UTILITY OF ENDORING-ASSISTED COLONOSCOPY IN ENDOSCOPISTS WITH A BASELINE HIGH ADENOMA DETECTION RATE

AuthorBlock: Haitam M. Buaisha, Jose G. Machain Palacio, Ryan W. Walters, Robert Kizer, Savio Reddymasu Internal Medicine ,CHI Health/Creighton University Medical Center, Omaha, Nebraska, United  States; Gastroenterology  ,CHI  Health/Creighton  University  Medical  Center, Omaha,  Nebraska,  United  States;4Internal Medicine,  CHI  Health/Creighton  University Medical Center, Omaha, Nebraska, United States

Introduction

A  relatively  new  distal  attachment  device  called  endoring  (US  endoscopy)  recently became  available  as an  adjunct  to  standard  colonoscopy  and  supposed  to improve adenoma  detection  rate  (ADR).  

However,  it  is  unclear  whether  using  this  device increases  ADR  over  and  above  a  standard  colonoscopy exam  in  endoscopists  with baseline high ADR.

The purpose of our study was to evaluate whether endoring assisted colonoscopy  (ERC)  increases  detection of  adenomas  even  in  providers  who  have  a relatively high ADR using a standard colonoscopy.

 

Methods

A  total  of  536  patients  who  underwent  colonoscopy  for  colon  cancer  screening  were included in the study.

Of these, 201 underwent ERC and 350 had standard colonoscopy.

All Colonoscopy exams were performed by endoscopists with baseline high ADR (>35%). A  1:1  propensity score  match  was  used  to  reduce  selection  bias  between  patients receiving  ERC   and  standard   colonoscopy   exam.  

Patients   were  matched  using   a multivariable logistic regression model that included age and gender.

Of the 552 patients in  the  original  sample,  the  algorithm  identified  177  matched  pairs  (354  patients total).

Matched-pair  differences  in  the  detection  rate  of any  tubular,  villous,  tubulo-villous adenoma  as  well  as in  the  detection  rate  of  sessile  serrated  adenoma  (SSA)  only  were compared using Cochran-Mantel-Haenszel test (the former excluded 17 matched-pairs in which  one  or  more  patients  had  multiple adenomas).  

Negative  binomial  hurdle  models were  estimated  to  evaluate  matched-pair  differences  in  the  total  number  of  polyps detected and  the  number  of  left-sided  polyps  detected,  whereas Poisson  hurdle models were estimated to evaluate matched-pair differences in the number of right-sided polyps.

SAS  v.  9.4  was  used  for  all  statistical  analyses  withp<  .05  indicating  statistical significance.

 

Results

No   statistically   significant   post-match   differences   were   observed   in   either   age   or biological sex. 

Patients receiving ERC had ADR of 57.6% as opposed to 37.9% with standard colonoscope(OR = 2.2,p<  .001). The odds of detecting a SSA were 2.3 times greater with ERC (13.1% vs. 6.2%,p= .036).

The number of polyps detected with ERC was higher compared to a standard colonoscopy exam (1.7 vs. 0.8,p< .001).

More right-sided  polyps  were  detected  with  ERC  (1.0  vs.  0.4,p<  .001).  

No  difference  was observed in the number of left-sided polyps detected (0.5 vs. 0.3,p= .061) in ERC group.

No complications occurredin either group.

 

Conclusion

ERC  appears to  significantly  improve  ADR  even  in endoscopists  who  have  a  high  ADR with use of a standard colonoscope.

The benefit of ERC appears to extend to detecting more SSA’s and right-sided  polyps.

Whether this incremental increase in ADR  detected with ERC translates to clinically meaningful reduction in risk of interval colorectal cancer development is yet to be determined.