY DIFFER FOR EACH ENDOSCOPIST

The effect of simeticone (Sim) in bowel preparation in colonoscopy is controvertial. There are affirmative reports for Sim such as shortening of the time needed for the colonoscopy (Z Gastroenterol 1995) and improvement for visiability (World J Gastroneterol 2009), However there are some reports with no effect. In 2017, multicenter, randomized controlled trial showed marked improvement of adenoma detection rate from 14.3% to 20.0% by using Sim (Endoscopy 2017). However, there is no study comparing the additional effects with Sim for each endoscopist. We hypothesized that the additional effect of Sim differs by endoscopist, and conducted this single center, endoscopist-blinded cohort study

Improvement in Adenoma Detection Rate in a High Risk Population Using Two Simple Interventions

Introduction: High quality colonoscopy is associated with favorable adenoma detection rates (ADR) and polyp detection rates (PDR), which improve outcomes related to colorectal cancer. Inadequate bowel preparation limits colonoscopy by impairing visualization, increasing cost, and decreasing PDR and ADR. Barriers to adequate bowel preparation include Medicaid health insurance, non-English primary language, lower educational background or health literacy, low patient motivation, and increased time to procedure. Using a Plan Do Study Act (PDSA) model, we implemented a split-dose bowel regimen and multi-lingual educational booklet, and achieved >90% prep adequacy. Here, we report the effect of improved bowel preparation on ADR in a diverse, high-risk population at a New York City public hospital. Methods: In 1/2014 we implemented a split-dose bowel preparation regimen (cycle 1). In 8/2014, we implemented a visual multi-language educational booklet in English, Spanish and Chinese (cycle 2). Individual patient data on polyps found and histopathology was collected during inception of the interventions from October 2013 to December 2014. Hospital data was collected for years 2013 and 2015, which included number of screening, colonoscopies and adenomas detected. Chi-square testing was performed in R (version 3.3.1) to evaluate the difference in ADR pre and post interventions. Results: There was an overall upward trend noted in PDR and ADR from October 2013 to December 2014 through each intervention cycle (Figure 1). Within this group, patients were similar in age (median = 57; p=0.56). Across the hospital, there were 1345 screening colonoscopies with 320 adenomas detected in 2013. Post intervention (2015) there was 1555 colonoscopies with 424 adenomas detected. An ADR of 24% was achieved in 2013 versus 27% in 2015 (p=0.0331).Figure 1Conclusion: Split-dose bowel preparation combined with a multi-language educational booklet to improve bowel preparation is associated with improved PDR and ADR in a high risk, ethnically diverse population. Utilizing the PDSA cycle we made a significant impact on two important quality markers, preparation adequacy and ADR.

Laterally Spreading Tumor of the Rectum Delineated with Linked Color Imaging Technology.

Colonoscopy has been shown to decrease the incidence of colorectal cancer and cancer death through the removal of adenomatous polyps. To make an accurate diagnosis of colorectal neoplasms, several image-enhanced endoscopic systems, such as narrow band imaging (NBI), flexible spectral imaging color enhancement, and blue laser imaging (BLI), have been developed. However, no significant differences have been reported in the adenoma detection rate between image-enhanced endoscopy and conventional white light endoscopy [1]. NBI and BLI are often criticized for darkening the endoscopy image and, in turn, hampering a wider view of the colon [2]. Moreover, the miss rate for flat lesions was significantly higher than that for pedunculated lesions [3]. We present a case that suggests a possible improvement in adenoma detection rates, especially for flat adenomas.

967 Effect of Adenoma Detection Rate Improvement on the Risk of Colorectal Cancer and Death

967 Effect of Adenoma Detection Rate Improvement on the Risk of Colorectal Cancer and Death

Endoscopists with low adenoma detection rates benefit from high-definition endoscopy.

An endoscopists adenoma detection rate (ADR) of less than 20 % correlates with high risk for occurrence of interval cancer. The impact of high-definition (HD) imaging on the ADR is discussed controversially. We aimed to investigate whether detection rates of individual endoscopists increase within 1 year before and 1 year after the switch from standard to HD endoscopy. This cohort study analyzed 6,330 screening colonoscopies (2,968 with standard and 3,362 with HD) performed by 42 endoscopists between November 2007 and March 2013 within a nationwide quality assurance program for screening colonoscopy. The ADR of endoscopists with a low ADR (<20 %) increased significantly higher (from 11.8 to 18.1 %, p = 0.003) than of those with a high ADR (≥ 20 %) (from 28.6 to 30.7 %, p = 0.439) after switch from standard to HD colonoscopes (p = 0.0076). The proportion of endoscopists with an ADR < 20 % decreased from 45 to 42.9 % (p = 0.593). There was no significant increase in age- and sex-adjusted detection rates of adenomas (20.2 vs 23.7 %; p = 0.089), advanced adenomas (4.7 vs 5.5 %; p = 0.479), flat adenomas (2.7 vs 3.1 %; p = 0.515), polyps (38.8 vs 41.5 %; p = 0.305), proximal polyps (18.5 vs 20 %; p = 0.469) and hyperplastic polyps (15 vs 17.2 %; p = 0.243) of endoscopists after switch to HD colonoscopes. There was no difference in detection rates of flat polyps (5.5 vs 5.5 %; p = 0.987). The use of HD scopes is associated with marginal improvement in adenoma detection rates limited to those endoscopists with low adenoma detection rates prior to its introduction.

Tu1025 Improvement in Adenoma Detection Rate After Distribution of a Report Card Is Due Solely to Improved Detection of Right Sided Polyps

Tu1025 Improvement in Adenoma Detection Rate After Distribution of a Report Card Is Due Solely to Improved Detection of Right Sided Polyps

Dramatic Improvement in Adenoma Detection Rate (ADR) after Enlisting All Room Staff in Polyp Detection

Purpose: To determine whether enlisting all endoscopy room staff as active observers in the process of identifying polyps during screening colonoscopy would cause a significant improvement in adenoma detection rates. Methods: Using Pentax high resolution colonoscopes unaided by other technologies, adenoma and sessile serrated adenoma location and occurrence per 100 patients screened (ADR and SSADR) were measured retrospectively in 970 asymptomatic patients undergoing first time screening colonoscopy during two consecutive quarters of 2010-2011 (Group I). The results were compared with ADR and SSADR in 1,050 patients (Group II) and 767 patients (Group III) screened during respective quarters of 2011-2012 (Group II) and 2012-2013 (Group III) by endoscopists fully aware of the intent to measure performance. For six months prior to Group II and continually thereafter, all endoscopy room staff were asked to focus on polyp detection. During endoscopy all were taught polyp morphology and encouraged to participate with the intent of creating a cohesive, highly effective team. Colonoscopies were performed in a single privately owned endoscopy center with a procedure completed in each room every 30 minutes. Greater than 90% of adenomas were classified by a single GI pathologist. Polyps proximal to the splenic flexure were classified as right colon polyps. Withdrawal time (WT) from cecum to rectum was measured in all patients. Data were calculated with a linear or logistic model with physician operator as the random effect to account for repeated measures over the three time periods. Results: See Table 1. The data sets for Groups I, II, and III, respectively, are as follows: Endoscopist Mean (SD) SSADR were 6.2% (4.2%), 7.7% (2.8%), and 13.4% (3.9%). Endoscopist Mean (SD) ADR were 34.0% (9.9%), 41.3% (11.6%), and 52.0% (8.5%). Center ADR for males were 40.3%, 43.1%, and 58.0%. Center ADR for females were 27.2%, 34.7%, and 46.7%. Patients with only right colon polyps were 11.2%, 17.1%, and 24.1%. Patients with polyps who had only right colon polyps were 33.3%, 44.1%, and 47.6%. The p-values for each data set were <0.001.Table 1: ADR by Study Time PeriodConclusion: 1. Enlisting all room staff in the task of polyp detection led to markedly increased adenoma detection rates in a high volume efficient endoscopy center. 2. These detection rates are far above the present thresholds and standards of care for colonoscopic screening. 3. No special equipment (e.g., enhanced imaging, contrast dyes) was required to realize this improvement in ADR and SSADR. 4. Minimal increase in procedure time but no decrement in endoscopy center efficiency occurred with these process improvement measures. 5. Screening sigmoidoscopy strategy would have missed at least one half of adenoma patients in this population.

Tu1403 Trainees With a CAP: Preliminary Results From a U.S Center

Colonoscopy with polypectomy has significantly reduced the incidence of colorectal cancer. Training to achieve thorough examination of the colon, accurately identify pre-cancerous lesions and complete polypectomy is essential aspect of fellowship in gastroenterology. Multiple studies using Cap Assisted Colonoscopy (CAC) demonstrated shorter cecal intubation time, higher cecal intubation rate and marginal improvement in adenoma detection rate. Experienced endoscopists (>500-1000 colonoscopies) performed majority of these procedures.

High-definition imaging and NBI—improving colonic imaging?

Detecting and characterizing colonic polyps using high-definition imaging and narrow-band imaging (NBI) has yielded modest results. Now, two randomized studies have substantiated the role of NBI in reducing polyp miss rates in patients with hyperplastic polyposis syndrome, and in differentiating adenomas from hyperplastic polyps, although with no improvement in adenoma detection rates.

Improvement in Adenoma Detection Rates (ADR) with Use of a Retrograde-Viewing Device (Third Eye® Retroscope®) During Colonoscopy in Older vs. Younger Patients

Improvement in Adenoma Detection Rates (ADR) with Use of a Retrograde-Viewing Device (Third Eye® Retroscope®) During Colonoscopy in Older vs. Younger Patients

Narrow-Band Versus White-Light High Definition Television Endoscopic Imaging for Screening Colonoscopy: A Prospective Randomized Trial

Narrow-band imaging (NBI) has been implemented in gastrointestinal endoscopy to improve the contrast of endoluminal pathologic structures, one of the aims being to increase colonic adenoma detection. Previous studies from referral centers have yielded variable and conflicting results with regard to improvement in adenoma detection rates by using NBI. The present large randomized trial was designed to finally settle this issue. In a prospective study performed exclusively in a multicenter private practice setting involving 6 examiners with substantial lifetime experience (>10,000 colonoscopies), 1256 patients (men:women, 47%:53%; mean age, 64.4 y) were randomized to HDTV screening colonoscopy with either NBI or white-light imaging on instrument withdrawal. The primary outcome measure was the adenoma detection rate (ie, number of adenomas/total number of patients). There was no difference between the 2 groups in terms of the general adenoma detection rate (0.32 vs 0.34), the total number of adenomas (200 vs 216), or in detection in subgroups of adenomas. This was despite a minimal, but significantly longer, withdrawal time in the NBI group (8.5 vs 7.9 min; P < .05). Only hyperplastic polyps were found more frequently in the NBI group (P = .03). This large randomized trial in a homogeneous private practice screening setting could not show any objective advantage of the NBI technique over white-light high definition television imaging in terms of improved adenoma detection rate. Contrast enhancement therefore likely will not contribute to a reduction in adenoma miss rates among experienced colonoscopists.