title: Lower adenoma miss rate with FUSE vs. conventional colonoscopy with proximal retroflexion: a randomized back-to-back trial.
abstract: Background and study aimsFull-spectrum colonoscopy (FSC) promises to increase adenoma detection by providing a wider field of view. The aim of this study was to compare adenoma miss rates of FSC with those of conventional colonoscopy complemented by right-colon re-examination using scope retroflexion (CC/R).Patients and methodsAt two tertiary endoscopy facilities, patients who were scheduled for colonoscopy for the assessment of symptoms or for colorectal cancer screening/surveillance were randomized (1:1) to undergo same-day, back-to-back colonoscopies (FSC or CC/R first), performed by one of five endoscopists who had documented adenoma detection rates > 35 %. Per-protocol data were analyzed.ResultsWe randomized 220 patients. There were five FSC technical failures (three air pump and two left screen); therefore, 107 and 108 cases were analyzed in the FSC and CC/R index procedure arms, respectively. Withdrawal times were similar for FSC and CC/R (7.7 minutes vs. 7.6 minutes). Overall, we detected 3 cancers and 153 adenomas (FSC = 92; CC/R = 61); 81 were detected in the proximal colon, 3 of which were detected by retroflexed examination. By per-lesion analysis, FSC showed a significantly lower adenoma miss rate compared with CC/R overall (10.9 % [95 % confidence interval (CI) 3.8 to 18.1] vs. 33.7 % [95 %CI 23.4 to 44.1]) and in the proximal colon (13.9 % [95 %CI 2.6 to 25.2] vs. 42.2 % [95 %CI 27.8 to 56.7]). The advanced adenoma miss rate was lower with FSC overall (4.3 % [95 %CI - 4.0 to 12.7] vs. 25.9 % [95 %CI 9.4 to 42.5]). There were no adverse events.ConclusionsFSC outperformed conventional colonoscopy with right-colon scope retroflexion in the detection of missed adenomas, both overall and in the proximal colon, even when performed by experienced endoscopists.Trial registered at ClinicalTrials.gov (NCT02117674).
authors.affiliation: Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University, Attikon University General Hospital, Athens, Greece.
authors.forename: Ioannis S
authors.initials: IS
authors.lastname: Papanikolaou
authors.affiliation: Department of Gastroenterology, 417 Army Veterans Hospital, Athens, Greece.
authors.forename: Periklis
authors.initials: P
authors.lastname: Apostolopoulos
authors.affiliation: Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University, Attikon University General Hospital, Athens, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Tziatzios
authors.affiliation: Department of Gastroenterology, 417 Army Veterans Hospital, Athens, Greece.
authors.forename: Erasmia
authors.initials: E
authors.lastname: Vlachou
authors.affiliation: Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University, Attikon University General Hospital, Athens, Greece.
authors.forename: Athanasios D
authors.initials: AD
authors.lastname: Sioulas
authors.affiliation: Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University, Attikon University General Hospital, Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Polymeros
authors.affiliation: Laboratory of Pathology, 417 Army Veterans Hospital, Athens, Greece.
authors.forename: Andreas
authors.initials: A
authors.lastname: Karameris
authors.affiliation: Second Department of Pathology, Medical School, National and Kapodistrian University, Attikon University General Hospital, Athens, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Panayiotides
authors.affiliation: Department of Gastroenterology, 417 Army Veterans Hospital, Athens, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Alexandrakis
authors.affiliation: Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University, Attikon University General Hospital, Athens, Greece.
authors.forename: George D
authors.initials: GD
authors.lastname: Dimitriadis
authors.affiliation: Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University, Attikon University General Hospital, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Triantafyllou
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging*; D000368:Aged; D044682:Colon, Ascending / Q000000981:diagnostic imaging; D044684:Colon, Transverse / Q000000981:diagnostic imaging; D003110:Colonic Neoplasms / Q000000981:diagnostic imaging*; D003113:Colonoscopy / Q000379:methods*; D018592:Cross-Over Studies; D055088:Early Detection of Cancer / Q000379:methods*; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*; D011446:Prospective Studies; D013997:Time Factors