Improve Adenoma Detection Rate Research Articles

S0275 Multimedia-Based Education on Bowel Preparation Improves Adenoma Detection Rate - A Systematic Review & Meta-Analysis of Randomized Controlled Trials

INTRODUCTION: Colorectal cancer (CRC) is the third most common cause of cancer worldwide and the third leading cause of cancer deaths in western countries. Studies have shown a strong association between screening colonoscopy and a reduced risk of death from colorectal cancers. The incidence of poor bowel preparation has been reported in up to 25% cases. We conducted a systematic review and comprehensive meta-analysis to evaluate the effect of patient education using multimedia education on adenoma detection rate and adequacy of bowel preparation. METHODS: Multiple databases were searched through May 2020 for studies that reported the efficacy of multimedia education (smartphone app and audio-visual aids) in improving quality of bowel preparation and its effect on adenoma detection rate (ADR). Meta-analysis was performed to determine whether multimedia based patient education (MM) helps improve ADR and bowel preparation quality as compared to controls (CT). RESULTS: We included 13 randomized controlled trials with a total of 3754 patients. Overall ADR was higher in patients receiving multimedia based education (26%) as compared to CT (20.1%) (OR 1.4 CI 1.01–1.85; I2 = 57; P = 0.04) (Figure 1). In particular, for patients over 50 years of age, ADR was better in MM cohort as compared to controls (OR 1.8 CI 1.1–2.9; I2 = 0; P = 0.03) (Figure 2). Finally, a higher proportion of patients receiving multimedia based education achieved optimal bowel preparation. CONCLUSION: Pre-colonoscopy patient education using multimedia based platforms seems to improve ADR by improving the adequacy of bowel preparation for colonoscopy.Figure 1.: Overall ADR.Figure 2.: ADR by mean age.

S0274 Real-time Computer-Aided Colonoscopy vs Standard Colonoscopy for Improving Adenoma Detection Rate: A Meta-Analysis of Randomized Controlled Trials

S0274 Real-time Computer-Aided Colonoscopy vs Standard Colonoscopy for Improving Adenoma Detection Rate: A Meta-Analysis of Randomized Controlled Trials

Increased Sessile Serrated Adenoma Detection Rate With Mechanical New Technology Devices: A Systematic Review and Meta-Analysis.

This meta-analysis aims to compare the sessile-serrated adenoma detection rate (SSADR) of currently available mechanical new technology devices (NTDs) to conventional colonoscopy (CC). NTDs including Endocuff, EndoRing, G-Eye, and AmplifEYE were developed with the aim of improving adenoma detection rate by enhancing colonic mucosal visualization. Increasing awareness of the risk of sessile-serrated adenoma progression to malignancy has ushered a need to increase the detection of these characteristically flat lesions. Embase and PubMed/Medline databases were searched from inception through January 2019 for published manuscripts or major conference abstracts reporting SSADR with Endocuff, EndoRing, G-Eye, AmplifEYE, and CC. Randomized controlled trials, high-quality case-control, cohort, and observational studies in adults with >10 subjects were included. The primary outcome was pooled SSADR odds ratio (ORs) with 95% confidence interval (95% CI) comparing CC with the NTDs. In addition, an analysis comparing each device to CC was performed. Of 207 citations identified, a total of 14 studies with 12,655 subjects were included in our analysis (5931 subjects with NTDs and 6724 with CC). There were 12 studies with Endocuff, 2 with EndoRing, 1 with G-EYE, and 1 with AmplifEYE. The mean age was 62.4 years and 57.5% were males. Pooled SSADR with NTDs was 12.3% as compared with 6.4% with CC, with an OR of 1.81 (95% CI: 1.6-2.0, I2: 77%). Analysis of Endocuff alone yielded an OR 1.81 (95% CI: 1.6-2.1, I2: 79%). Mechanical NTDs, notably Endocuff, are a safe and effective tool to increase the SSADR.

Oral IBGard™ Before Colonoscopy: A Single-Center Double-Blinded, Randomized, Placebo-Controlled Trial.

Peppermint oil is well known to inhibit smooth muscle contractions, and its topical administration during colonoscopy is reported to reduce colonic spasms. We aimed to assess whether oral administration of IBGard™, a sustained-release peppermint oil formulation, before colonoscopy reduces spasms and improves adenoma detection rate (ADR). METHODS: We performed a single-center randomized, double-blinded, placebo-controlled trial. Patients undergoing screening or surveillance colonoscopies were randomized to receive IBGard™ or placebo. The endoscopist graded spasms during insertion, inspection, and polypectomy. Bowel preparation, procedure time, and time of drug administration were documented. Statistical analysis was performed using the Student's t test and Wilcoxon rank-sum test. There was no significant difference in baseline characteristics or dose-timing distribution between IBGard™ and placebo groups. Similarly, there was no difference in ADR (IBGard™ = 47.8%, placebo = 43.1%, p = 0.51), intubation spasm score (1.23 vs 1.2, p = 0.9), withdrawal spasm score (1.3 vs 1.23, p = 0.72), or polypectomy spasm score (0.52 vs 0.46, p = 0.69). Limiting the analysis to patients who received the drug more than 60min prior to the start of the procedure did not produce any significant differences in these endpoints. This randomized controlled trial failed to show benefit of orally administered IBGard™ prior to colonoscopy on the presence of colonic spasms or ADR. Because of its low barrier to widespread adoption, the use of appropriately formulated and timed oral peppermint oil warrants further study to determine its efficacy in reducing colonic spasms and improving colonoscopy quality.

Individual feedback and monitoring of endoscopist performance improves the adenoma detection rate in screening colonoscopy: a prospective case-control study.

Previous reports have suggested that a longer withdrawal time (WT) during colonoscopy led to an improved adenoma detection rate (ADR); however, there are few controlled studies that substantiated monitoring WT as an educational method. We aimed to validate a feedback and monitoring system to improve the ADR in screening colonoscopy in a prospective case-control setting. After collecting data in the pre-feedback period (3.5months), the individual performance and the average ADR and WT values of the facility were provided to 6 endoscopists in the intervention group, while 3 endoscopists were isolated as the control group during the feedback period (2weeks). The intervention group consisted of two subgroups, the Fast and Slow WT groups, according to the results from the pre-feedback period. The endoscopists in the intervention group were instructed to be aware of their own WT in each examination during the post-feedback period (4months). The performances of all endoscopists in the post-feedback period were analyzed and compared with those in the pre-feedback period. Among the initial analyses, the correlation analysis and multivariate analysis revealed that WT was an independent predictor for the ADR (P = 0.0101). After providing individual performance feedback and instruction regarding real-time WT monitoring, the WT was significantly prolonged in the Fast WT group (P = 0.0346) but did not change in the Slow WT and control groups. In addition, the ADR of the Fast WT group significantly improved after the intervention (P = 0.024), whereas the ADR of the Slow WT and control groups did not change. Providing individual feedback on ADR and WT and monitoring WT helped improve the endoscopists' ADRs.

The impact of deep convolutional neural network-based artificial intelligence on colonoscopy outcomes: A systematic review with meta-analysis.

The utility of artificial intelligence (AI) in colonoscopy has gained popularity in current times. Recent trials have evaluated the efficacy of deep convolutional neural network (DCNN)-based AI system in colonoscopy for improving adenoma detection rate (ADR) and polyp detection rate (PDR). We performed a systematic review and meta-analysis of the available studies to assess the impact of DCNN-based AI-assisted colonoscopy in improving the ADR and PDR. We queried the following database for this study: PubMed, Embase, Cochrane Library, Web of Sciences, and Computers and Applied Sciences. We only included randomized controlled trials that compared AI colonoscopy to standard colonoscopy (SC). Our outcomes included ADR and PDR. Risk ratios (RR) with 95% confidence interval (CI) were calculated using random effects model and DerSimonian-Laird approach for each outcome. A total of three studies with 2815 patients (1415 in SC group and 1400 in AI group) were included. AI colonoscopy resulted in significantly improved ADR (32.9% vs 20.8%, RR: 1.58, 95% CI 1.39-1.80, P=<0.001) and PDR (43.0% vs 27.8%, RR: 1.55, 95% CI 1.39-1.72, P=<0.001) compared with SC. Given the results and limitations, the utility of AI colonoscopy holds promise and should be evaluated in more randomized controlled trials across different population, especially in patients solely undergoing colonoscopy for screening purpose as improved ADR will ultimately help in reducing incident colorectal cancer.

Artificial Intelligence for Colorectal Polyp Detection and Characterization

To elucidate the advantages and limitations of existing artificial intelligence technologies for colonoscopy by evaluating the currently available eight prospective studies (two for automated polyp detection and six for automated polyp characterization). AI is expected to mitigate the inherent risk of human error causing a polyp to be missed or mischaracterized by assisting polyp detection and characterization (i.e., pathological prediction). Some of the prospective studies clearly demonstrate the potential for AI to improve adenoma detection rates, which is considered one of the most important quality indicators for colonoscopies, or achieve a > 90% negative predictive value in differentiating diminutive (≤ 5 mm) rectosigmoid adenomas which is considered as a threshold required for optical diagnosis. However, it is also important to consider the negative impacts of AI, such as the deskilling effect on healthcare providers, which has yet to be sufficiently addressed. We believe that AI can become standard practice in colonoscopy procedures within several years, given its rapid spread and its expected low implementation cost. However, considering the limited evidence supporting the use of AI for colonoscopy, additional studies should be done to explore the long-term efficacy and safety of AI in colonoscopy and implement robust endpoints such as colorectal cancer incidence and mortality.

A149 COMPARING THE REAL-WORLD EFFECTIVENESS OF 4L VERSUS 2L SPLIT COLONOSCOPY PREPARATIONS: PRELIMINARY DATA OF A SINGLE CENTRE EXPERIENCE THROUGH THE BRITISH COLUMBIA COLONOSCOPY SCREENING PROGRAM

Abstract Background The British Columbia Colon Screening Program (CSP) is a population-based program offering biennial fecal immunochemical test (FIT) to individuals age 50–74 years with follow-up colonoscopy for a positive FIT as well as individuals with a personal history of neoplastic polyps or a high risk family history of colorectal cancer. Over 20,000 colonoscopies are performed annually. In December 2018, program colonoscopists in Vancouver, Canada agreed to switch from a 2L polyethylene glycol (PEG) preparation to a 4L PEG preparation after studies suggested superiority of the higher volume preparation in achieving adequate bowel cleansing and improving adenoma detection rates (ADR). High quality bowel cleansing is critical to minimize repeat procedures and maximize neoplasia detection. Aims To compare the quality of bowel preparation and neoplasia detection rates using the 4L high volume split preparation (HVSP) versus the 2L low volume split preparation (LVSP) in patients undergoing colonoscopy in the BC CSP. Methods A retrospective review of consecutive patients undergoing colonoscopy through the CSP at St. Paul’s Hospital from Dec 2017-Apr 2018 and Dec 2018-Apr 2019 was conducted. Inclusion criteria included: age 50–74, patients undergoing colonoscopy for any reason through the BC CSP. Variables collected included: patient demographics, bowel preparation qualty and pathologic findings. ADR and sessile serrated polyp detection rate (SSDR) were analyzed. Results 462 colonoscopies were included, 280 in the LVSP group and 182 in the HVSP group. 8/280 (2.9%) had poor bowel preparation in the LVSP group, while 10/182 (5.5%) had poor bowel preparation in the HVSP group. The ADR and SSDR were 53.6% in LVSP vs. 50.0% in HVSP and 8.2% in LVSP vs. 8.8% in HVSP, respectively. Conclusions In this preliminary evaluation, the high volume PEG-based split preparation did not reduce the proportion of inadequate bowel preparations. Further evaluation of a larger number of colonoscopies is planned. Funding Agencies None

Association between improved adenoma detection rates and interval colorectal cancer rates after a quality improvement program

Although colonoscopy reduces colorectal cancer (CRC) risk, interval CRCs (iCRCs) still occur. We aimed to determine iCRC incidence, assess the relationship between adenoma detection rates (ADRs) and iCRC rates, and evaluate iCRC rates over time concomitant with initiation of an institutional colonoscopy quality improvement (QI) program. We performed a retrospective cohort study of patients who underwent colonoscopy at an academic medical center (January 2003 to December 2015). We identified iCRCs through our data warehouse and reviewed charts to confirm appropriateness for study inclusion. iCRC was defined as a cancer diagnosed 6 to 60 months and early iCRC as a cancer diagnosed 6 to 36 months after index colonoscopy. We measured the relationship between provider ADRs and iCRC rates and assessed iCRC rates over time with initiation of a QI program that started in2010. A total of 193,939 colonoscopies were performed over the study period. We identified 186 patients with iCRC. The overall iCRC rate was .12% and the early iCRC rate .06%. Average-risk patients undergoing colonoscopy by endoscopists in the highest ADR quartile (34%-52%) had a 4-fold lower iCRC risk (relative risk, .23; 95% confidence interval, .11-.48) than those undergoing colonoscopy by endoscopists in the lowest quartile (12%-21%). After QI program initiation, overall iCRC rates improved from .15% to .08% (P< .001) and early iCRC rates improved from .07% to .04% (P= .004). We confirmed that iCRC rate is inversely correlated with provider ADR. ADRs increased and iCRC rates decreased over time, concomitant with a QI program focused on split-dose bowel preparation, quality metric measurement, provider education, and feedback. iCRC rate measurement should be considered a feasible, outcomes-driven institutional metric of colonoscopy quality.

Ileal intubation is not associated with higher detection rate of right-sided conventional adenomas and serrated polyps compared to cecal intubation after adjustment for overall adenoma detection rate

BackgroundHigh cecal intubation rate (CIR) is associated with significant improved adenoma detection rate (ADR), however, self-reported CIR may be overestimated and inadequate documentation of cecal intubation is associated with a lower polyp detection rate compared to clear documentation. We aimed to investigate if ileal intubation may be associated with higher detection rates (DR) for right-sided conventional adenomas (cAD) and serrated polyps (SP) compared to cecal intubation in a large screening colonoscopy cohort.Material and methodsRetrospective analysis of individuals ≥50 years with average risk for colorectal cancer (CRC) who underwent screening colonoscopy between 01/01/2012 and 14/12/2016 at a tertiary academic hospital and six community-based private practices. Exclusion criteria were conditions with increased risk for CRC (e.g. inflammatory bowel disease, history of CRC, hereditary cancer syndromes), previous colonoscopy at the same institution, and incomplete procedures. Right-sided colon was defined as caecum and ascending colon.Results4.138 individuals were analysed (mean age 62 years, 52.1% female). DR for right-sided cADs and SPs were significantly higher after ileal compared to cecal intubation in univariate (12.5% vs. 6.8%, p < 0.001, and 6.3% vs. 3.3%, p < 0.001), but not in multivariate analysis (OR 1.025, 95%-CI 0.639–1.646, p = 0.918, and OR 0.937, 95%-CI 0.671–1.309, p = 0.704). DRs did not differ between ileal and cecal intubation for endoscopists with ADR ≥25 and < 25%, respectively. ADR ≥25% was significantly associated with ileal intubation (OR 21.862, 95%-CI 18.049–26.481, p < 0.001).ConclusionIleal intubation may not provide any benefit over cecal intubation concerning the detection of cADs and SPs in the right-sided colon.

EndoCuff-assisted colonoscopy could improve adenoma detection rate: A meta-analysis of randomized controlled trials.

This meta-analysis aimed to evaluate whether EndoCuff-assisted colonoscopy (EAC) could improve adenoma detection rate (ADR) compared with standard colonoscopy (SC). PubMed, EMBASE, Scopus, Cochrane Library, and Google Scholar databases were searched for articles published up to March 2019. All pure randomized controlled trials comparing ADR between EAC and SC groups were included. Dichotomous data were pooled to obtain the odds ratio with a 95% confidence interval (CI), whereas continuous data were pooled using a mean difference with 95% CI. Review Manager Version 5.3 was used for data analysis. Thirteen randomized controlled trials consisting of 9038 patients (EAC: 4574; SC: 4464) were included. The EAC group showed significant superiority over the SC group in ADR (odds ratio 1.37, 95% CI 1.15-1.62). However, there were no differences between the EAC and SC groups in adverse events, cecal intubation rate, and cecal intubation time. EAC could significantly improve ADR without increasing adverse events, especially for operators with low ADRs. In addition, no significant difference was observed in cecal intubation time and cecal intubation rate between EAC and SC.

Training interventions to improve adenoma detection rates during colonoscopy: a systematic review and meta-analysis.

Colonoscopies are effective means of detecting and removing precancerous adenomatous polyps. The adenoma detection rate (ADR) is a marker of colonoscopy quality and an independent predictor of colorectal cancer incidence. Focused training interventions may improve an endoscopist's ADR, but the supporting research is limited. This systematic review and meta-analysis identified, critically appraised, and meta-analyzed data from randomized trials (RCTs) evaluating the effect of training interventions on ADRs. Ovid Medline, EMBASE, CENTRAL, Eric, CINAHL, Scopus, Web of Science, and ClinicalTrials.gov were searched for RCTs investigating the effect of an educational intervention on ADRs. Two reviewers independently screened, identified, and extracted trial-level data. Internal validity was assessed in duplicate using the Risk of Bias tool. Our primary outcome was the ADR. Secondary outcomes were advanced ADR, adenocarcinoma detection rate, polyp detection rate, and withdrawal times. Safety outcomes were post-polypectomy bleeding rate and colonoscopy-related perforation rate. From 2837 screened citations, we identified 3 trials (119 endoscopists) meeting our inclusion criteria. Training interventions were associated with a trend toward increased ADRs (odds ratio 1.16, 95% confidence interval (CI) 1.00-1.34; I2 83%; 3 trials; 119 endoscopists). When limited to screening colonoscopies, the odds ratio for ADRs associated with training interventions was 1.17 (95% CI 1.00-1.36; I2 80%; 3 trials; 119 endoscopists). There was a high level of heterogeneity between the trials' training interventions. Training intervention improved the advanced ADR, adenocarcinoma detection rate, polyp detection rate, and withdrawal times. Safety outcomes were not reported. A focused training intervention was associated with a strong trend toward increased ADRs among certified endoscopists. While the described training interventions definitely show promise, further efforts around continuing professional developments activities are needed to more consistently improve ADRS among certified endoscopists.

2892 Adenoma Detection With Endocuff at a Veterans Affairs Medical Center: Encouraging Results From a Single Endoscopist Consecutive Series

INTRODUCTION: Improving adenoma detection rate should improve the colorectal cancer prevention that can be expected from screening and surveillance colonoscopies. METHODS: To address this goal, one endoscopist at the Albany Veterans Affairs Medical Center employed the Endocuff device (AEC120 or AEC130, Arc Medical, Leeds, UK), which attaches to the end of the colonoscope and has flexible projections that splay open the colonic lumen on withdrawal. Consecutive charts of all outpatients undergoing screening and surveillance colonoscopies were prospectively reviewed starting three months prior to institutional availability of the Endocuff and continued three months after. 91 cases were done with the Endocuff and 143 without. 21 cases were done without the Endocuff after institutional availability due to exhaustion of the supply, endoscopist failure to request the device, or fellow preference, and these are included in the analysis in the “without Endocuff” group. RESULTS: After excluding cases aborted for poor prep, 91 cases with and 135 cases without the Endocuff remained. The groups were not different with respect to sex, age, body mass index or hemoglobin A1c. Similar proportions of patients in each group had IBD, diverticulosis, family history of colorectal cancer, personal history of colorectal cancer or partial colectomy. The groups were also similar in quality of preparation, fellow participation, withdrawal time or sedative used for the procedure. Adenomas were detected in 47 of 91 (51.6%) patients in whom the Endocuff was used, with a total of 104 adenomas, vs. 61 of 135 (42.7%) patients in whom it was not, with a total of 143 adenomas. As the Endocuff provides a good view of the distal rectum on direct endoscopy, retroflexion in the rectum was not routinely performed with this device but was done without the device if there was suspicion for a distal rectal lesion. Even without retroflexed views, one rectal adenocarcinoma and one anal squamous cell carcinoma were detected in patients undergoing colonoscopy with the Endocuff. No cancers were detected in the patients in whom the Endocuff was not used but retroflexion in the rectum was performed. Results did not reach the P &lt; 0.05 level of significance with Pearson’s chi-squared test. CONCLUSION: High baseline rate of adenomas and small sample size were limitations of this study. These preliminary results show a trend toward increased adenoma detection with the Endocuff device in our patient population, and the trial is ongoing.

284 Factors That Underpin the Increase in Right Colon Adenoma Detection Rate: A Pooled Analysis of Three Reports Comparing Water Exchange, Water Immersion, and Air Insufflation Colonoscopy

INTRODUCTION: Interval cancers due to missed adenomas tend to cluster in the right colon. Both water immersion (WI) and water exchange (WE) use water infusion to aid insertion. WI, which is easy to adopt at the discretion of the colonoscopist, removes water mainly during withdrawal. WE, which has evolved from WI, removes water mainly during insertion using new skills. WE, but not WI, provides insertion cleansing and improves bowel cleanliness. Reduced cleaning-related multi-tasking distractions from search for polyps, but not improved bowel cleanliness per se, is linked significantly to the improved adenoma detection rate (ADR) with WE (UEGJ Dec 5, 2018). In a pooled data analysis of three reports, WE significantly increased right colon adenoma detection rate (rADR) compared with WI and air insufflation (AI) (DDW 2019). However, the significant and independent factors that account for the increased rADR have not been described. We aim to assess the factors associated with an increase in rADR by multiple logistic regression analysis of the pooled individual patient data in the three aforementioned reports. METHODS: Three reports with data on rADR comparing WE with WI and AI were identified. The demographic and procedural data were extracted, pooled to optimize sample size and analyzed. Multiple logistic regression analysis was conducted using backward likelihood ratio selection procedure. RESULTS: Table 1 shows comparable pooled demographic data. Table 2 shows volume infused and suctioned confirm use of WE, WI and AI. WE has highest cleanliness scores, least use of adjunct maneuvers, and highest willingness to repeat. rADR of WE (22.4%) is significantly higher than those of WI (17.4%) (P = 0.009) and AI (15.7%) (P &lt; 0.001); but WI and AI are similar (reported 2019 DDW). Table 3 shows multiple logistic regression analysis (unreported): older age, shorter insertion time, longer withdrawal time, and WE; but not WI (when compared with AI), are significant and independent factors associated with a higher rADR. CONCLUSION: WE, compared with AI, was significantly associated with a higher rADR, adjusting for other confounding factors. The improved quality adds value to WE colonoscopy, and justifies the call to incorporate WE into colorectal cancer prevention programs. Since WE = WI + suction of water during insertion, the higher rADR of WE provides incentive for transitioning from WI to WE. The impact of WE on right colon interval cancers warrants further assessment.

Artificial intelligence for colorectal polyp detection: are we ready for prime time?

Colorectal cancer (CRC) is a leading cause of cancer-related mortality worldwide. Colonoscopy is protective against CRC through the detection and removal of neoplastic polyps. Unfortunately, the procedure is highly operator dependent with significant miss rates for polyps. Artificial intelligence (AI) and computer-aided detection software offers a promising solution by providing real-time assistance to highlight lesions that may otherwise be overlooked. Rapid advances have occurred in the field with recent prospective clinical trials demonstrating an improved adenoma detection rate (ADR) with AI assistance. Deployment in routine clinical practice is possible in the near future although further robust clinical trials are necessary and important practical challenges relating to real-world implementation must be addressed.

Endocuff Vision is safe to use for dysplasia surveillance in patients with ulcerative colitis: a feasibility study.

Background and study aims Endocuff Vision improves adenoma detection rates in patients without inflammatory bowel disease. This study aimed to investigate the safety and feasibility of Endocuff Vision-assisted high-definition white light endoscopy (HDWLE) with dye-spray chromoendoscopy for detection of dysplasia in patients with ulcerative colitis. Patients and methods Patients with clinically inactive ulcerative colitis due for dysplasia surveillance were recruited. Procedural endpoints included safety, cecal intubation rate (CIR), terminal ileum intubation rate (TIR), withdrawal time, polyp detection rate, dysplasia detection rate (DDR), and sessile serrated lesion detection rate. Results Twenty-five patients (9 female, median age 57 [range 28 – 82] years) were studied. Endocuff Vision-assisted HDWLE was completed in all participants, with a CIR of 100 %, in a median 4 minutes (range 2 – 16), and a TIR of 88% in a median of 6.5 minutes (range 3 – 19). Median withdrawal time was 18 minutes (range 10 – 55), including application of dye-spray, biopsies and polypectomy. The Mayo Endoscopic subscore was 0 in 11, 1 in 9, and 2 in 5 patients. The DDR was 24 % (6 patients had a total of 12 dysplastic lesions) and sessile serrated lesion detection rate was 12 % (3 patients had a total of 4 sessile serrated polyps). No serious adverse events occurred, with one patient developing clinically insignificant minor mucosal bleeding. Conclusion Endocuff Vision-assisted HDWLE is feasible and safe in patients with ulcerative colitis undergoing dysplasia surveillance. Further studies are required to assess superiority of this technique compared with standard high-definition white light endoscopy with chromoendoscopy.

The significance of retroflexion technique in the right colon on adenoma detection rates during colonoscopy

Background and aimRight colon adenomas can easily missed with significant adenoma miss rate particularly when they are located behind the haustral folds and anatomical flexures. The aim of this study was to assess the significance of retroflexion technique in the right colon for improving adenoma detection rates compared with forward-view technique. MethodsA total of 200 patients scheduled for elective colonoscopy were recruited. During the standard forward-view examination, the colonoscope was withdrawn from the cecum to the hepatic flexure while under meticulous observation. Subsequently, the cecum was reintubated and the right side of the colon was assessed in the retroflexed-view to the hepatic flexure. The primary outcome of this study was comparison of the adenoma detection rates and adenoma miss rate of the retroflexed-view versus forward-view examination of the right colon. ResultsOf the 200 enrolled patients, retroflexion was successful in 182 (91%). Forward-view examination of the right colon detected 88 polyps, of which 66 were adenomas yielding a polyp and adenoma detection rates of 25.5% and 19%, respectively. Additionally, retroflexion detected a further 30 polyps of which 23 were adenomas, accordingly improving the polyp and adenoma detection rates to 29.5% and 25%, respectively. Furthermore, the polyp and adenoma miss rate in the right colon was 24.1% and 25.8% respectively. ConclusionColonoscopy with right-sided retroflexion after forward-view examination significantly increases the detection of adenomas compared with standard forward-view examination with a high success rate and small risk of adverse events.

Su1698 A PROSPECTIVE SINGLE CENTER TRIAL EVALUATING CAP ASSISTED COLONOSCOPY WITH TREMBLING DURING WITHDRAWAL VERSUS STANDARD COLONOSCOPY : AS A NOVEL TECHNIQUE TO FIND RIGHT COLON ADENOMA

Cap assisted colonoscopy (CAC) can flatten and depress colonic folds to decrease the blind mucosal areas. Although CAC expects to improve adenoma detection rate (ADR), the outcomes are inconsistent. We developed cap assisted colonoscopy with trembling technique (CACT) to improve ADR by shaking the operating hand slightly during withdrawal. The purpose of this study was to compare CACT with standard colonoscopy (SC) for ADR.

To cap/cuff or ring: do distal attachment devices improve the adenoma detection?

ABSTRACTIntroduction: Colonoscopy reduces the risk of colorectal cancer, by interrupting the adenoma–carcinoma sequence enabling the detection and removal of adenomas before they turn into colorectal cancer. Colonoscopy has its limitations as adenoma miss rates as high as 25% have been reported. The reasons for missed pathology are complicated and multi-factorial. The recent drive to improve adenoma detection rates has led to a plethora of new technologies.Areas covered: An increasing number of advanced endoscopes and distal attachment devices have appeared in the market. Advanced endoscopes aim to improve mucosal visualization by widening the field of view. Distal attachment devices aim to increase adenoma detection behind folds by flattening folds on withdrawal. In this review article, we discuss the three following distal attachment devices: the transparent cap, the Endocuff, and the Endoring.Expert commentary: The authors believe that the distal attachment devices will have a greater benefit for endoscopists with low baseline adenoma detection rates.

The benefit of adding oral simethicone in bowel preparation regimen for the detection of colon adenoma: A systematic review and meta-analysis.

Simethicone is an anti-foaming agent commonly used during colonoscopy. Although several randomized trials have shown that oral simethicone in the bowel preparation regimen may improve bowel cleanness, whether it improves adenoma detection rate (ADR) or polyp detection rate remains undetermined. The aim of this study was to determine if oral simethicone in bowel preparation regimen before colonoscopy improves the ADR. A comprehensive literature review was conducted using PubMed, SDOL, Cochrane Library, and ProQuest databases through December 2017. Randomized controlled trials that compared bowel preparation regimens with simethicone versus those without it were included. Effect estimates from each study were extracted and underwent meta-analysis using appropriate models. The primary outcomes were ADR and polyp detection rate, and secondary outcomes included bowel preparation, bubble score, and withdrawal time. Twelve published randomized controlled studies with 6003 participants were included for meta-analysis. There was no difference in the overall ADR (pooled risk ratio=1.06, 95% confidence interval=0.91-1.24) and right-side ADR (risk ratio=1.50, 95% confidence interval=0.82-2.75) between the groups with or without simethicone. However, the addition of simethicone improved adenoma detected per patient (2.20±1.36 vs 1.63±0.89) according to one of the included studies. Meta-regression revealed that the baseline ADR <25% of the included studies was associated with significant benefit of oral simethicone; the number needed to treat was 15. The adjunction of oral simethicone significantly improved bowel preparation quality and might benefit adenoma detection in specific settings with low baseline ADR.