Faculty Bibliography

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.

Introduction: Colorectal cancer (CRC) detection is attributed to the early detection and removal of polyps and adenomas during colonoscopy procedures. Although colonoscopy is considered to be the "gold standard" for CRC prevention, a significant number of polyps and adenomas go undetected during standard procedures. This is largely due to polyps that are hidden behind colonic folds that obscure endoscopic optics and result in interval cancers. The G-EYE endoscope (Smart Medical Systems Ltd., Ra'anana, Israel) comprises a standard forward-viewing endoscope with a permanently integrated balloon at the distal end. Upon withdrawal of the endoscope, the G-EYE balloon is inflated to a partial pressure allowing for the flattening of haustral folds, centralization of the endoscope optics, and reduction in bowel slippage, thus providing improved visualization of the colon anatomy and increased detection of polyps and adenomas. Aims & Methods: This prospective, randomized, multicentre study compares the adenoma detection rate (ADR) of the G-EYE HD colonoscopy with that of standard HD colonoscopy (SC). Patients (age450) referred to colonoscopy for screening, surveillance, following positive FOBT, or due to change in bowel habits were randomized to either G-EYE colonoscopy or SC. Detected polyps were removed and sent for pathology. Polyp and adenoma detection rates were calculated. Result: 480 patients were enrolled in the study, of which 238 subjects were randomized to SC and 242 subjects were randomized to G-EYETM colonoscopy. Baseline parameters and indication for colonoscopy were similar in both groups. The ADR, adenoma per patient, number of adenomas by size and advanced adenomas for each group are presented in Table 1. G-EYE colonoscopy improved ADR by 45.6% when compared to SC. More specifically, the GEYE endoscope increased the number of advanced adenomas and large-size adenomas by 96.9% and 96.2%, respectively. Procedural times were similar in both groups. Conclusion: Our study shows that the G-EYE endoscope can substantially improve ADR when compared to SC. In addition to diminutive and small adenomas, the G-EYE endoscope detects a larger number of advanced and large-size adenomas. Consequently, we conclude that the G-EYE endoscope can significantly enhance the quality of CRC screening and thus reduce colonoscopic miss rates and interval cancer incidents. (Table Presented)

GOAL: The purpose of this study was to assess the effect of decreased colonoscopy reimbursement on gastroenterologist practice behavior, including time to retirement and procedure volume. BACKGROUND: In 2015, the Centers for Medicare and Medicaid Services proposed reductions in colonoscopy reimbursements. With new initiatives for increased colorectal cancer screening, it is crucial to understand how reimbursement changes could affect these efforts. STUDY: Randomly selected respondents from the American College of Gastroenterology membership database were surveyed on incremental changes in practice behavior if colonoscopy reimbursement were to decrease by 10, 20, 30, or 40 %. Data were analyzed using both Pearson's Chi-square and analysis of variance. RESULTS: Two thousand and nine gastroenterologists received the survey with a 16.3 % response rate. Procedure volume significantly decreased with degree of reimbursement reductions (p < 0.001). With a 10 % decrease, 72 % of respondents reported no change in the number of colonoscopies performed. With a 20 % decrease, 39 % would decrease their procedure volume, while 21 % of respondents would increase their procedure volume. With a 30 and 40 % decrease, procedure volume decreased by 48 and 50 %, respectively. In terms of retirement, current plans predict a cumulative retirement rate of 29.4 % at 10 years. More than 42 % of respondents plan to retire after 2030. In the 2014-2023 retirement subgroup (N = 74 responses), there was a significant hastening of retirement year at 20 % (p = 0.016), 30 % (p < 0.001), and 40 % (p < 0.001) reimbursement reductions as compared to baseline responses. CONCLUSION: Decreasing colonoscopy reimbursements may have a significant effect on the effective gastroenterology work force.

BACKGROUND AND AIMS: The advent of capsule endoscopy has revolutionized evaluation of the small bowel. Capsule endoscopy has become the criterion standard as the initial examination to diagnose small-bowel abnormalities, but does not allow for tissue sampling or therapeutic intervention. Deep enteroscopy can be performed by using a balloon-assisted device or a spiral overtube for both diagnostic and therapeutic interventions of the small bowel. Deep enteroscopy is time-consuming and requires special endoscopes and accessories to perform the examination. We studied a novel through-the-scope balloon catheter system used for deep enteroscopy that uses a conventional colonoscope and standard accessories. METHODS: We performed a 9-center, retrospective study using a novel TTS balloon system for small-bowel evaluation. The new through-the-scope device is an on-demand balloon catheter that is inserted through the instrument channel of a standard colonoscope and enables deep advancement into the small bowel in either the anterograde or retrograde approach. It consists of a balloon inflation/deflation system and a single-use balloon catheter designed for anchoring in the small bowel. The balloon is inflated to an anchoring pressure in the small intestine, and a repetitive push-pull technique is performed, with the endoscope sliding over the guiding catheter to the inflated balloon. The catheter may be removed and reinserted to allow for therapeutic intervention while maintaining the endoscope position. RESULTS: A total of 98 patients were included; 52% were male, and the mean age was 55 years old (range 15-94 years). Indications included abdominal pain, iron-deficiency anemia, occult GI bleeding, diarrhea, abnormal capsule endoscopy, weight loss, protein losing enteropathy, retained foreign body, altered anatomy ERCP, and small-bowel strictures. Anterograde enteroscopy was performed in 65 patients. The average depth of insertion was 158 cm (range 50-350 cm) from the pylorus. Retrograde enteroscopy was performed in 33 cases. The average depth of insertion was 89 cm (range 20-150 cm) beyond the ileocecal valve. Overall, diagnostic yield was 44%. The average advancement time for the anterograde and retrograde enteroscopy cases was 15.5 minutes. There were no procedural adverse outcomes reported in the 98 cases. CONCLUSIONS: The TTS advancing balloon is a safe and effective way to perform deep enteroscopy by using a conventional colonoscope without the need for an overtube. Procedure time is shorter than that of other forms of deep enteroscopy. Diagnostic yield and depth of insertion are on par with other forms of deep enteroscopy. This is the largest reported study using this novel technology to diagnose and treat small-bowel disease.