Document Detail


A retrograde-viewing device improves detection of adenomas in the colon: a prospective efficacy evaluation (with videos).
MedLine Citation:
PMID:  20018280     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Colonoscopy may fail to detect neoplasia located on the proximal sides of haustral folds and flexures. The Third Eye Retroscope (TER) provides a simultaneous retrograde view that complements the forward view of a standard colonoscope.
OBJECTIVE: To evaluate the added benefit for polyp detection during colonoscopy of a retrograde-viewing device.
DESIGN: Open-label, prospective, multicenter study evaluating colonoscopy by using a TER in combination with a standard colonoscope.
SETTING: Eight U.S. sites, including university medical centers, ambulatory surgery centers, a community hospital, and a physician's office.
PATIENTS: A total of 249 patients (age range 55-80 years) presenting for screening or surveillance colonoscopy.
INTERVENTIONS: After cecal intubation, the disposable TER was inserted through the instrument channel of the colonoscope. During withdrawal, the forward and retrograde video images were observed simultaneously on a wide-screen monitor.
MAIN OUTCOME MEASUREMENTS: The number and sizes of lesions (adenomas and all polyps) detected with the standard colonoscope and the number and sizes of lesions found only because they were first detected with the TER.
RESULTS: In the 249 subjects, 257 polyps (including 136 adenomas) were identified with the colonoscope alone. The TER allowed detection of 34 additional polyps (a 13.2% increase; P < .0001) including 15 additional adenomas (an 11.0% increase; P < .0001). For lesions 6 mm or larger, the additional detection rates with the TER for all polyps and for adenomas were 18.2% and 25.0%, respectively. For lesions 10 mm or larger, the additional detection rates with the TER for all polyps and for adenomas were 30.8% and 33.3%, respectively. In 28 (11.2%) individuals, at least 1 additional polyp was found with the TER. In 8 (3.2%) patients, the polyp detected with the TER was the only one found. Every polyp that was detected with the TER was subsequently located with the colonoscope and removed. For all polyps and for adenomas, the additional detection rates for the TER were 9.7%/4.1% in the left colon (the splenic flexure to the rectum) and 16.5%/14.9% in the right colon (the cecum to the transverse colon), respectively.
LIMITATIONS: There was no randomization or comparison with a separate control group.
CONCLUSIONS: A retrograde-viewing device revealed areas that were hidden from the forward-viewing colonoscope and allowed detection of 13.2% additional polyps, including 11.0% additional adenomas. Additional detection rates with the TER for adenomas 6 mm or larger and 10 mm or larger were 25.0% and 33.3%, respectively. (Clinical trial registration number: NCT00657371.).
Authors:
Jerome D Waye; Russell I Heigh; David E Fleischer; Jonathan A Leighton; Suryakanth Gurudu; Leslie B Aldrich; Jiayi Li; Sanjay Ramrakhiani; Steven A Edmundowicz; Dayna S Early; Sreenivasa Jonnalagadda; Robert S Bresalier; William R Kessler; Douglas K Rex
Publication Detail:
Type:  Journal Article     Date:  2009-12-16
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  71     ISSN:  1097-6779     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-01     Completed Date:  2010-05-27     Revised Date:  2011-04-01    
Medline Journal Info:
Nlm Unique ID:  0010505     Medline TA:  Gastrointest Endosc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  551-6     Citation Subset:  IM    
Copyright Information:
2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
Affiliation:
Mount Sinai Medical Center, New York, New York, USA. jdwaye@aol.com
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00657371
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MeSH Terms
Descriptor/Qualifier:
Adenoma / diagnosis*
Aged
Aged, 80 and over
Colonic Neoplasms / diagnosis*
Colonoscopes*
Colonoscopy*
Disposable Equipment
Equipment Design
Female
Humans
Male
Middle Aged
Prospective Studies
Video Recording
Comments/Corrections
Comment In:
Gastrointest Endosc. 2010 Mar;71(3):557-9   [PMID:  20189514 ]
Gastrointest Endosc. 2011 Mar;73(3):637; author reply 637-8   [PMID:  21353861 ]
Gastrointest Endosc. 2011 Jan;73(1):190; author reply 193-4   [PMID:  21184890 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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