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Missed adenomas with "behind-folds visualizing" colonoscopy technologies compared with standard colonoscopy: a pooled analysis of 3 randomized back-to-back tandem colonoscopy studies.

Brand EC1, Dik VK1, van Oijen MG2, Siersema PD3.

Gastrointest Endosc. 2017 Jan 6. pii: S0016-5107(17)30002-0. doi: 10.1016/j.gie.2016.12.025.

The Third Eye Retroscope, Full Spectrum Endoscope (FUSE) and EndoRings device have been shown to reduce overall adenoma miss rates. We evaluated the characteristics of adenomas and patient subgroups for which these "behind folds visualizing" technologies mostly reduce adenoma miss rates.

Data of 3 multicenter randomized trials (NCT01044732NCT01549535NCT01955122) were combined. Patients underwent same-day, back-to-back tandem examinations with standard colonoscopy and Third Eye Retroscope, FUSE or EndoRings colonoscopy, respectively. Adenoma miss rates were stratified by adenoma characteristics and patient subgroups.


"Behind folds visualizing" colonoscopy reduces miss rates for 1 to 9 mm adenomas in the entire colon, whereas no advantage was found for ≥10 mm and advanced adenomas. Whether increased detection and removal of <10mm adenomas also reduces colorectal cancer incidence and mortality remains to be determined. Future research is needed to determine which colonoscopy technology would be most beneficial for which patient or endoscopist.

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