Gkolfakis Paraskevas, Tziatzios Georgios, Facciorusso Antonio, Muscatiello Nicola, Triantafyllou Konstantinos
Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece.
Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy.
Eur J Gastroenterol Hepatol. 2018 Dec;30(12):1482-1490. doi: 10.1097/MEG.0000000000001245.
A variety of add-on devices and new-generation endoscopes have the potential to detect lesions 'hidden' behind colonic folds. We measured the effect of these new modalities on colonoscopy's lesions miss rates by a meta-analysis of data from individual studies.
We performed literature searches in Medline and Cochrane Library for back-to-back randomized-controlled trials evaluating colonoscope add-on devices and new endoscopes in terms of lesions miss rates. The effect size on study outcomes is shown as relative risk (95% confidence interval).
We identified nine tandem studies with 1594 patients: seven evaluating add-on devices (one with cap, two with Endocuff, one with Endorings, one with Third-Eye Retroscope, two with G-EYE endoscope) and two evaluating the full-spectrum endoscopy system (FUSE) in comparison with conventional colonoscopy (CC). Overall, adenoma miss rate (AMR) was significantly lower with add-on devices/FUSE [0.33 (0.22-0.50), P<0.00001] compared with CC, the effect being similar among the add-on devices [0.35 (0.22-0.57), P<0.0001] and the FUSE [0.26 (0.15-0.46), P<0.00001] studies, respectively. Advanced AMR and polyp miss rate (PMR) were also significantly lower using add-on devices/FUSE [0.30 (0.21-0.44), P<0.0001 and 0.31 (0.13-0.79), P=0.01, respectively]. Use of add-on devices/FUSE scope was associated with significantly lower AMR and PMR in the proximal colon and it was associated with shortening of the colonoscopy surveillance interval.
Our meta-analysis provides evidence that AMR, advanced AMR, and PMR are significantly lower using add-on to colonoscope devices and the full-spectrum endoscopy systems compared with CC. Heterogeneity among the included studies and the small number of detected advanced adenomas call for cautious interpretation of the results.
多种附加设备和新一代内窥镜有潜力检测隐藏在结肠皱襞后的病变。我们通过对个体研究数据进行荟萃分析，来评估这些新方法对结肠镜检查病变漏诊率的影响。
我们在Medline和Cochrane图书馆进行文献检索，查找背对背随机对照试验，这些试验评估了结肠镜附加设备和新型内窥镜的病变漏诊率。研究结果的效应大小以相对风险（95%置信区间）表示。
我们确定了9项包含1594例患者的串联研究：7项评估附加设备（1项带帽，2项带Endocuff，1项带Endorings，1项带Third-Eye Retroscope，2项带G-EYE内窥镜），2项评估全谱内窥镜系统（FUSE）并与传统结肠镜检查（CC）进行比较。总体而言，与CC相比，附加设备/FUSE的腺瘤漏诊率（AMR）显著更低[0.33（0.22 - 0.50），P < 0.00001]，附加设备[0.35（0.22 - 0.57），P < 0.0001]和FUSE[0.26（0.15 - 0.46），P < 0.00001]研究中的效应相似。使用附加设备/FUSE时，高级腺瘤漏诊率和息肉漏诊率（PMR）也显著更低[分别为0.30（0.21 - 0.44），P < 0.0001和0.31（0.13 - 0.79），P = 0.01]。使用附加设备/FUSE结肠镜与近端结肠中显著更低的AMR和PMR相关，并且与结肠镜监测间隔的缩短相关。
我们的荟萃分析提供了证据，表明与CC相比，使用结肠镜附加设备和全谱内窥镜系统时，AMR、高级AMR和PMR显著更低。纳入研究之间的异质性以及检测到的高级腺瘤数量较少，需要谨慎解释结果。
