Endoscopic technological innovations did not increase adenoma detection rates, according to results of a systemic review and meta-analysis published in Gastrointestinal Endoscopy.

Publication databases were searched through January 2020 for randomized controlled trials that evaluated endoscopic technological innovations. Overall, 1690 studies were evaluated and a total of 8 studies, encompassing 3645 patients, was included. Three studies investigated advanced imaging including narrow band imaging (n=2) and full-spectrum endoscopy (n=1), and 5 were focused on mechanical devices: Endocuff™ (Arc Medical Design; n=3), Endorings™ (Steris Healthcare; n=1), and G-EYE® (SMART Medical Systems; n=1). All included studies were conducted in Europe.

Pooled adenoma detection rate for studies in the intervention arm was 56.5% (95% CI, 49.9%-62.9%), which was similar to standard colonoscopy studies with a detection rate of 55.9% (95% CI, 48.6%-63%). The overall risk ratio (RR) for adenoma detection was 1.01 (95% CI, 0.93-1.10; I2=50.4%). No statistical difference between advanced imaging (RR 0.95; 95% CI, 0.85-1.07) and mechanical innovations (RR1.04; 95% CI, 0.92-1.17) was observed.

The Endocuff studies reported an RR of 1.05 (95% CI, 0.90-1.21; I2=75.3%), which did not differ significantly from the studies on narrow band imaging (RR 0.95; 95% CI, 0.81-1.12; I2=0%).


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Studies that used fecal occult blood tests reported an RR for adenoma detection of 0.95 (95% CI, 1.2-1.8; I2=0%), which did not differ significantly from the studies that used fecal immunochemical tests (RR 1.09; 95% CI, 0.95-1.25; I2=59%).

The pooled mean of adenomas per colonoscopy was the same for intervention studies (1.5; 95% CI, 1.2-1.8) and standard colonoscopy studies (1.5; 95% CI, 1.1-1.8). The unstandardized mean difference was observed to be 0.04 (95% CI, -0.13 to 0.20; I2=53.6%).

Similar results were observed for studies of advanced adenoma detection, with rates of 23.7% (95% CI, 15.9-33.6) for intervention and 25.9% (95% CI, 17.5-36.5) for standard colonoscopy procedures. For the studies on colon cancer, the detection rate for the intervention arm was 3.6% (95% CI, 2.2-5.7), which did not differ significantly from standard colonoscopy procedures (4%; 95% CI, 3.1-5.1).

The primary limitation of this study was the low number of included studies that covered the same technology, making it impossible for the pooling of results from studies on full-spectrum endoscopy, Endorings, or G-EYE.

“[W]e have shown that…no technological improvement seems to significantly increase detection of colorectal neoplasia during high-quality colonoscopies,” the researchers concluded. These data indicated implementation of these technologies should not be recommended.

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Reference

Thayalasekaran S, Frazzoni L, Antonelli G, et al. Endoscopic technological innovations for neoplasia detection in organized colorectal cancerscreening programs: A meta-analysis [published online June 23, 2020]. Gastrointest Endosc. doi: 10.1016/j.gie.2020.06.046