Colorectal cancer remains the second leading cause of cancer death in the world. Incidence has declined as rates of screening colonoscopy have increased, but colonoscopy is not perfect. Low adenoma detection rates (ADR's) have been associated with increased interval cancers. Both optical and mechanical devices for improving ADR have shown promising results. Here we demonstrate a novel colonoscope with a 360° integrated view to improve visualization behind folds (Figure 1). The aim of this study is to compare polyp detection rates using the novel 360° scope and a standard forward only view (FOV) scope in colon models.
324 endoscopists around the US were enrolled in the study. 20 anatomic colon models (Champerlain Group, Great Barrington, MA) containing simulated 6–15 mm polyps were used. Polyps varied in number, location, and shape. Models were examined in a tandem fashion with the 360° scope and the FOV scope. Endoscopists were randomly assigned to perform the initial exam with either scope. The primary outcome was the number of polyps identified during withdrawal. Subgroup analysis was performed evaluating effects of order of examination, experience, and practice setting. Means were compared with a paired T-test and subgroups were compared with ANOVA.
153 endoscopists performed their initial exam with the 360° scope, and 171 with the FOV scope. The 360° view colonoscope identified significantly more polyps overall (13.2 vs 7.7, mean difference 5.5, P < 0.0001). Each individual endoscopist identified more polyps with the 360° scope. The difference persisted regardless of which scope was used first. The difference also persisted between endoscopists of different experience and practice environments (Table 1). The only statistically significant difference was between endoscopists stratified by years of training, in which the <5 year group had a larger difference in polyp detection (P = 0.0006).
This study shows that the 360° integrated view colonoscope is more effective at polyp detection than a traditional colonoscope in simulated models. The increased polyp detection is not dependent on experience level or practice environment. The expanded field of view allows endoscopists to identify polyps that may be missed by a traditional scope such as behind folds. Further studies in humans will be needed to prove safety/efficacy for clinical use but these initial results show promise for increasing ADR using this novel colonoscope.