Faculty Bibliography

Introduction: The need to increase adenoma detection rate (ADR) for colorectal cancer screening has ushered in enhanced visualization devices, designed to mechanically (Endocuff, Endorings and G-Eye) or optically (G-Eye, FUSE and EWAVE) improve conventional colonoscopy (CC). Cap-assisted colonoscopy (CAC) was the first device in the market but studies have not shown benefit over CC. In recent years, newer enhanced technology devices (NTD) have become available. Our aims were: 1) to compare the ADR, adenoma miss rate (AMR) and polyp detection rate (PDR) between CC and NTD 2) to compare the ADR, AMR and PDR between mechanical and optical NTD. Methods: MEDLINE and Embase databases were searched from inception through May 2017 for manuscripts or conference abstracts reporting ADR, AMR and PDR with the available NTD. Data on CAC was collected and analyzed separately. Randomized controlled trials and high-quality casecontrol studies in adults with >10 subjects were included, with dual extraction of data. Primary outcomes included pooled ADR, AMR and PDR odds ratio (OR) with 95% confidence interval (95% CI) between CC and NTD. AMR was assessed in RCTs with tandem colonoscopies. Secondary outcomes included cecal intubation rates (CIR), complications, cecal intubation time (CIT), and total colonoscopy time (TCT). Results: Of 247 citations identified without CAC, 47 studies with 17,543 subject were eligible for >=1 analyses. Mean age was 61.3 years (range 37.1-76.0) and 50.3% were males. The overall OR for ADR/ PDR was higher with NTD than CE (Fig 1). Sub-analysis between NTD showed a higher ADR (OR1.44 vs 1.18, P=0.03) and PDR (OR1.63 vs 1.16, P=0.01) for mechanical compared to optical NTD. Comparison of each NTD to CC showed an improved ADR/PDR with Endocuff and higher ADR with G-Eye, but not with FUSE (Table 1). No significant ADR difference was found between CAC and CC. The overall AMR with NTD was lower than CC (Fig 2). Mechanical NTD had lower AMR compared to optical NTD (OR0.11 vs 0.33, P<0.01). There was no difference in CIR (OR1.03, 0.81-1.30). The CIT was 7.33 min (+/-2.5) in NTD vs 7.39 min (+/-2.88) in CC. The TCT was 18.54 (+/-5.92) in NTD and 19.01 (+/-6.31) in CC. Major complications were uncommon (9 in NTD and 10 CC). Conclusion: Newer endoscopic technologies are an effective option to increase ADR/PDR, and decrease AMR, particularly mechanical NTD. Overall, the risk of major complications is similar to CC. Further comparisons between devices are warranted

Despite the small bowel comprising 90% of the mucosal surface area of the gastrointestinal tract, it is a rare site for neoplasia and only accounts for a little over 3% of the tumors that arise in the digestive tract. Benign small bowel lesions include lipomas, lymphangiomas, leiomyomas, neurofibromas, nodular lymphoid hyperplasia and adenomas, many of which are precursors to malignant lesions. Several polyposis syndromes are associated with small bowel polyps as well, including familial adenomatous polyposis syndrome, lynch syndrome, Peutz-Jeghers syndrome, Cowden syndrome and juvenile polyposis syndrome. Our aim was to review non-malignant small bowel polyps and discuss the prevalence, typical location, clinical presentation, diagnosis, endoscopic and histologic description and lastly management of each of these lesions.

Worldwide, colorectal cancer is the third commonest cancer. Over 90% follow an adenoma-to-cancer sequence over many years. Colonoscopy is the gold standard method for cancer screening and early adenoma detection. However, considerable variation exists between endoscopists' detection rates. This review considers the effects of different endoscopic techniques on adenoma detection. Two areas of technological interest were considered: (1) optical technologies and (2) mechanical technologies. Optical solutions, including FICE, NBI, i-SCAN and high definition colonoscopy showed mixed results. In contrast, mechanical advances, such as cap-assisted colonoscopy, FUSE, EndoCuff and G-EYE, showed promise, with reported detections rates of up to 69%. However, before definitive recommendations can be made for their incorporation into daily practice, further studies and comparison trials are required.

BACKGROUND & AIMS: The incidence and predictors of non-gastrointestinal (GI) adverse events (AEs) following colonoscopy are not well understood. We studied the effects of anti-thrombotic agents, cardiopulmonary comorbidities, and age on risk of non-GI AEs after colonoscopy. METHODS: We performed a retrospective longitudinal analysis to assess the diagnosis, procedure, and prescription drug codes in a United States commercial claims database (March 2010 - March 2012). Data from patients at increased risk (n=82,025; defined as patients with pulmonary comorbidities or cardiovascular disease requiring anti-thrombotic medications) were compared with data from 398,663 average-risk patients. In a 1:1 matched analysis, 51,932 patients at increased risk, examined by colonoscopy, were compared with 51,932 matched (based on age, sex, and comorbidities) patients at increased risk who did not undergo colonoscopy. We tracked cardiac, pulmonary, and neurovascular events 1-30 days after colonoscopy. RESULTS: Thirty days after outpatient colonoscopy, non-GI AEs were significantly higher in patients taking anti-thrombotic medications (7.3%; odds ratio [OR], 10.75; 95% CI, 10.13-11.42) or those with pulmonary comorbidities (1.8%; OR, 2.44; 95% CI, 2.27-2.62) vs average-risk patients (0.7%), and in patients 60-69 yrs old (OR, 2.21; 95% CI, 2.01-2.42) or 70 yrs or older (OR, 6.45; 95% CI, 5.89-7.06), compared to patients younger than 50 yrs. The 30-day incidence of non-GI AEs in patients at increased risk who underwent colonoscopy was also significantly higher than in matched patients at increased risk who did not undergo colonoscopy, in the anticoagulant group (OR, 2.31; 95% CI, 2.01-2.65) and in the chronic obstructive pulmonary disease group (OR, 1.33; 95% CI, 1.13-1.56). CONCLUSIONS: Increased number of comorbidities and older age (older than 60 years) are associated with increased risk of non-GI AEs after colonoscopy. These findings indicate the importance of determining comorbid risk and evaluating anti-thrombotic management prior to colonoscopy.