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Meta-analysis indicates that add-on devices and new endoscopes reduce colonoscopy adenoma miss rate

Gkolfakis, Paraskevasa; Tziatzios, Georgiosa; Facciorusso, Antoniob; Muscatiello, Nicolab; Triantafyllou, Konstantinosa

European Journal of Gastroenterology & Hepatology: December 2018 - Volume 30 - Issue 12 - p 1482–1490
doi: 10.1097/MEG.0000000000001245
Original Articles: Gastroenterology

Introduction A variety of add-on devices and new-generation endoscopes have the potential to detect lesions ‘hidden’ behind colonic folds. We measured the effect of these new modalities on colonoscopy’s lesions miss rates by a meta-analysis of data from individual studies.

Materials and methods We performed literature searches in Medline and Cochrane Library for back-to-back randomized-controlled trials evaluating colonoscope add-on devices and new endoscopes in terms of lesions miss rates. The effect size on study outcomes is shown as relative risk (95% confidence interval).

Results We identified nine tandem studies with 1594 patients: seven evaluating add-on devices (one with cap, two with Endocuff, one with Endorings, one with Third-Eye Retroscope, two with G-EYE endoscope) and two evaluating the full-spectrum endoscopy system (FUSE) in comparison with conventional colonoscopy (CC). Overall, adenoma miss rate (AMR) was significantly lower with add-on devices/FUSE [0.33 (0.22–0.50), P<0.00001] compared with CC, the effect being similar among the add-on devices [0.35 (0.22–0.57), P<0.0001] and the FUSE [0.26 (0.15–0.46), P<0.00001] studies, respectively. Advanced AMR and polyp miss rate (PMR) were also significantly lower using add-on devices/FUSE [0.30 (0.21–0.44), P<0.0001 and 0.31 (0.13–0.79), P=0.01, respectively]. Use of add-on devices/FUSE scope was associated with significantly lower AMR and PMR in the proximal colon and it was associated with shortening of the colonoscopy surveillance interval.

Conclusion Our meta-analysis provides evidence that AMR, advanced AMR, and PMR are significantly lower using add-on to colonoscope devices and the full-spectrum endoscopy systems compared with CC. Heterogeneity among the included studies and the small number of detected advanced adenomas call for cautious interpretation of the results.

aHepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece

bGastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy

Part of this study was presented as an oral presentation during ESGE Days, Budapest, 20 April 2018.

Correspondence to Konstantinos Triantafyllou, MD, PhD, Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Rimini 1, 12462 Athens, Greece Tel: +30 210 583 2087; fax: +30 210 532 6454; e-mail: ktriant@med.uoa.gr

Received May 27, 2018

Accepted July 12, 2018

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.