首页|Retrograde-viewing device improves adenoma detection rate in colonoscopies for surveillance and diagnostic workup

Retrograde-viewing device improves adenoma detection rate in colonoscopies for surveillance and diagnostic workup

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AIM:To determine which patients might benefit most from retrograde viewing during colonoscopy through subset analysis of randomized,controlled trial data.METHODS:The Third Eye(R) Retroscope(R) Randomized Clinical Evaluation (TERRACE) was a randomized,controlled,multicenter trial designed to evaluate the efficacy of a retrograde-viewing auxiliary imaging device that is used during colonoscopy to provide a second video image which allows viewing of areas on the proximal aspect of haustral folds and flexures that are difficult to see with the colonoscope's forward view.We performed a post-hoc analysis of the TER-RACE data to determine whether certain subsets of the patient population would gain more benefit than others from use of the device.Subjects were patients scheduled for colonoscopy for screening,surveillance or diagnostic workup,and each underwent same-day tandem examinations with standard colonoscopy (SC)and Third Eye colonoscopy (TEC),randomized to SC followed by TEC or vice versa.RESULTS:Indication for colonoscopy was screening in 176/345 subjects (51.0％),surveillance after previous polypectomy in 87 (25.2％) and diagnostic workup in 82 (23.8％).In 4 subjects no indication was specified.Previously reported overall results had shown a net additional adenoma detection rate (ADR) with TEC of 23.2％ compared to SC.Relative risk (RR) of missing adenomas with SC vs TEC as the initial procedure was 1.92 (P =0.029).Post-hoc subset analysis shows additional ADRs for TEC compared to SC were 4.4％ for screening,35.7％ for surveillance,55.4％ for diagnostic and 40.7％ for surveillance and diagnostic combined.The RR of missing adenomas with SC vs TEC was 1.11 (P =0.815) for screening,3.15 (P =0.014) for surveillance,8.64 (P =0.039) for diagnostic and 3.34(P =0.003) for surveillance and diagnostic combined.Although a multivariate Poisson regression suggested gender as a possibly significant factor,subset analysis showed that the difference between genders was not statistically significant.Age,bowel prep quality and withdrawal time did not significantly affect the RR of missing adenomas with SC vs TEC.Mean sizes of adenomas detected with TEC and SC were similar at 0.59cm and 0.56 cm,respectively (P =NS).CONCLUSION:TEC allows detection of significantly more adenomas compared to SC in patients undergoing surveillance or diagnostic workup,but not in screening patients (ClinicalTrials.gov Identifier:NCT01044732).

ColonoscopyColorectal cancerAdenomasMiss ratesRetrograde-viewing

Peter D Siersema、Amit Rastogi、Anke M Leufkens、Paul A Akerman、Kassem Azzouzi、Richard I Rothstein、Frank P Vleggaar

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Department of Gastroenterology and Hepatology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands

Division of Gastroenterology and Hepatology, Kansas City Veterans Administration Medical Center, Kansas City, MO 64128, United States

Department of Gastroenterology, Bayside Endoscopy Center, 33 Staniford Street, Providence, RI 02905,United States

Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, B-1200 Brussels, Belgium

Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, United States

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2012

10.3748/wjg.v18.i26.3400

世界胃肠病学杂志(英文版)
太原消化病研治中心

世界胃肠病学杂志(英文版)

SCI
影响因子：1.001
ISSN：1007-9327
年,卷(期)：2012.18(26)
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