Analysis: 10 periprocedural interventions improve adenoma detection during colonoscopy
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Key takeaways:
- Ten interventions improved adenoma detection rate across six predetermined domains.
- These results may help guide future endoscopy decisions and inform clinical guidelines.
VANCOUVER, British Columbia — Results from a systematic review and network meta-analysis showed 10 interventions, including dual observation, iScan and G-EYE, improved adenoma detection rate during screening-related colonoscopy.
“We became interested in this topic because we wanted to create a high-quality evidence base for endoscopists to look at when they were deciding which dimensions to implement for their patients coming for screening colonoscopy with respect to quality,” Rishad Khan, MD, a resident in adult gastroenterology at the University of Toronto, said at the ACG Annual Scientific Meeting. “When we talk about quality, we’re mainly interested in adenoma detection. We know this is inversely correlated with post-colonoscopy colorectal cancer, as well as colorectal cancer-associated mortality.”
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Khan and colleagues reviewed 118 randomized controlled trials that evaluated 36 unique interventions among 93,819 patients (mean age, 60 years; 47.9% women) who underwent screening-related colonoscopy. Predetermined intervention domains included periprocedural parameters, endoscopist interventions, intraprocedural techniques, endoscopic technologies, disposable assistive devices and additive substances.
The primary outcome of interest was ADR, while secondary outcomes included polyp detection rate, right ADR, advanced ADR, sessile serrated ADR, adenomas per colonoscopy, APC subtypes, cecal intubation rate, withdrawal time and adverse events.
Researchers used a Bayesian random-effects model for the network meta-analysis and ranked interventions in each domain using surface under the cumulative ranking area curves (SUCRA).
According to results, 41 interventions were identified, of which 36 reported adenoma detection. Ten interventions had significant improvement in ADR vs. standard colonoscopy: dual observation, water exchange, iScan, linked color imaging (LCI), computer-aided detection (CADe), G-EYE, WingCap, Endocuff First Generation and Vision, and oral methylene blue.
Dual observation (SUCRA = 0.84) and water exchange (SUCRA = 0.78) increased ADR by 6.3% and 5.9%, respectively, and ranked highest in the intraprocedural techniques domain, while iScan (SUCRA = 0.95), LCI (SUCRA = 0.8) and CADe (SUCRA = 0.78) increased ADR by 11.8%, 10.3% and 7.4%, respectively, and ranked highest for endoscopic technologies.
In the disposable assistive devices domain, G-EYE (SUCRA = 0.86), WingCap (SUCRA = 0.82), Endocuff (SUCRA = 0.77) and Endocuff Vision (SUCRA = 0.42) increased ADR by 12.7%, 10.5%, 10.1% and 4.5%, respectively, and ranked highest, while oral methylene blue (SUCRA = 0.94) increased ADR by 8.6% and ranked highest in the additive substances domain.
Khan noted that researchers downgraded evidence certainty for risk of bias, inconsistency and imprecision.
“We’re hopeful that once these [ongoing studies] are published, this will help practicing endoscopists and endoscopy units make decisions about which technologies and techniques to adopt, and also provide good quality evidence for endoscopy societies that make guidelines for colonoscopy quality,” Khan concluded.
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Khan R, et al. Relative efficacies of interventions to improve the quality of screening-related colonoscopy: A systematic review and network meta-analysis of randomized controlled trials. Presented at: ACG Annual Scientific Meeting; Oct. 20-25, 2023; Vancouver, British Columbia (hybrid meeting).
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