Faculty Bibliography

AIMS: Colorectal cancer (CRC) prevention by colonoscopy is often attributed to the early detection of adenomas, but lesions that go undetected can result in interval cancers. This is largely due to lesions that are hidden behind colonic folds that obscure endoscopic optics. The G-EYETM endoscope (Smart Medical Systems Ltd., Ra'anana, Israel) combines a forward-viewing endoscope with a permanently integrated balloon at the distal end, that when inflated flattens haustral folds, centralizes endoscope optics, and reduces bowel slippage. This provides improved visualization and increased detection of adenomas. Our study compares the adenoma detection rate of G-EYETM colonoscopy with that of Standard Colonoscopy.
METHOD(S): Patients (age >50) referred to colonoscopy for screening, surveillance, following positive FOBT, or due to change in bowel habits were randomized to G-EYETM colonoscopy or SC. Detected lesions were removed and sent for pathology. Adenoma detection rates were calculated.
RESULT(S): Nine hundred patients were enrolled in the study, of which 445 subjects were randomized to SC and 455 subjects were randomized to G-EYETM colonoscopy. Baseline parameters were similar in both groups. Results are presented in Table 1.
CONCLUSION(S): Our study shows that the G-EYETM endoscope has the potential to enhance the quality of CRC screening through increased adenoma detection. The G-EYETM detected not only small and diminutive adenomas, but a substantially higher number of advanced and large adenomas as well. Furthermore, increased detection by G-EYETM colonoscopy of sessile serrated adenomas, lesions strongly associated with CRC, can further reduce the incidents of interval cancers. (Table Presented)

BACKGROUND & AIMS: Colon capsule endoscopy (CCE) is a non-invasive technique used to explore the colon without sedation or air insufflation. A second-generation capsule was recently developed to improve accuracy of detection, and clinical use has expanded globally. We performed a systematic review and meta-analysis to assess the accuracy of CCE in detecting colorectal polyps. METHODS: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and other databases, from 1966 through 2015, for studies that compared accuracy of colonoscopy with histologic evaluation with CCE. The risk of bias within each study was ascertained according to QUADAS recommendations. Per-patient accuracy values were calculated for polyps, overall and for first- (CCE1) and second-generation (CCE2) capsules. We analyzed data using forest plots, the I2 statistic to calculate heterogeneity, and meta-regression analyses. RESULTS: Fourteen studies provided data from 2420 patients (1128 for CCE1 and 1292 for CCE2). CCE2 and CCE1 detected polyps >6 mm with 86% sensitivity (95% confidence interval [CI], 82%-89%) and 58% sensitivity (95% CI, 44%-70%), respectively and 88.1% specificity (95% CI, 74.2%-95.0%) and 85.7% specificity (95% CI, 80.2%-90.0%), respectively. CCE2 and CCE1 detected polyps >10 mm with 87% sensitivity (95% CI, 81%-91%) and 54% sensitivity (95% CI, 29%-77%), respectively and 95.3% specificity (95% CI, 91.5%-97.5%) and 97.4% specificity (95% CI, 96.0%-98.3%), respectively. CCE2 identified all 11 invasive cancers detected by colonoscopy. CONCLUSIONS: The sensitivity in detection of polyps >6 mm and >10 mm increased substantially between development of first- and second-generation colon capsules. High specificity values for detection of polyps by CCE2 seems to be achievable with a 10 mm cut-off and in a screening setting.