title: Full-spectrum (FUSE) versus standard forward-viewing colonoscopy in an organised colorectal cancer screening programme.
abstract: Miss rate of polyps has been shown to be substantially lower with full-spectrum endoscopy (FUSE) compared with standard forward-viewing (SFV) colonoscopy in a tandem study at per polyp analysis. However, there is uncertainty on whether FUSE is also associated with a higher detection rate of colorectal neoplasia, especially advanced lesions, in per patient analysis.
  
  
  
  Consecutive subjects undergoing colonoscopy following a positive faecal immunochemical test (FIT) by experienced endoscopists and performed in the context of a regional colorectal cancer population-screening programme were randomised between colonoscopy with either FUSE or SFV colonoscopy in seven Italian centres. Randomisation was stratified by gender, age group and screening history. Primary outcomes included detection rates of advanced adenomas (A-ADR), adenomas (ADR) and sessile-serrated polyps (SSPDR).
  
  
  
  Of 741 eligible subjects, 658 were randomised to either FUSE (n=328) or SFV (n=330) colonoscopy and included in the analysis. Overall, 293/658 and 143/658 subjects had at least one adenoma (ADR 44.5%) and advanced adenoma (A-ADR 21.7%), respectively, while SSP was the most advanced lesion in 18 cases (SSPDR 2.7%). ADR and A-ADR were 43.6% and 19.5% in the FUSE arm, and 45.5% and 23.9% in the SFV arm, with no difference for both ADR (OR for FUSE: 0.96, 95% CI 0.81 to 1.14) and A-ADR (OR for FUSE: 0.82, 95% CI 0.61 to 1.09). No difference in SSPDR or multiplicity was detected between the two arms. In the per polyp analysis, the mean number of adenomas and proximal adenomas per patient was 0.81±1.25 and 0.47±0.93 in the FUSE arm, and 0.85±1.33 and 0.48±0.96 in the SFV colonoscopy arm (p=NS for both comparisons).
  
  
  
  No statistically significant difference in ADR and A-ADR between FUSE and SFV colonoscopy was detected in a per patient analysis in FIT-positive patients.
  
  
  
  ISRCTN10357435.
authors: Endoscopy Unit, Ospedale Nuovo Regina Margherita, Rome, Italy.
authors: Cesare
authors: C
authors: Hassan
authors: AOU Città della Salute e della Scienza, CPO Piemonte, Turin, Italy.
authors: Carlo
authors: C
authors: Senore
authors: Endoscopy Unit, Ospedale Valduce, Como, Italy.
authors: Franco
authors: F
authors: Radaelli
authors: Endoscopy Unit, Ospedale S Chiara, Trento, Italy.
authors: Giovanni
authors: G
authors: De Pretis
authors: Endoscopy Unit, Ospedale ASMN Reggio Emilia, Reggio Emilia, Italy.
authors: Romano
authors: R
authors: Sassatelli
authors: AOU Città della Salute e della Scienza di Torino, SC Gastroenterologia U, Endoscopia Presidio S.Giovanni A.S., Torino, Italy.
authors: Arrigo
authors: A
authors: Arrigoni
authors: Endoscopy Unit, ASST-Rhodense, Garbagnate Milanese e Rho, Milan, Italy.
authors: Gianpiero
authors: G
authors: Manes
authors: Endoscopy Unit, Ospedale Valduce, Como, Italy.
authors: Arnaldo
authors: A
authors: Amato
authors: Digestive Endoscopy Unit, Humanitas Research Hospital, Milan, Italy.
authors: Andrea
authors: A
authors: Anderloni
authors: Endoscopy Unit, Ospedale S Chiara, Trento, Italy.
authors: Franco
authors: F
authors: Armelao
authors: AOU Città della Salute e della Scienza di Torino, SC Gastroenterologia U, Endoscopia Presidio S.Giovanni A.S., Torino, Italy.
authors: Alessandra
authors: A
authors: Mondardini
authors: Endoscopy Unit, Catholic University, Rome, Italy.
authors: Cristiano
authors: C
authors: Spada
authors: Endoscopy Unit, ASST-Rhodense, Garbagnate Milanese e Rho, Milan, Italy.
authors: Barbara
authors: B
authors: Omazzi
authors: Endoscopy Unit, Ospedale ASMN Reggio Emilia, Reggio Emilia, Italy.
authors: Maurizio
authors: M
authors: Cavina
authors: Endoscopy Unit, Ospedale S Chiara, Trento, Italy.
authors: Gianni
authors: G
authors: Miori
authors: Endoscopy Unit, Catholic University, Rome, Italy.
authors: Chiara
authors: C
authors: Campanale
authors: Endoscopy Unit, Ospedale ASMN Reggio Emilia, Reggio Emilia, Italy.
authors: Giuliana
authors: G
authors: Sereni
authors: AOU Città della Salute e della Scienza, CPO Piemonte, Turin, Italy.
authors: Nereo
authors: N
authors: Segnan
authors: Digestive Endoscopy Unit, Humanitas Research Hospital, Milan, Italy.|Digestive Endoscopy Unit, Humanitas Unversity, Milan, Italy.
authors: Alessandro
authors: A
authors: Repici
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging*; D000368:Aged; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D015233:Models, Statistical; D016037:Single-Blind Method
keywords: COLONIC NEOPLASMS; COLONIC POLYPS; COLONOSCOPY; COLORECTAL ADENOMAS; COLORECTAL CANCER SCREENING