Department of Medicine.
The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai.
J Clin Gastroenterol. 2018 Nov/Dec;52(10):885-890. doi: 10.1097/MCG.0000000000000874.
To investigate the effect of implementing full-spectrum endoscopy (Fuse) on adenoma detection rate (ADR) at an ambulatory surgical center (ASC).
Traditional forward viewing (TFV) endoscopes have 1 camera and provide an angle of view of 140 to 170 degrees, whereas Fuse provides a 330 degrees view through the addition of 2 side cameras. Although randomized studies have shown that Fuse decreases adenoma miss rates, its impact on ADR in a screening population is currently unknown.
We conducted a retrospective analysis of data from average risk screening colonoscopies at a 5-room ASC. This ASC transitioned from TFV to Fuse in April 2014. The primary outcome was ADR defined as the percentage of patients who underwent screening colonoscopy and were found to have at least 1 adenomatous polyp.
A total of 1696 screening colonoscopies were performed with TFV and 2302 with Fuse. Overall ADR was 23.7% with TFV and 29.0% with Fuse (P<0.01), an absolute increase of 5.3%. ADR for the proximal colon increased from 13.0% with TFV to 16.7% with Fuse (3.8% increase, P<0.01). ADR for advanced adenomas improved from 3.8% with TFV to 6.0% with Fuse (2.2% increase; P<0.01). The mean number of adenomas detected per colonoscopy increased from 0.32 to 0.41 (P<0.01). In multivariate analysis, the adjusted odds ratio for detecting an adenoma with Fuse versus TFV was 1.30 (P<0.01; 95% confidence interval, 1.11-1.51).
ADR significantly increased after adopting Fuse endoscopes at an ASC. Further studies are warranted to further understand the effects of Fuse on ADR in real-world settings.
研究在门诊手术中心（ASC）实施全谱内镜（Fuse）对腺瘤检出率（ADR）的影响。
传统的前视（TFV）内窥镜只有 1 个摄像头，视角为 140 度至 170 度，而 Fuse 通过增加 2 个侧摄像头提供 330 度的视野。尽管随机研究表明 Fuse 降低了腺瘤漏诊率，但它对筛查人群中 ADR 的影响尚不清楚。
我们对 5 个房间 ASC 的平均风险筛查结肠镜检查数据进行了回顾性分析。该 ASC 于 2014 年 4 月从 TFV 过渡到 Fuse。主要结果是 ADR，定义为接受筛查结肠镜检查且至少发现 1 个腺瘤性息肉的患者百分比。
共进行了 1696 例 TFV 筛查结肠镜检查和 2302 例 Fuse 筛查结肠镜检查。TFV 的总体 ADR 为 23.7%，Fuse 的 ADR 为 29.0%（P<0.01），绝对增加了 5.3%。TFV 的近端结肠 ADR 从 13.0%增加到 Fuse 的 16.7%（增加 3.8%，P<0.01）。TFV 的高级腺瘤 ADR 从 3.8%增加到 Fuse 的 6.0%（增加 2.2%；P<0.01）。每例结肠镜检查发现的腺瘤数量从 0.32 个增加到 0.41 个（P<0.01）。多变量分析中，Fuse 与 TFV 相比，检测腺瘤的调整优势比为 1.30（P<0.01；95%置信区间，1.11-1.51）。
在 ASC 采用 Fuse 内窥镜后，ADR 显著增加。需要进一步研究以进一步了解 Fuse 在实际环境中对 ADR 的影响。
