Faculty Bibliography

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.

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)