Background and Aims
By different mechanisms, image-enhancement techniques (linked color imaging [LCI])
and mucosal exposure devices (Endocuff-assisted colonoscopy [EAC]) can improve the
adenoma detection rate (ADR) during screening colonoscopy. The impact of the combination
of the 2 techniques has never been studied. This study aimed to compare the ADR between
the combination of LCI and EAC (LCI+EAC), LCI alone, EAC alone, and standard high-definition
(HD) colonoscopy.
Methods
This prospective randomized controlled trial included participants who underwent screening
colonoscopy. Participants were randomized to LCI+EAC, LCI, EAC, and standard HD colonoscopy.
All colonoscopies were performed by endoscopists with a recorded ADR ≥35%. The primary
outcome was the ADR. Secondary outcomes were proximal ADR (pADR) and the mean number
of adenomas per colonoscopy (APC).
Results
One thousand participants were included in the study. The LCI+EAC group provided the
highest ADR and pADR. The ADRs in the LCI+EAC, LCI, EAC, and standard HD colonoscopy
groups were 57.2%, 52.8%, 51.6%, and 47.6%, respectively, with pADRs of 38.4%, 34.8%,
33.6%, and 28.0%, respectively. The mean numbers of APC were 1.28, 1.20, 1.16, and
.89, respectively. After a multiple comparison adjustment, a significant difference
in pADR was only observed between the LCI+EAC and standard HD colonoscopy groups (difference,
10.3 percentage points; 95% confidence interval, .02%-17.4%; P = .05). The incidence rate ratios of the adenoma numbers were significantly higher
in the LCI+EAC (1.43), LCI (1.34), and EAC (1.30) groups relative to the standard
HD colonoscopy group (.89) (P < .009 for all comparisons).
Conclusions
The combination of LCI and EAC can significantly improve the detection of pADR and
APC but not ADR by high-ADR performers. (Clinical trial registration number: TCTR20190319001.)
Abbreviations:
ADR (adenoma detection rate), APC (adenomas per colonoscopy), CRC (colorectal cancer), CI (confidence interval), EAC (Endocuff-assisted colonoscopy), HD (high definition), LCI (linked color imaging), IRR (incidence rate ratio), pADR (proximal adenoma detection rate), pAPC (proximal adenomas per colonoscopy), SD (standard deviation)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Colorectal cancer screening: recommendations for physicians and patients from the US Multi-Society Task Force on Colorectal Cancer.Gastroenterology. 2017; 153: 307-323
- Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths.N Engl J Med. 2012; 366: 687-696
- Prevalence, risk factors, and outcomes of interval colorectal cancers: a systematic review and meta-analysis.Am J Gastroenterol. 2014; 109: 1375-1389
- Colorectal cancers soon after colonoscopy: a pooled multicohort analysis.Gut. 2014; 63: 949-956
- Risk of post-colonoscopy colorectal cancer in Denmark: time trends and comparison with Sweden and the English National Health Service.Endoscopy. 2019; 51: 733-741
- Adenoma detection rate and risk of colorectal cancer and death.N Engl J Med. 2014; 370: 1298-1306
- New technologies improve adenoma detection rate, adenoma miss rate, and polyp detection rate: a systematic review and meta-analysis.Gastrointest Endosc. 2018; 88: 209-222
- The role of behind folds visualizing techniques and technologies in improving adenoma detection rate.Curr Treat Options Gastroenterol. 2019; 17: 394-407
- Linked color imaging application for improving the endoscopic diagnosis accuracy: a pilot study.Sci Rep. 2016; 6: 1-7
- Linked-color imaging improves endoscopic visibility of colorectal nongranular flat lesions.Gastrointest Endosc. 2017; 86: 692-697
- Colon polyp detection using linked color imaging compared to white light imaging: systematic review and meta-analysis.Dig Endosc. 2020; 32: 874-881
- Comparative efficacy of colonoscope distal attachment devices in increasing rates of adenoma detection: a network meta-analysis.Clin Gastroenterol Hepatol. 2018; 16: 1209-1219
- Effect of Endocuff-assisted colonoscopy on adenoma detection rate: meta-analysis of randomized controlled trials.Endoscopy. 2018; 50: 846-860
- Defining benchmarks for adenoma detection rate and adenomas per colonoscopy in patients undergoing colonoscopy due to a positive fecal immunochemical test.Am J Gastroenterol. 2016; 111: 1743-1749
WHO Classification of Tumours Editorial Board, editors. WHO classification of tumours: digestive system tumours. 5th ed. Lyon: IARC; 2019. p. 170-3.
- Usefulness of adenomas per positive participant for identifying meticulous endoscopists among those who achieve acceptable adenoma detection rates.Endoscopy. 2021; 53: 394-401
- The secondary quality indicator to improve prediction of adenoma miss rate apart from adenoma detection rate.Am J Gastroenterol. 2016; 111: 723-729
- Improved adenoma detection with Endocuff Vision: the ADENOMA randomised controlled trial.Gut. 2019; 68: 280-288
- Quality indicators for colonoscopy.Gastrointest Endosc. 2015; 81: 31-53
- Monitoring colonoscopy withdrawal time significantly improves the adenoma detection rate and the performance of endoscopists.Endoscopy. 2016; 48: 256-262
- Comparison of adenoma detection by colonoscopy between polypectomy performed during both insertion and withdrawal versus during withdrawal only: a multicenter, randomized, controlled trial.Surg Endosc. 2020; 34: 5461-5468
- Impact of linked-color imaging on colorectal adenoma detection.Gastrointest Endosc. 2019; 90: 826-834
- Cap-assisted chromoendoscopy using a mounted cap versus standard colonoscopy for adenoma detection.Am J Gastroenterol. 2020; 115: 465-472
- High-definition colonoscopy versus Endocuff versus EndoRings versus full-spectrum endoscopy for adenoma detection at colonoscopy: a multicenter randomized trial.Gastrointest Endosc. 2018; 88: 335-344
- Linked color imaging reduces the miss rate of neoplastic lesions in the right colon: a randomized tandem colonoscopy study.Endoscopy. 2018; 50: 396-402
- Impact of fellow participation on colon adenoma detection rates: a multicenter randomized trial.Gastrointest Endosc. 2020; 92: 1228-1235
- Defining and applying locally relevant benchmarks for the adenoma detection rate.Am J Gastroenterol. 2019; 114: 1315-1321
- Recommendations for follow-up after colonoscopy and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer.Gastroenterology. 2020; 158: 1131-1153
- Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) guideline—update 2020.Endoscopy. 2020; 52: 687-700
Article info
Publication history
Published online: May 31, 2021
Accepted:
May 19,
2021
Received:
November 24,
2020
Footnotes
DISCLOSURE: All authors disclosed no financial relationships. Research support for this study (S. Aniwan, K. Vanduangden) was provided by the Grant for International Research Integration: Chula Research Scholar; Ratchadaphiseksomphot Endowment Fund, Chulalongkorn University (RA62/087) and the Gastroenterology Association of Thailand.
DIVERSITY, EQUITY, AND INCLUSION: We worked to ensure sex balance and ethnic or other types of diversity in the selection of human subjects. The author list of this article includes contributors from the location where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.
Identification
Copyright
© 2021 by the American Society for Gastrointestinal Endoscopy
