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

Introduction: Colorectal Cancer (CRC) prevention has resulted in the implementation of screening programs worldwide in hopes to reduce the number of CRC incidences. Despite these programs' best efforts, interval cancers continue to arise from lesions missed during standard procedures. Interval cancers have been found to occur more frequently in the right colon, often developing from flat and sessile lesions. These lesions have had reported miss rates of up to 60% compared to reported miss rates of 20%-30% for polyps and adenomas. The innovative G-EYE endoscope (SMART Medical Systems Ltd, Ra'anana, Israel) includes an integral, reusable balloon that is permanently installed on the distal end of a standard endoscope. Upon withdrawal, inflation of the GEYE balloon to a partial pressure results in the centralization of endoscope optics, reduction in bowel slippage, and flattening of colon topography. The enhanced visualization provided by the G-EYE balloon can result in an increase detection of lesions. Aims & Methods: In this prospective, randomized, multicentre study, patients (age >50) referred to colonoscopy as a result of screening, surveillance, positive FOBT or change in bowel habits were randomized to either standard colonoscopy (SC) or G-EYE colonoscopy. Detected lesions were removed and sent for pathology. We compared the detection rates of G-EYE colonoscopy with that of SC in the right colon. Results: 1000 patients were enrolled in the study, of which 498 underwent SC and 502 underwent G-EYE colonoscopy. Baseline parameters were similar in both groups. The right colon was defined as the cecum, ascending colon, and hepatic flexure. Results are presented in Table 1. In addition, the G-EYEincreased the detection of both advanced and large-size adenomas by 40% in the right colon Conclusion: Our study shows that G-EYE colonoscopy has the potential to significantly improve the quality of CRC screening through improved adenoma detection rates. Special attention should be given to the significant increase in right-sided flat lesions and sessile serrated adenomas by the G-EYE, as these lesions are strongly attributed to CRC. Through increased detection of these right-sided lesions, G-EYE colonoscopy can impact the quality of CRC screening by reducing miss rates and consequently reduce the incidents of interval cancers. (Table Presented)

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.