Impact of experience with a retrograde-viewing device on adenoma detection rates and withdrawal times during colonoscopy: the Third Eye Retroscope study group - 22/08/11
Reprint requests: Daniel C. DeMarco, MD, Baylor University Medical Center, Digestive Health Associates of Texas, 712 North Washington, Suite 200, Dallas, TX 75246Résumé |
Background |
Colonoscopy has been adopted as the preferred method to screen for colorectal neoplasia in the United States. However, lesions can be missed because of numerous factors, including location on the proximal aspect of folds or flexures, where they may be difficult to detect with the forward-viewing colonoscope. The Third Eye Retroscope (TER) is a disposable device that is passed through the instrument channel of a standard colonoscope to provide a retrograde view that complements the forward view of the colonoscope during withdrawal.
Objective |
To evaluate whether experience with the TER affects polyp detection rates and procedure times in experienced endoscopists who had not previously used the equipment.
Design, Setting, Patients |
This was an open-label, prospective, multicenter study at 9 U.S. sites, involving 298 patients presenting for colonoscopy, evaluating the use of the TER in combination with a standard colonoscope.
Interventions |
After cecal intubation, the TER was inserted through the instrument channel of the colonoscope. During withdrawal, the forward and retrograde video images were observed simultaneously on a wide-screen monitor.
Main Outcome Measurements |
Primary outcome measures were the number and size of adenomas and all polyps detected with the standard colonoscope and with the colonoscope combined with the TER. Secondary outcome measures were withdrawal phase time and total procedure time. Each endoscopist examined 20 subjects, divided into quartiles according to the order of their procedures, and results were compared among quartiles.
Results |
Overall, 182 polyps were detected with the colonoscope and 27 additional polyps with the TER, a 14.8% increase (P < .001). A total of 100 adenomas were detected with the colonoscope and 16 more with the TER, a 16.0% increase (P < .001). For procedures performed after each endoscopist had completed 15 procedures while using the TER, the mean additional detection rates with the TER were 17.0% for all polyps (P < .001) and 25.0% for adenomas (P < .001). For lesions 6 mm or larger, the overall additional detection rates with the TER for all polyps and for adenomas were 23.2% and 24.3%, respectively. For lesions 10 mm or larger, the overall additional detection rates with the TER for all polyps and for adenomas were 22.6% and 19.0%, respectively. The mean withdrawal times in the first and fourth quartiles were 10.6 and 9.2 minutes, respectively (P = .044).
Limitations |
There was no randomization or separate control group. The endoscopists judged whether each lesion could have been detected with the colonscope alone by using their standard technique.
Conclusions |
Polyp detection rates improved significantly with the TER, especially after 15 procedures, when the mean additional detection rate for adenomas was 25.0%. Additional detection rates with the TER for medium-size and large adenomas were greater than for smaller lesions. These results suggest that, compared with a colonoscope alone, a retrograde-viewing device can increase detection rates for clinically significant adenomas without detriment to procedure time or procedure complications. (Clinical trial registration number:NCT00969124.)
Le texte complet de cet article est disponible en PDF.Abbreviation : TER
Plan
| Disclosure | The following author disclosed a financial relationship relevant to this publication: D.C. DeMarco: Consultant for Spirus Medical. All other authors disclosed no financial relationships relevant to this publication. |
| Current affiliations: Baylor University Medical Center (D.C.D, E.O., L.F.L., J.K.H., D.P.), Dallas, Texas, North Hills Hospital (D.B.), North Richland Hills, Texas, S.W. Fort Worth Endoscopy Center (C.H. T.D., T.M.D.), Fort Worth, Texas, Hennepin County Medical Center (T.K., K.G.), Minneapolis, Minnesota, University of Texas Southwestern (L.W.), Dallas, Texas, NorthShore University HealthSystem (M.K.M.), Evanston, Illinois, Florida Hospital (M.B.A.), Celebration, Florida, University of Massachusetts (R.P.), Worcester, Massachusetts, University of Chicago (K.G.R., I.H.), Chicago, Illinois. |
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| If you would like to chat with an author of this article, you may contact Dr. DeMarco at DanielD@BaylorHealth.edu. |
Vol 71 - N° 3
P. 542-550 - mars 2010 Retour au numéro
Article précédent
- Double-balloon endoscopy as the primary method for small-bowel video capsule endoscope retrieval
- Stijn J.B. Van Weyenberg, Sietze T. Van Turenhout, Gerd Bouma, Jan Hein T.M. Van Waesberghe, Donald L. Van der Peet, Chris J.J. Mulder, Maarten A.J.M. Jacobs
- A retrograde-viewing device improves detection of adenomas in the colon: a prospective efficacy evaluation (with videos)
- Jerome D. Waye, Russell I. Heigh, David E. Fleischer, Jonathan A. Leighton, Suryakanth Gurudu, Leslie B. Aldrich, Jiayi Li, Sanjay Ramrakhiani, Steven A. Edmundowicz, Dayna S. Early, Sreenivasa Jonnalagadda, Robert S. Bresalier, William R. Kessler, Douglas K. Rex
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