Prototype Extra Wide Angle View Colonoscope: A Randomized Controlled Multicenter Simulated Study Using Anatomic Colorectal Models Toshio Uraoka*, Shinji Tanaka, Takayuki Matsumoto, Takahisa Matsuda, Shiro Oka, Tomohiko Moriyama, Kazuhide Yamamoto, Yutaka Saito Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan; Department of Endoscopy, Okayama University Hospital, Okayama, Japan; Department of Endoscopy, Hiroshima University Hospital, Hiroshioma, Japan; Department of Medicine and Clinical Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan; Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan Background and Aim: Colonoscopy is the preferred screening method for colorectal cancer, but previously reported rates of undetected colorectal polyps have been approximately 25%. A major contributing factor may be that undetected lesions are located behind haustra folds, flexures or rectal valves. Several different techniques including chromoendoscopy, cap-fitted colonoscopy and retroflexion of the colonoscope have been used to improve polyp detection. The aim of this randomized controlled multicenter simulated study was to evaluate the efficacy of a prototype extra wide angle view colonoscope for polyp detection. Method: Two colonoscopes were used including a commercially available standard colonoscope with a 140°-angle lens; and the prototype colonoscope with a 144°-to-232°-angle lateral-backward view lens and a 140°angle forward view lens. Views from both lenses are simultaneously constructed and displayed on a video monitor as a single image. Two anatomic colorectal models were prepared each with eight polyps that were positioned in obvious locations and eight polyps that were placed behind folds. Thirty-two participating endoscopists from four institutions including 16 experienced endoscopists ( 5,000 colonoscopies) and 16 less experienced endoscopists ( 5,000 colonoscopies) conducted examinations of the two models in random order using the two colonoscopes. All polyps were 3mm or 5mm in diameter with a round shape and dark red in color, but varied in their individual markings. Insertion and withdrawal examination times and detected polyps were recorded by an independent observer. The primary outcome measurement was the detection rate of simulated colorectal polyps. Results: Although the mean withdrawal times were not significantly different for the two colonoscopes (6.5 vs. 6.7 minutes; p 0.60), the detection rate with the prototype colonoscope was significantly higher than the detection rate with the standard colonosocpe (68% vs. 51%; p 0.0001). While there was no statistical difference in the detection rate of polyps located behind folds between the two colonoscopes when used by experienced endoscopists (61% vs. 51%; p 0.11), the detection rate for such polyps with the prototype colonoscope was significantly higher than the detection rate with the standard colonosocpe (63% vs. 43%; p 0.003) when used by less experienced endoscopists. There were no significant differences in insertion times for the two colonoscopes even for less experienced endoscopists. Conclusion: Based on this study’s results, the prototype colonoscope may represent a considerable advancement in colorectal polyp detection particularly for less experienced endoscopists, but a randomized controlled multicenter trial should be conducted to fully evaluate its efficacy for screening and surveillance purposes.