Full Spectrum Endoscopy Detects Significantly More Polyps

A pivotal comparison study shows that full spectrum endoscopy dramatically outperforms standard forward-viewing colonoscopy (SFV).

Researchers at the Rambam Health Care Campus (Haifa, Israel) conducted an international randomized trial in Israel, the Netherlands, and the USA involving 185 participants (18–70 years of age) referred for colorectal cancer screening, polyp surveillance, or diagnostic assessment. The patients underwent same-day, back-to-back tandem colonoscopy; 48% were randomly assigned to receive SFV first, and 52% to receive full-spectrum colonoscopy with the EndoChoice Fuse System colonoscope first. The primary endpoint was adenoma miss rates.

The results showed that by per-lesion analysis, the adenoma miss rate was significantly lower in patients in the full-spectrum endoscopy group (7%) than in those in the SFV procedure group (41%). Full-spectrum endoscopy missed 5 adenomas in 5 patients in whom an adenoma had already been detected with first-pass SFV; none of these missed adenomas that were advanced. SFV, on the other hand, missed 20 adenomas in 15 patients; of those, 3 were advanced adenomas. Five minor adverse events were reported including vomiting, diarrhoea, cystitis, gastroenteritis, and bleeding. The study was published in the March 2014 issue of the Lancet Oncology.

“As the gold standard for colorectal cancer screening, standard forward-viewing colonoscopy still misses a significant percentage of precancerous polyps due to inadequate visualization of the many folds and bends of the colon,” said lead author Ian Gralnek, MD, of the Rambam department of gastroenterology. “These study results confirm that Fuse is an important technological advancement in colorectal cancer screening that significantly improves visualization and has the potential to improve screening outcomes for many patients.”

“The results of this study support our greatest priority as physicians, which is to miss fewer precancerous polyps and improve the quality of our colonoscopies,” added Dr. Gralnek. “It is important for doctors and their patients to know the Fuse endoscopy platform is now available and has the ability to significantly increase adenoma detection rates.”

For the study the researchers used the EndoChoice (Atlanta, GA, USA) Fuse system, which uses three small cameras at the tip of a flexible gastrointestinal endoscope. By using three cameras, the system allows physicians to see nearly twice as much surface area as they can with traditional endoscopes, since the wider angles allow examination of folds that occur naturally in the colon and stomach anatomy, problem areas that can easily go undetected when using traditional one-camera endoscopes.

Related Links:
Rambam Health Care Campus
EndoChoice