Endoscopy 2018; 50(04): S16
DOI: 10.1055/s-0038-1637071
ESGE Days 2018 oral presentations
20.04.2018 – Colon: Improving detection
Georg Thieme Verlag KG Stuttgart · New York

META-ANALYSIS INDICATES THAT ADD-ON DEVICES AND NEW ENDOSCOPES REDUCE COLONOSCOPY ADENOMA MISS RATE

P Gkolfakis
1   Attikon University General Hospital, Hepatogastroenterology Unit, Athens, Greece
,
G Tziatzios
1   Attikon University General Hospital, Hepatogastroenterology Unit, Athens, Greece
,
A Facciorusso
2   Department of Medical Sciences, University of Foggia, Gastroenterology Unit, Foggia, Italy
,
N Muscatiello
2   Department of Medical Sciences, University of Foggia, Gastroenterology Unit, Foggia, Italy
,
K Triantafyllou
1   Attikon University General Hospital, Hepatogastroenterology Unit, Athens, Greece
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

Also available at
 
 

    Aims:

    Several add-on devices and new generation endoscopes promise to improve colonoscopy's outcomes by detecting polyps “hidden” behind the colonic folds. We aimed to measure the effect of these new modalities on colonoscopy's adenoma miss rate by meta-analyzing data from individual studies.

    Methods:

    We performed literature searches in MEDLINE and Cochrane Library for back-to-back randomized-controlled trials published as full papers in English language evaluating colonoscope add-on devices and new endoscopes in terms of adenoma miss rate (AMR) and advanced AMR (AAMR). The effect size on study outcomes, shown as RR (95% CI), was calculated using random effect model.

    Results:

    We identified 8 tandem studies with 1545 patients: six evaluating add-on devices (1 with cap-assisted colonoscopy, 2 with Endocuff, 1 with Endorings, 1 with Third-Eye Retroscope, 1 with the balloon-assisted G-EYE endoscope) and two evaluating the full spectrum endoscopy system (FUSE) in comparison to conventional colonoscopy. All studies enrolled mixed indications populations (screening, surveillance, symptomatic). AMR was significantly lower with add-on devices/FUSE [0.32 (0.21 – 0.50), p < 0.001; I 2= 68%] as compared to conventional colonoscopy; the effect being similar among the add-on devices [0.34 (0.20 – 0.58), p < 0.001; I 2= 72%] and the FUSE [0.26 (0.15 – 0.46), p < 0.001; I 2= 0%] studies, respectively. Meta-analysis of data from 7 studies showed that AAMR was also significantly lower using add-on devices/FUSE [0.29 (0.11 – 0.81), p = 0.02; I 2= 0%].

    Conclusions:

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


    #