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%).
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.
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