Endoscopy 2024; 56(10): 759-767
DOI: 10.1055/a-2324-8807
Original article

Impact of linked color imaging on the proximal adenoma miss rate: a multicenter tandem randomized controlled trial (the COCORICO trial)

1   Digestive Endoscopy Unit, Pôle Digestif Paris Bercy, Clinique Paris-Bercy, Charenton-le-Pont, France
,
2   Gastroenterology and Digestive Endoscopy, Hôpital Européen Georges Pompidou, Paris, France
,
Bastien Perrot
3   UMR 1246 SPHERE (MethodS in Patient-centered outcomes and HEalth ResEarch), INSERM, Nantes University, Tours University, Nantes, France
,
Lucille Quénéhervé
4   Department of Gastroenterology and Hepatology, Brest University Hospital, Brest, France
,
Edouard Chabrun
5   Digestive Endoscopy Unit, Clinique Saint-Joseph, Trélazé, France
,
Stéphane Koch
6   Gastroenterology Unit, Besançon University Hospital, Besancon, France
,
7   Pôle DIGi-TUNED, Endoscopie Digestive, Centre Hospitalier Universitaire de Nice, Hôpital L’Archet 2, Nice, France
,
Gabriel Rahmi
2   Gastroenterology and Digestive Endoscopy, Hôpital Européen Georges Pompidou, Paris, France
,
Guillaume Velut
8   Center for Digestive Endoscopy, Sorbonne University, Saint Antoine Hospital, APHP, Paris, France
,
Maira Moreno-Garcia
9   Research and Development Unit, French Society of Digestive Endoscopy, Paris, France
,
Maryan Cavicchi
1   Digestive Endoscopy Unit, Pôle Digestif Paris Bercy, Clinique Paris-Bercy, Charenton-le-Pont, France
,
Xavier Dray
8   Center for Digestive Endoscopy, Sorbonne University, Saint Antoine Hospital, APHP, Paris, France
› Author Affiliations
Clinical Trial: Registration number (trial ID): NCT04112563, Trial registry: EU Clinical Trials Register (https://www.clinicaltrialsregister.eu), Type of Study: Prospective Multicenter Randomized Trial


Abstract

Background Missed lesions are common during standard colonoscopy and are correlated with post-colonoscopy colorectal cancer. Contrast-enhanced technologies have recently been developed to improve polyp detection. We aimed to evaluate the impact of linked color imaging (LCI) on the proximal adenoma miss rate in routine colonoscopy.

Methods This national, multicenter, tandem, randomized trial compared the outcomes of colonoscopy with white-light imaging (WLI) versus LCI for polyp detection in the right colon. Two consecutive examinations of the right colon (upstream of the hepatic flexure) were made with WLI and LCI by the same operator. First-pass examination by WLI or LCI was randomized 1:1 after cecal intubation. According to statistical calculations, 10 endoscopy units had to include approximately 700 patients. The primary outcome was proximal adenoma miss rate. Secondary outcomes were the proximal miss rates for sessile serrated lesions (SSL), advanced adenomas, and polyps.

Results 764 patients were included from 1 January 2020 to 22 December 2022, and 686 patients were randomized (345 WLI first vs. 341 LCI first). Both groups were comparable in terms of demographics and indications. The proximal adenoma miss rate was not significantly higher in the WLI-first group (36.7%) vs. the LCI-first group (31.8%) (estimated mean absolute difference: 4.9% [95%CI –5.2% to 15.0%], P = 0.34). There was also no significant difference in miss rates for SSLs, advanced adenomas, and polyps in the proximal colon.

Conclusions In contrast to previous data, this study does not support the benefit of LCI to the proximal adenoma miss rate in routine colonoscopy.

Supplementary Material



Publication History

Received: 05 January 2024

Accepted after revision: 13 May 2024

Accepted Manuscript online:
13 May 2024

Article published online:
21 June 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Corley DA, Jensen CD, Marks AR. et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med 2014; 370: 1298-1306 DOI: 10.1056/NEJMoa1309086. (PMID: 24693890)
  • 2 Kaminski MF, Thomas-Gibson S, Bugajski M. et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2017; 49: 378-397 DOI: 10.1177/2050640617700014. (PMID: 28507745)
  • 3 Rex DK, Johnson DA, Anderson JC. et al. American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected]. Am J Gastroenterol 2009; 104: 739-750 DOI: 10.1038/ajg.2009.104. (PMID: 19240699)
  • 4 Laiyemo AO, Doubeni C, Sanderson AK. et al. Likelihood of missed and recurrent adenomas in the proximal versus the distal colon. Gastrointest Endosc 2011; 74: 253-261 DOI: 10.1016/j.gie.2011.02.023. (PMID: 21549375)
  • 5 IJspeert JEG. Proximal serrated polyp detection rate and post-colonoscopy colorectal cancer: the missing link. Endoscopy 2023; 55: 442-443 DOI: 10.1055/a-2003-1068. (PMID: 36702129)
  • 6 Zessner-Spitzenberg J, Waldmann E, Jiricka L. et al. Comparison of adenoma detection rate and proximal serrated polyp detection rate and their effect on post-colonoscopy colorectal cancer mortality in screening patients. Endoscopy 2023; 55: 434-441
  • 7 Paggi S, Mogavero G, Amato A. et al. Linked color imaging reduces the miss rate of neoplastic lesions in the right colon: a randomized tandem colonoscopy study. Endoscopy 2018; 50: 396-402 DOI: 10.1055/a-0580-7405. (PMID: 29539651)
  • 8 Min M, Deng P, Zhang W. et al. Comparison of linked color imaging and white-light colonoscopy for detection of colorectal polyps: a multicenter, randomized, crossover trial. Gastrointest Endosc 2017; 86: 724-730 DOI: 10.1016/j.gie.2017.02.035. (PMID: 28286095)
  • 9 Paggi S, Radaelli F, Senore C. et al. Linked-color imaging versus white-light colonoscopy in an organized colorectal cancer screening program. Gastrointest Endosc 2020; 92: 723-730 DOI: 10.1016/j.gie.2020.05.044. (PMID: 32502550)
  • 10 Lovász BD, Szalai M, Oczella L. et al. Improved adenoma detection with linked color imaging technology compared to white-light colonoscopy. Scand J Gastroenterol 2020; 55: 877-883
  • 11 Kudo T, Horiuchi A, Kyodo R. et al. Linked colour imaging versus white-light colonoscopy for the detection of flat colorectal lesions: a randomized controlled trial. Colorectal Dis 2021; 23: 1414-1420 DOI: 10.1111/codi.15605. (PMID: 33645911)
  • 12 Oliveira Dos Santos CE, Malaman D, Pereira-Lima JC. et al. Impact of linked-color imaging on colorectal adenoma detection. Gastrointest Endosc 2019; 90: 826-834
  • 13 Miyaguchi K, Takabayashi K, Saito D. et al. Linked color imaging versus white light imaging colonoscopy for colorectal adenoma detection: a randomized controlled trial. J Gastroenterol Hepatol 2021; 36: 2778-2784 DOI: 10.1111/jgh.15539. (PMID: 33973300)
  • 14 Hasegawa I, Yamamura T, Suzuki H. et al. Detection of colorectal neoplasms using linked color imaging: a prospective, randomized, tandem colonoscopy trial. Clin Gastroenterol Hepatol 2021; 19: 1708-1716.e4
  • 15 Li J, Zhang D, Wei Y. et al. Colorectal sessile serrated lesion detection using linked color imaging: a multicenter, parallel randomized controlled trial. Clin Gastroenterol Hepatol 2023; 21: 328-336.e2
  • 16 Tanaka S, Omori J, Hoshimoto A. et al. Comparison of linked color imaging and white light imaging colonoscopy for detection of colorectal adenoma requiring endoscopic treatment: a single-center randomized controlled trial. J Nippon Med Sch 2023; 90: 111-120 DOI: 10.1272/jnms.JNMS.2023_90-117. (PMID: 36908124)
  • 17 Shinozaki S, Kobayashi Y, Hayashi Y. et al. Colon polyp detection using linked color imaging compared to white light imaging: systematic review and meta-analysis. Dig Endosc 2020; 32: 874-881 DOI: 10.1111/den.13613. (PMID: 31869487)
  • 18 Wang J, Ye C, Wu K. et al. The effect of linked color imaging for adenoma detection. A meta-analysis of randomized controlled studies. J Gastrointestin Liver Dis 2022; 31: 67-73 DOI: 10.15403/jgld-4027. (PMID: 35306544)
  • 19 Sun Y, Lv XH, Zhang X. et al. Linked color imaging versus white light imaging in the diagnosis of colorectal lesions: a meta-analysis of randomized controlled trials. Therap Adv Gastroenterol 2023; 16 DOI: 10.1177/17562848231196636. (PMID: 37810280)
  • 20 Lai EJ, Calderwood AH, Doros G. et al. The Boston Bowel Preparation Scale: a valid and reliable instrument for colonoscopy-oriented research. Gastrointest Endosc 2009; 69: 620-625 DOI: 10.1016/j.gie.2008.05.057. (PMID: 19136102)
  • 21 The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58: S3-43 DOI: 10.1016/s0016-5107(03)02159-x. (PMID: 14652541)
  • 22 Rex DK, Ahnen DJ, Baron JA. et al. Serrated lesions of the colorectum: review and recommendations from an expert panel. Am J Gastroenterol 2012; 107: 1315-1329
  • 23 Schlemper RJ, Riddell RH, Kato Y. et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000; 47: 251-255 DOI: 10.1136/gut.47.2.251. (PMID: 10896917)
  • 24 Cairns SR, Scholefield JH, Steele RJ. British Society of Gastroenterology; Association of Coloproctology for Great Britain and Ireland. et al. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002).. Gut 2010; 59: 666-689
  • 25 Calderwood AH, Jacobson BC. Comprehensive validation of the Boston Bowel Preparation Scale. Gastrointest Endosc 2010; 72: 686-692 DOI: 10.1016/j.gie.2010.06.068. (PMID: 20883845)
  • 26 Ball AJ, Johal SS, Riley SA. Position change during colonoscope withdrawal increases polyp and adenoma detection in the right but not in the left side of the colon: results of a randomized controlled trial. Gastrointest Endosc 2015; 82: 488-494
  • 27 Kamal F, Khan MA, Lee-Smith W. et al. Second exam of right colon improves adenoma detection rate: systematic review and meta-analysis of randomized controlled trials. Endosc Int Open 2022; 10: E1391-E1398 DOI: 10.1055/a-1896-4499. (PMID: 36262512)
  • 28 Cavicchi M, Tharsis G, Burtin P. et al. Difference in physician- and patient-dependent factors contributing to adenoma detection rate and serrated polyp detection rate. Dig Dis Sci 2019; 64: 3579-3588 DOI: 10.1007/s10620-019-05808-y. (PMID: 31471862)
  • 29 Suzuki S, Aniwan S, Chiu HM. ATLAS Trial Group. et al. Linked-color imaging detects more colorectal adenoma and serrated lesions: an international randomized controlled trial. Clin Gastroenterol Hepatol 2023; 21: 1493-1502.e4
  • 30 Leung WK, Guo CG, Ko MKL. et al. Linked color imaging versus narrow-band imaging for colorectal polyp detection: a prospective randomized tandem colonoscopy study. Gastrointest Endosc 2020; 91: 104-112.e5
  • 31 Li J, Chen K, Wei Y. et al. Colorectal sessile serrated lesion detection using linked-color imaging versus narrow-band imaging: a parallel randomized controlled trial. Endoscopy 2023; 55: 546-554 DOI: 10.1055/a-1995-2685. (PMID: 36482165)
  • 32 Antonelli G, Bevivino G, Pecere S. et al. Texture and color enhancement imaging versus high definition white-light endoscopy for detection of colorectal neoplasia: a randomized trial. Endoscopy 2023; 55: 1072-1080 DOI: 10.1055/a-2129-7254. (PMID: 37451283)
  • 33 Zimmermann-Fraedrich K, Pohl H, Rösch T. et al. Designs of colonoscopic adenoma detection trials: more positive results with tandem than with parallel studies – an analysis of studies on imaging techniques and mechanical devices. Gut 2021; 70: 268-275
  • 34 Cochrane handbook for systematic reviews of interventions. Version 5.1.0 updated March 2011. Chapter 16.4.3: Assessing risk of bias in cross-over trials. The Cochrane Collaboration, 2011. Higgins JPT, Green S. Accessed May 17, 2024 at: https://www.handbook.cochrane.org