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

David Karsenti; Guillaume Perrod; Bastien Perrot; Lucille Quénéhervé; Edouard Chabrun; Stéphane Koch; Geoffroy Vanbiervliet; Gabriel Rahmi; Guillaume Velut; Maira Moreno-Garcia; Maryan Cavicchi; Xavier Dray

doi:10.1055/a-2324-8807

Endoscopy, Table of Contents

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)

David Karsenti

¹Digestive Endoscopy Unit, Pôle Digestif Paris Bercy, Clinique Paris-Bercy, Charenton-le-Pont, France

,

Guillaume Perrod

²Gastroenterology and Digestive Endoscopy, Hôpital Européen Georges Pompidou, Paris, France

,

Bastien Perrot

³UMR 1246 SPHERE (MethodS in Patient-centered outcomes and HEalth ResEarch), INSERM, Nantes University, Tours University, Nantes, France

,

Lucille Quénéhervé

⁴Department of Gastroenterology and Hepatology, Brest University Hospital, Brest, France

,

Edouard Chabrun

⁵Digestive Endoscopy Unit, Clinique Saint-Joseph, Trélazé, France

,

Stéphane Koch

⁶Gastroenterology Unit, Besançon University Hospital, Besancon, France

,

Geoffroy Vanbiervliet

⁷Pôle DIGi-TUNED, Endoscopie Digestive, Centre Hospitalier Universitaire de Nice, Hôpital L’Archet 2, Nice, France

,

Gabriel Rahmi

²Gastroenterology and Digestive Endoscopy, Hôpital Européen Georges Pompidou, Paris, France

,

Guillaume Velut

⁸Center for Digestive Endoscopy, Sorbonne University, Saint Antoine Hospital, APHP, Paris, France

,

Maira Moreno-Garcia

⁹Research and Development Unit, French Society of Digestive Endoscopy, Paris, France

,

Maryan Cavicchi

¹Digestive Endoscopy Unit, Pôle Digestif Paris Bercy, Clinique Paris-Bercy, Charenton-le-Pont, France

,

Xavier Dray

⁸Center for Digestive Endoscopy, Sorbonne University, Saint Antoine Hospital, APHP, Paris, France

› Author Affiliations

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.

Full Text

References

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Supplementary Material

Supplementary Material