Role of high definition colonoscopy in colorectal adenomatous polyp detection

AIM:To investigate the rates of polyp detection in a mixed risk population using standard definition (SDC) vs high definition colonoscopes (HDC).METHODS:This was a retrospective cohort comparative study of 3 colonoscopists who each consecutively performed 150 SDC (307,200 pixel) and 150 HDC (792,576 pixels) in a community teaching hospital.RESULTS:A total of 900 colonoscopies were evaluated (mean age 56,46.8% men),450 with each resolution.Polyps of any type were detected in 46.0% of patients using SDC and 43.3% with HDC (P=0.42).There was no significant difference between the overall number of polyps,HDC (397) and SDC (410),detected among all patients examined,(P=0.73).One or more adenomatous polyps were detected in 24.2% of patients with HDC and 24.9% of patients with SDC colonoscopy (P=0.82).There was no significant difference between HDC (M=0.41) and SDC (M=0.42) regarding adenomatous polyp (P=0.88) or advanced adenoma (P=0.56) detection rate among all patients examined.CONCLUSION:HDC did not improve yield of adenomatous polyp,advanced adenoma or overall polyp detection in a population of individuals with mixed risk for colorectal cancer.

Small caliber overtube-assisted colonoscopy

AIM: To combine the benefits of a new thin flexible scope with elimination of excessive looping through the use of an overtube. METHODS: Three separate retrospective series. Series 1: 25 consecutive male patients undergoing unsedated colonoscopy using the new device at a Veteran's hospital in the United States. Series 2: 75 male patients undergoing routine colonoscopy using an adult colonoscope, pediatric colonoscope, or the new device. Series 3: 35 patients who had incomplete colonoscopies using standard instruments. RESULTS: Complete colonoscopy was achieved in all 25 patients in the unsedated series with a median cecal intubation time of 6 min and a median maximal pain score of 3 on a 0-10 scale. In the 75 routine cases, there was significantly less pain with the thin scope compared to standard adult and pediatric colonoscopes. Of the 35 patients in the previously incomplete colonoscopy series, 33 were completed with the new system. CONCLUSION: Small caliber overtube-assisted colonoscopy is less painful than colonoscopy with standard adult and pediatric colonoscopes. Male patients could undergo unsedated colonoscopy with the new system with relatively little pain. The new device is also useful for most patients in whom colonoscopy cannot be completed with standard instruments.

Efficacy of morning-only 4 liter sulfa free polyethylene glycol vs 2 liter polyethylene glycol with ascorbic acid for afternoon colonoscopy

AIM: To compare the bowel cleansing efficacy of same day ingestion of 4-L sulfa-free polyethylene glycol (4-L SF-PEG) vs 2-L polyethylene glycol solution with ascorbic acid (2-L PEG + Asc) in patients undergoing afternoon colonoscopy.

Stool DNA-based versus colonoscopy-based colorectal cancer screening: Patient perceptions and preferences

Objective:Stool DNA(sDNA)tests offer a noninvasive form of colon cancer screening for pa-tients,and although the test is expected to increase uptake of colon cancer screening,it is unknown if patients’perceptions of the sDNA test differ according to race and other patient characteristics.Methods:We conducted a self-administered survey of patients undergoing both a colonoscopy and an sDNA test to evaluate perceptions of sDNA testing.Results:Of the 613 participants who were sent surveys,423 responded(69%response rate).Respondents self-identified as African American(n=127,30%),Caucasian(n=284,67%),and other ethnicity(n=12,3%).In general,participants found the sDNA test more suitable than a colonos-copy(n=309,75%).In univariate analyses,a higher percentage of Caucasians as compared with African Americans found the sDNA test more suitable than a colonoscopy(89%vs.76%,p<0.01),and more Caucasians than African Americans preferred the sDNA test(43%vs.32%,p<0.05).Ad-justment for covariates reduced these racial differences to no significance.A family history of colo-rectal cancer remains a significant factor for patient’s preferences for screening regardless of race.Conclusions:Our study shows no racial differences in the perception of and preference for sDNA testing for colon screening.Intervention to increase the uptake of sDNA testing may help reduce racial disparities in colorectal cancer.

Artificial intelligence empowers the second-observer strategy for colonoscopy:a randomized clinical trial

Background:In colonoscopy screening for colorectal cancer,human vision limitationsmay lead to highermiss rate of lesions;artificial intelligence(AI)assistance has been demonstrated to improve polyp detection.However,there still lacks direct evidence to demonstrate whether AI is superior to trainees or experienced nurses as a second observer to increase adenoma detection during colonoscopy.In this study,we aimed to compare the effectiveness of assistance fromAI and human observer during colonoscopy.Methods:A prospective multicenter randomized study was conducted from 2 September 2019 to 29 May 2020 at four endoscopy centers in China.Eligible patients were randomized to either computer-aided detection(CADe)-assisted group or observer-assisted group.The primary outcome was adenoma per colonoscopy(APC).Secondary outcomes included polyp per colonoscopy(PPC),adenoma detection rate(ADR),and polyp detection rate(PDR).We compared continuous variables and categorical variables by using R studio(version 3.4.4).Results:A total of 1,261(636 in the CADe-assisted group and 625 in the observer-assisted group)eligible patients were analysed.APC(0.42 vs 0.35,P=0.034),PPC(1.13 vs 0.81,P<0.001),PDR(47.5%vs 37.4%,P<0.001),ADR(25.8%vs 24.0%,P=0.464),the number of detected sessile polyps(683 vs 464,P<0.001),and sessile adenomas(244 vs 182,P=0.005)were significantly higher in the CADe-assisted group than in the observer-assisted group.False detections of the CADe system were lower than those of the human observer(122 vs 191,P<0.001).Conclusions:Compared with the human observer,the CADe system may improve the clinical outcome of colonoscopy and reduce disturbance to routine practice(Chictr.org.cn No.:ChiCTR1900025235).