Detection Of Serrated Lesions Research Articles

A comprehensive RCT in screening, surveillance, and diagnostic AI-assisted colonoscopies (ACCENDO-Colo study).

Adenoma detection rate (ADR) serves as a primary quality metric in colonoscopy. Various computer-aided detection (CADe) tools have emerged, yielding diverse impacts on ADR across different demographic cohorts. This study aims to evaluate a new CADe system in patients undergoing colonoscopy. This is an Italian multicenter randomized control trial (RCT) that included patients aged 40-85 scheduled for screening, surveillance or diagnostic colonoscopy randomly assigned to CADe or standard colonoscopy (SC). Patients with a Boston Bowel Preparation Scale < 2 in any segment were excluded. The primary outcome was ADR in both groups. Secondary outcomes included adenoma per colonoscopy (APC), polyp per colonoscopy (PPC) and sessile serrated lesion detection rate (SSLDR). 1228 patients were enrolled of whom 70 were excluded for inadequate bowel cleansing or missed cecal intubation. Therefore, 1158 subjects (578 CADe vs 580 SC) were included in the final analysis. ADR was significantly higher in CADe than in the control group (50.2 % vs 40.5 %, p = 0.001). CADe also significantly increased PPC and APC (1.64 ± 2.03 vs 1.23 ± 1.72, p < 0.001; 1.16 ± 1.82 vs 0.80 ± 1.46 p < 0.001; respectively). No significant differences were found in SSLDR between CADe and SC (12.1 % vs 11.0 %, p = 0.631). The results of this RCT indicate that AI-assisted colonoscopy significantly improved ADR in a non-selected population undergoing colonoscopy without causing any significant delay in procedure time or increasing the detection of nonneoplastic lesions. (Ethical committee approval: NCT05862948).

Terminal ileal intubation is not necessary in routine colonoscopy: data from a large-scale retrospective study.

Terminal ileal intubation (TII) demonstrates a complete colonoscopy, but whether it should be performed in routine colonoscopies remains uncertain. We aimed to explore the diagnostic yield of TII in routine colonoscopy and investigate the association of TII and the detection of lesion. We conducted a retrospective study included patients who underwent colonoscopy with cecal intubation at our endoscopic center between November 1 2022 and July 31 2023. Macroscopic and histologic findings of terminal ileum were recorded. We used propensity score matching to adjust for differences between groups and further analyzed the difference of polyp detection rate (PDR), adenoma detection rate (ADR), sessile serrated lesion detection rate (SSDR) and lesion detection rate of right-sided colon, cecum and ascending colon between patients underwent TII or not. There were 13,372 patients with cecal intubation colonoscopy, including 7599 (56.8%) with TII and 5773 (43.2%) without TII. Abnormal endoscopic findings were observed in 150 of 7599 unselected individuals and only 7 of these cases were regarded as pathologically significant. Likewise, abnormal endoscopic findings were found in 62 of 3502 asymptomatic individuals with 54 nonspecific ileitis determined by histopathology. After PSM, there were no significant differences in PDR (52.0% vs. 52.3%, P = 0.761), ADR (30.9% vs. 32.2%, P = 0.208), SSDR (1.6% vs. 1.5%, P = 0.541), right-sided lesion detection rate (16.9% vs. 16.8%, P = 0.908), lesion detection rate of cecum (4.9% vs. 4.7%, P = 0.613) and ascending colon (13.5% vs. 13.2%, P = 0.656) between the two groups. TII was not necessary in routine colonoscopy, owing to the limited diagnostic value and lack of superiority on lesion detection.

Association Between Longer Cecal Intubation Time and Detection and Miss Rate of Colorectal Neoplasms.

Background/Aims: A longer cecal intubation time (CIT) occurs during colonoscopy under difficult insertion conditions, which may hinder meticulous mucosal observation. However, whether a longer CIT has detrimental effects on the detection of adenomas remains unclear. We evaluated the effects of CIT on the detection and miss rates of colorectal neoplasms in asymptomatic participants. Methods: Healthy examinees who underwent colonoscopy between March and July 2011, August 2015, and December 2016 were retrospectively enrolled. The primary outcome was the adenoma detection rate (ADR) across CIT quartiles, while the secondary outcomes included the mean number of adenomas, advanced ADR (AADR), clinically significant serrated lesion (CSSP) detection, adenoma miss rate (AMR), miss rate of CSSPs and any colorectal neoplasms, and the mean number of missed colorectal neoplasms in relation to CIT. Results: Overall, 12,402 participants were classified into quartiles according to the CIT. The longer the CIT, the lower the ADR (p < 0.001), AADR (p = 0.004), and mean number of adenomas (p < 0.001). The CSSP detection rate was not associated with CIT. On follow-up colonoscopy, AMR showed marginal increase with longer CIT (p = 0.065). The missed rates of CSSPs (p = 0.002) and colorectal neoplasms (p = 0.001) also increased with longer CIT. In the multivariate analysis, CIT was significantly associated with ADR, AADR, and AMR. Conclusions: Longer CIT was associated with lower ADR and higher AMR. Meticulous inspection is important for high-quality colonoscopy, particularly in patients requiring a longer CIT.

Online patient endoscopy education platform improves outpatient bowel preparation quality: Retrospective observational study.

Background and study aims High-quality bowel preparation is integral to high-quality colonoscopy and adenoma detection. Studies evaluating the effect of pre-colonoscopy educational videos on bowel preparation quality have been variable. We investigated whether augmenting bowel preparation education using our professionally produced, patient-oriented, online educational video series would improve preparation quality, reduce need for repeat procedures, and improve adenoma detection rate (ADR). Patients and methods We conducted a pilot, retrospective, single-center observational study using endoscopy data from a tertiary hospital. Colonoscopy outcomes were compared between two discrete 6-month study periods, before (control group) and after (video group) implementation of the online video intervention. All patients received standard-of-care written and verbal instructions. The video group received a link providing access to the video platform. Primary outcome was adequacy of bowel preparation (defined by the Aronchick Scale). Secondary outcomes included rate of repeat colonoscopy due to inadequate preparation, ADR, and sessile serrated lesion (SSL) detection rate. Results The video intervention group had a lower rate of inadequate bowel preparation compared with the control group (6.3% vs 9.8%, P = 0.018). There was no difference between groups in rate of repeat colonoscopies due to inadequate preparation ( P = 0.62), ADR ( P = 0.11), or SSL detection rate ( P = 0.94). Multivariable analysis did not reveal any independent predictors of bowel preparation quality. Conclusions Our study supports the addition of a novel patient-oriented online educational video resource as an effective tool in enhancing bowel preparation adequacy while maintaining provision of high-quality colonoscopy.

The impact of linked color imaging on adenoma detection rate in colonoscopy: a systematic review and meta-analysis.

Colorectal cancer prevention relies on surveillance colonoscopy, with the adenoma detection rate as a key factor in examination quality. Linked color imaging (LCI) enhances lesion contrast and improves the examination performance. This systematic review and meta-analysis aimed to evaluate the effect of LCI on adenoma detection rate in adults who underwent colonoscopy. We searched the Medline, PubMed, BIREME, LILACS, and Scientific Electronic Library Online databases for randomized controlled trials comparing the use of LCI versus white light (WL), published up to March 2023. The outcomes included lesion characteristics, number of adenomas per patient, and the additional polyp detection rate. Sixteen studies were included in the analysis, which showed that LCI was more accurate than WL in detecting adenomas, with an increased number of adenomas detected per patient. Although LCI performed well in terms of lesion size, morphology, and location, the subgroup analyses did not reveal any statistically significant differences between LCI and WL. The addition of LCI did not result in significant improvements in the detection of serrated lesions, and there were no differences in the withdrawal time between groups. LCI has been shown to be effective in detecting colonic lesions, improving the number of adenomas detected per patient and improving polyp detection rate without negatively affecting other quality criteria in colonoscopy.

S526 Evaluation of the Impact of Endoscopic Education With Endoscopist-Specific Scorecard Feedback on the Sessile Serrated Lesion Detection Rate (SSLDR)

S526 Evaluation of the Impact of Endoscopic Education With Endoscopist-Specific Scorecard Feedback on the Sessile Serrated Lesion Detection Rate (SSLDR)

Practical utility of linked color imaging in colonoscopy: Updated literature review.

The remarkable recent developments in image-enhanced endoscopy (IEE) have significantly contributed to the advancement of diagnostic techniques. Linked color imaging (LCI) is an IEE technique in which color differences are expanded by processing image data to enhance short-wavelength narrow-band light. This feature of LCI causes reddish areas to appear redder and whitish areas to appear whiter. Because most colorectal lesions, such as neoplastic and inflammatory lesions, have a reddish tone, LCI is an effective tool for identifying colorectal lesions by clarifying the redder areas and distinguishing them from the surrounding normal mucosa. To date, eight randomized controlled trials have been conducted to evaluate the effectiveness of LCI in identifying colorectal adenomatous lesions. The results of a meta-analysis integrating these studies demonstrated that LCI was superior to white-light endoscopy for detecting colorectal adenomatous lesions. LCI also improves the detection of serrated lesions by enhancing their whiteness. Furthermore, accumulating evidence suggests that LCI is superior to white-light endoscopy for the diagnosis of the colonic mucosa in patients with ulcerative colitis. In this review, based on a comprehensive search of the current literature since the implementation of LCI, the utility of LCI in the detection and diagnosis of colorectal lesions is discussed. Additionally, the latest data, including attempts to combine artificial intelligence and LCI, are presented.

Effectiveness of a novel artificial intelligence-assisted colonoscopy system for adenoma detection: a prospective, propensity score-matched, non-randomized controlled study in Korea.

The real-world effectiveness of computer-aided detection (CADe) systems during colonoscopies remains uncertain. We assessed the effectiveness of the novel CADe system, ENdoscopy as AI-powered Device (ENAD), in enhancing the adenoma detection rate (ADR) and other quality indicators in real-world clinical practice. We enrolled patients who underwent elective colonoscopies between May 2022 and October 2022 at a tertiary healthcare center. Standard colonoscopy (SC) was compared to ENAD-assisted colonoscopy. Eight experienced endoscopists performed the procedures in randomly assigned CADe- and non-CADe-assisted rooms. The primary outcome was a comparison of ADR between the ENAD and SC groups. A total of 1,758 sex- and age-matched patients were included and evenly distributed into two groups. The ENAD group had a significantly higher ADR (45.1% vs. 38.8%, p=0.010), higher sessile serrated lesion detection rate (SSLDR) (5.7% vs. 2.5%, p=0.001), higher mean number of adenomas per colonoscopy (APC) (0.78±1.17 vs. 0.61±0.99; incidence risk ratio, 1.27; 95% confidence interval, 1.13-1.42), and longer withdrawal time (9.0±3.4 vs. 8.3±3.1, p<0.001) than the SC group. However, the mean withdrawal times were not significantly different between the two groups in cases where no polyps were detected (6.9±1.7 vs. 6.7±1.7, p=0.058). ENAD-assisted colonoscopy significantly improved the ADR, APC, and SSLDR in real-world clinical practice, particularly for smaller and nonpolypoid adenomas.

Diagnostic Performance of Stool-based Testing for Colorectal Lesions Among Average-risk Individuals: A Real-world Evidence Study.

We assessed the real-world performance of stool-based tests (SBTs) for colorectal cancer screening. Retrospective review of average-risk individuals with positive SBT for advanced neoplasia (adenocarcinoma, advanced adenoma, and/or advanced serrated lesions) detection at follow-up colonoscopy. There was no statistical difference in the detection of advanced neoplasia (P= 0.16) between SBTs [30.7% for multitargeted stool DNA (mt-sDNA) vs 22.8% for fecal immunochemical test]. However, there was a significant difference in the detection of advanced serrated lesions (11.3% for mt-sDNA vs 1.8% for fecal immunochemical test, P< 0.001). There was no difference between SBTs for advanced neoplasia detection, though mt-sDNA detected significantly more advanced serrated lesions.

Linked color imaging improves colorectal lesion detection especially for low performance endoscopists: An international trial in Asia.

Linked color imaging (LCI) is an image-enhanced endoscopy technique that accentuates the color difference between red and white, potentially improving the adenoma detection rate (ADR). However, it remains unclear whether LCI performance in detecting colorectal lesions differs based on endoscopists' experience levels. We aimed to evaluate the differences in LCI efficacy based on the experience levels of endoscopists by conducting an exploratory analysis. In this post hoc analysis of an international randomized controlled trial comparing the detection of adenoma and other lesions using colonoscopy with LCI and high-definition white light imaging (WLI), we included patients from 11 institutions across four countries/regions: Japan, Thailand, Taiwan, and Singapore. We retrospectively reviewed differences in the lesion detection of LCI according to endoscopists' colonoscopy history or ADR. We included 1692 and 1138 patients who underwent colonoscopies performed by 54 experts (experience of ≥5000 colonoscopies) and by 43 non-experts (experience of <5000 colonoscopies), respectively. Both expert and non-expert groups showed a significant improvement in ADR with LCI compared to WLI (expert, 61.7% vs 46.4%; P<0.001; non-expert, 56.6% vs 46.4%; P<0.001). LCI had no effect on sessile serrated lesion detection rate in non-experts (3.1% vs 2.5%; P=0.518). LCI significantly improved detection rates in endoscopists with relatively low detection performance, defined as an ADR<50%. This exploratory study analyzed data from a previous trial and revealed that LCI is useful for both experts and non-experts and is even more beneficial for endoscopists with relatively low detection performance using WLI.

Relative Efficacies of Interventions to Improve the Quality of Screening-Related Colonoscopy: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

Significant variability exists in colonoscopy quality indicators, including adenoma detection rate (ADR). We synthesized evidence from randomized trials in a network meta-analysis on interventions to improve colonoscopy quality. We included trials from database inceptions to September 25, 2023, of patients undergoing screening-related colonoscopy and presented efficacies of interventions within domains (periprocedural parameters, endoscopist-directed interventions, intraprocedural techniques, endoscopic technologies, distal attachment devices, and additive substances) compared to standard colonoscopy. The primary outcome was ADR. We used a Bayesian random-effects model using Markov-chain Monte Carlo simulation, with 10,000 burn-ins and 100,000 iterations. We calculated odds ratios with 95% credible intervals and present surface under the cumulative ranking (SUCRA) curves. We included 124 trials evaluating 37 interventions for the primary outcome. Nine interventions resulted in statistically significant improvements in ADR compared to standard colonoscopy (9-minute withdrawal time, dual observation, water exchange, i-SCAN [Pentax Ltd], linked color imaging, computer-aided detection, Endocuff [Olympus Corp], Endocuff Vision [Olympus Corp], and oral methylene blue). Dual observation (SUCRA, 0.84) and water exchange (SUCRA, 0.78) ranked highest among intraprocedural techniques; i-SCAN (SUCRA, 0.95), linked color imaging (SUCRA, 0.85), and computer-aided detection (SUCRA, 0.78) among endoscopic technologies; WingCap (A&A Medical Supply LLC) (SUCRA, 0.87) and Endocuff (SUCRA, 0.85) among distal attachment devices and oral methylene blue (SUCRA, 0.94) among additive substances. No interventions improved detection of advanced adenomas, and only narrow-band imaging improved detection of serrated lesions (odds ratio, 2.94; 95% credible interval, 1.46-6.25). Several interventions are effective in improving adenoma detection and overall colonoscopy quality, many of which are cost-free. These results can inform endoscopists, unit managers, and endoscopy societies on relative efficacies.

A128 OPTIMIZED COMPUTER ASSISTED TECHNIQUE FOR INCREASING ADENOMA DETECTION DURING COLONOSCOPY: A RANDOMIZED CONTROLLED TRIAL

Abstract Background Efforts to improve colonoscopy have recently focused on improving adenoma detection interventions such as artificial intelligence (CADe) that have demonstrated improvements in Adenoma Detection Rates (ADR). Although studies have focused on implementation of one intervention at a time. Aims We evaluated an optimized computer assisted technique (CADopt) versus standard colonoscopy to improve ADR during colonosocopy. Methods A prospective randomized controlled trial was conducted enrolling adults (45–80 years) undergoing elective colonoscopy. Participants were randomized (1:1) to the intervention group (CADopt, and control group. In the CADopt group, endoscopists used a computer aided polyp detection combined with linked colour imaging, water exchange colonoscopy, and cecal retroflexion. In the control group, standard colonoscopy was performed. Primary outcome was Adenoma Detection Rate (ADR) in the intervention and control groups. Secondary outcomes included advanced ADR (AADR) and sessile serrated lesion detection rates (SDR). Results A total of 467 patients were recruited and randomized (CADopt group 229 patients, 50.2% female vs 238 patients, 48.3% female in the control group). ADR was 49.3% (95%CI 42.7-56.0) for the CADopt group vs 38.2% (95%CI 32.0-44.7) for the control group (p=0.016). AADR and SDR were 13.1% (95%CI 9.0-18.2) and 6.6% (95%CI 3.7-10.6) for the CADopt group versus 8.0% (95%CI 4.9-12.2), and 7.1% (95%CI 4.2-11.1) for the control group, respectively. Conclusions Using an optimized computer assisted technique led to significant improvements in ADR and a trend towards AADR improvements. Funding Agencies Fujifilm

Use of a Novel Artificial Intelligence System Leads to the Detection of Significantly Higher Number of Adenomas During Screening and Surveillance Colonoscopy: Results From a Large, Prospective, US Multicenter, Randomized Clinical Trial.

Adenoma per colonoscopy (APC) has recently been proposed as a quality measure for colonoscopy. We evaluated the impact of a novel artificial intelligence (AI) system, compared with standard high-definition colonoscopy, for APC measurement. This was a US-based, multicenter, prospective randomized trial examining a novel AI detection system (EW10-EC02) that enables a real-time colorectal polyp detection enabled with the colonoscope (CAD-EYE). Eligible average-risk subjects (45 years or older) undergoing screening or surveillance colonoscopy were randomized to undergo either CAD-EYE-assisted colonoscopy (CAC) or conventional colonoscopy (CC). Modified intention-to-treat analysis was performed for all patients who completed colonoscopy with the primary outcome of APC. Secondary outcomes included positive predictive value (total number of adenomas divided by total polyps removed) and adenoma detection rate. In modified intention-to-treat analysis, of 1,031 subjects (age: 59.1 ± 9.8 years; 49.9% male), 510 underwent CAC vs 523 underwent CC with no significant differences in age, gender, ethnicity, or colonoscopy indication between the 2 groups. CAC led to a significantly higher APC compared with CC: 0.99 ± 1.6 vs 0.85 ± 1.5, P = 0.02, incidence rate ratio 1.17 (1.03-1.33, P = 0.02) with no significant difference in the withdrawal time: 11.28 ± 4.59 minutes vs 10.8 ± 4.81 minutes; P = 0.11 between the 2 groups. Difference in positive predictive value of a polyp being an adenoma among CAC and CC was less than 10% threshold established: 48.6% vs 54%, 95% CI -9.56% to -1.48%. There were no significant differences in adenoma detection rate (46.9% vs 42.8%), advanced adenoma (6.5% vs 6.3%), sessile serrated lesion detection rate (12.9% vs 10.1%), and polyp detection rate (63.9% vs 59.3%) between the 2 groups. There was a higher polyp per colonoscopy with CAC compared with CC: 1.68 ± 2.1 vs 1.33 ± 1.8 (incidence rate ratio 1.27; 1.15-1.4; P < 0.01). Use of a novel AI detection system showed to a significantly higher number of adenomas per colonoscopy compared with conventional high-definition colonoscopy without any increase in colonoscopy withdrawal time, thus supporting the use of AI-assisted colonoscopy to improve colonoscopy quality ( ClinicalTrials.gov NCT04979962).

Serum DNA methylome of the colorectal cancer serrated pathway enables non-invasive detection.

The clinical relevance of the colorectal cancer serrated pathway is evident, but the screening of serrated lesions remains challenging. We aimed to characterize the serum methylome of the serrated pathway and to evaluate circulating cell-free DNA (cfDNA) methylomes as a potential source of biomarkers for the non-invasive detection of serrated lesions. We collected serum samples from individuals with serrated adenocarcinoma (SAC), traditional serrated adenomas, sessile serrated lesions, hyperplastic polyps and individuals with no colorectal findings. First, we quantified cfDNA methylation with the MethylationEPIC array. Then, we compared the methylation profiles with tissue and serum datasets. Finally, we evaluated the utility of serum cfDNA methylation biomarkers. We identified a differential methylation profile able to distinguish high-risk serrated lesions from no serrated neoplasia, showing concordance with tissue methylation from SAC and sessile serrated lesions. Serum methylation profiles are pathway-specific, clearly separating serrated lesions from conventional adenomas. The combination of ninjurin 2 (NINJ2) and glutamate-rich 1 (ERICH1) methylation discriminated high-risk serrated lesions and SAC with 91.4% sensitivity (64.4% specificity), while zinc finger protein 718 (ZNF718) methylation reported 100% sensitivity for the detection of SAC (96% specificity). This is the first study exploring the serum methylome of serrated lesions. Differential methylation of cfDNA can be used for the non-invasive detection of colorectal serrated lesions.

Artificial intelligence fails to improve colonoscopy quality: A single centre retrospective cohort study

BACKGROUND Limited data currently exists on the clinical utility of Artificial Intelligence Assisted Colonoscopy (AIAC) outside of clinical trials. AIM To evaluate the impact of AIAC on key markers of colonoscopy quality compared to conventional colonoscopy (CC). METHODS This single-centre retrospective observational cohort study included all patients undergoing colonoscopy at a secondary centre in Brisbane, Australia. CC outcomes between October 2021 and October 2022 were compared with AIAC outcomes after the introduction of the Olympus Endo-AID module from October 2022 to January 2023. Endoscopists who conducted over 50 procedures before and after AIAC introduction were included. Procedures for surveillance of inflammatory bowel disease were excluded. Patient demographics, proceduralist specialisation, indication for colonoscopy, and colonoscopy quality metrics were collected. Adenoma detection rate (ADR) and sessile serrated lesion detection rate (SSLDR) were calculated for both AIAC and CC. RESULTS The study included 746 AIAC procedures and 2162 CC procedures performed by seven endoscopists. Baseline patient demographics were similar, with median age of 60 years with a slight female predominance (52.1%). Procedure indications, bowel preparation quality, and caecal intubation rates were comparable between groups. AIAC had a slightly longer withdrawal time compared to CC, but the difference was not statistically significant. The introduction of AIAC did not significantly change ADR (52.1% for AIAC vs 52.6% for CC, P = 0.91) or SSLDR (17.4% for AIAC vs 18.1% for CC, P = 0.44). CONCLUSION The implementation of AIAC failed to improve key markers of colonoscopy quality, including ADR, SSLDR and withdrawal time. Further research is required to assess the utility and cost-efficiency of AIAC for high performing endoscopists.

S419 Bi-Institutional Colonoscopy Quality Report Card Improves Adenoma and Sessile Serrated Lesion Detection Rates

S419 Bi-Institutional Colonoscopy Quality Report Card Improves Adenoma and Sessile Serrated Lesion Detection Rates

S319 Sessile Serrated Lesion Detection Rate in Individuals with Positive Fecal Immunohistochemical Test Undergoing Colonoscopy: Results from a Large Nationwide Veterans Affairs Database

S319 Sessile Serrated Lesion Detection Rate in Individuals with Positive Fecal Immunohistochemical Test Undergoing Colonoscopy: Results from a Large Nationwide Veterans Affairs Database

S322 Sessile Serrated Lesion Detection Rate in Individuals with Positive Fecal Immunohistochemical Test Undergoing Colonoscopy: A Systematic Review and Meta-Analysis

S322 Sessile Serrated Lesion Detection Rate in Individuals with Positive Fecal Immunohistochemical Test Undergoing Colonoscopy: A Systematic Review and Meta-Analysis

S728 Impact of a Polyp Detection Poster on Sessile Serrated Lesion Detection Rate

S728 Impact of a Polyp Detection Poster on Sessile Serrated Lesion Detection Rate

The Time Has Come to Adopt the Sessile Serrated Lesion Detection Rate as a Quality Metric.

The Time Has Come to Adopt the Sessile Serrated Lesion Detection Rate as a Quality Metric.