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
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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
