Endoscopy 2019; 51(04): S131
DOI: 10.1055/s-0039-1681557
ESGE Days 2019 ePoster podium presentations
Friday, April 5, 2019 10:30 – 11:00: Colonic polyps: detection ePoster Podium 4
Georg Thieme Verlag KG Stuttgart · New York

MUCOSAL FLATTENING ASSISTED COLONOSCOPY (FAC) FOR IMPROVING ADENOMA DETECTION RATE: A SYSTEMATIC REVIEW WITH PAIRWISE AND NETWORK META-ANALYSIS

C Marmo
1   Gastroenterology, Vanvitelli University of Naples, Naples, Italy
,
S Thayalasekaran
2   Gastroenterology, Queen Alexandra Hospital, Portsmouth, United Kingdom
,
B Pradeep
2   Gastroenterology, Queen Alexandra Hospital, Portsmouth, United Kingdom
,
P Gkolfakis
3   Gastroenterology, Attikon University Hospital, University of Athens School of Medicine, Athens, Greece
,
K Triantafyllou
3   Gastroenterology, Attikon University Hospital, University of Athens School of Medicine, Athens, Greece
,
C Hassan
4   Gastroenterology, Nuovo Regina Margherita Hospital, Rome, Italy
,
R Marmo
5   Gastroenterology, Hospital Curto, Polla (Salerno), Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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    Aims:

    Improving ADR is currently the central focus of quality improvement in colonoscopy. Fold flattening devices could ameliorate the ADR. Aims of study; to compare efficacy of mucosal flattening assisted colonoscopy vs. standard colonoscopy in improving adenoma detection rate.

    Methods:

    Full text Randomized Clinical Trials (RCT) included in the analysis. Pairwise and then network meta-analysis performed; relative ranking was evaluated by surface under the cumulative ranking curves (SUCRA).

    Results:

    13 articles included; total of 8243 patients. Endocuff (EC), EndoRing (ER), G- Eye and Standard Colonoscopy (SC) were compared. Pairwise meta analysis : SC vs. EC:

    EC, improved ADR with an OR of 1.36 (c.l.95% 1.12 to 1.60) p = 0.001. A significant Heterogeneity was present: sub grouping studies in three level of ADR in the SC, the OR between the two treatment arms were significantly different. When in SC the ADR> 40% no difference was present: OR 1.07 (c.l.95% 0.85 to 1.34) p =.184; when ADR>= 25% OR = 1.85 (c.l.95% 1.35 to 2.53) p = 0.000; when ADR was > 25 and < 41, OR = 1.43 (c.l.95% 1.13 to1.77) p = 0.014. SC vs. ER:

    no difference was observed between the two procedures OR = 1.063 (c.l. 95% 0.875 to 1.291) p = 0.540. SC vs. G-Eye:

    OR = 0.63 (c.l.95% 0.48 to 0.83) p =< 0.001. Network meta analysis ER vs EC indirect comparison provided a trend favoring EC: ADR Log OR =-0.33 (c.l. 95% -0.72 to 0.04) p < 0.08. G Eye device reach the higher (SUCRA) percentage of effectiveness: SUCRA Estimated Probabilities = 90.5 and the probability best = 78.1%; EC SUCRA = 67.8 and probability best 17.4%.

    Conclusions:

    Endocuff devices improve ADR when the ADR in SC is <= 40%. G Eye reach the higher probability to be best device for improving ADR.


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