Carnegie Hill Endoscopy Great Neck, NY, United States
Tyler Chang, 1, Blair S. Lewis, MD2, Benjamin Nulsen, MD3, Netanel A. Deutsch, MA4 1Carnegie Hill Endoscopy, Great Neck, NY; 2Carnegie Hill Endoscopy, New York, NY; 3David Geffen School of Medicine at UCLA, Santa Monica, CA; 4Biostats, Modiin, Yerushalayim, Israel
Introduction: Colonoscopy with the removal of adenomatous polyps has been shown to decrease the development of colorectal cancer by 76 to 90% and death by up to 67%. Interval colon cancer is thought to develop because of adenomas that are missed during screening colonoscopies. Adenoma detection rate (ADR) has become a measure of the quality of a colonoscopy. Traditional forward-viewing endoscopes (TFV) provide an angle of view of 140-170°. Fuse endoscopes (Fuse) provide an increased field of view of 330° through the addition of two side cameras. It has previously been reported that Fuse increased the ADR by 5.4% when compared to previous rates using TFV. Fuse is no longer commercially available. The goal of this study is to re-examine the ADR of endoscopists who have used Fuse for 3 years who revert to back to TFV (R-TFV).
Methods: A retrospective study was performed for patients undergoing screening colonoscopy at a high-volume ambulatory surgical center in New York, NY. Data was extracted from medical records for patients undergoing colonoscopy for average risk colorectal cancer screening indication. The overall cohort was divided into three subcohorts: patients who had colonoscopies performed with TFV in 2013, patients who had colonoscopies performed with Fuse in 2015 and patients who had colonoscopies performed after the endoscopists reverted back to a R-TFV. Details of the procedures, gender, age, withdrawal time, number of adenomas that were discovered (and removed), whether the adenoma(s) removed had advanced features and whether the adenoma(s) were located in the right side of the colon, were recorded.
Results: 6,110 procedures were reviewed. The age and gender of the TFV, Fuse and R-TFV subcohorts were not statistically different. The ADR for TFV was 23.70% as compared to 29.02% for Fuse and 28.88% for R-TFV. The ADR for advanced lesions for TFV was 3.8% for TFV, 6.0% for Fuse and 7.3% for R-TFV. The ADR for right-sided adenomas was 13.0% for TFV, 16.7% for Fuse and 16.0% for R-TFV. The results for all 3 categories showed a statistical difference between TFV and Fuse as well as between TFV and R-TFV. There was no statistical differences between the ADR of Fuse compared to R-TFV.
Discussion: When endoscopists revert to using a traditional single camera, limited view colonoscope after using Fuse for 3 years, they are able to maintain their increased ability to detect adenomas. This would suggest that there was a durable change in behavior in endoscopists after Fuse.
Figure: Limited 170° single camera versus panoramic 330° three camera view
Patient Characteristics
TFV
FUSE
R-TFV
p value between TFV and Fuse
p value between TFV and R-TFV
p value between Fuse and R-TFV
Cases excluded because of suboptimal prep
116
176
101
Cases included in study (n)
1696
2302
2112
Mean age (years)
59.61
60.18
60.16
0.02
0.05
0.05
Male
776
1037
924
Female
920
1265
1188
Male (%)
45.75
45.05
43.75
0.66
0.22
0.39
Median withdrawal time
9:53
8:57
9:34
0.08
0.04
0.03
Cases with adenomas
402
669
610
Cases without adenomas
1294
1633
1502
ADR in study (%)
23.70
29.02
28.88
< 0.001
< 0.01
0.09
Females with polyp
184
313
305
ADR if females (%)
20.0
24.7
25.7
< 0.01
< 0.01
0.60
Males with polyp
218
356
305
ADR in males (%)
28.1
34.3
33.0
< 0.01
0.03
0.54
Advanced adenomas detected
64
138
155
ADR for advanced adenoma (%)
3.8
6.0
7.3
< 0.01
< .0.0001
0.07
Proximal adenomas detected
220
384
337
ADR for proximal adenomas (%)
13.0
16.7
16.0
< 0.01
< 0.01
0.52
Mean number of adenomas/case
0.32
0.4
0.45
Median cases per endoscopist
79
117
111
Table: Summary of data
Disclosures: Tyler Chang indicated no relevant financial relationships. Blair Lewis indicated no relevant financial relationships. Benjamin Nulsen indicated no relevant financial relationships. Netanel Deutsch indicated no relevant financial relationships.
Tyler Chang, 1, Blair S. Lewis, MD2, Benjamin Nulsen, MD3, Netanel A. Deutsch, MA4. P1305 - Changes in Adenoma Detection Rate From Full-Spectrum Endoscopy to Standard Forward-Viewing Endoscopy, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
