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.
