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      High Cecal Intubation Rates With a New Computer-Assisted Colonoscope: A Feasibility Study

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          Abstract

          OBJECTIVES:

          The acceptability of colonoscopy as a screening test is limited by several factors including patient discomfort. A new self-propelled colonoscope, the Invendo SC20 (Invendo Medical GmbH), may be helpful in reducing sedation. It consists of a sheathed endoscope contained within an “inverted sleeve,” and having an instrument channel and an electrohydraulic bendable tip; it is steered using a handheld device and propelled by a motorized drive unit. This study assessed the safety and efficacy of this new endoscope in volunteers undergoing colorectal cancer (CRC) screening.

          METHODS:

          Paid healthy volunteers aged 50–70 years and eligible for screening colonoscopy were included. Total colonoscopy using carbon dioxide insufflation or water instillation on demand was attempted, with all procedures being started without sedation. The main outcome parameters were safety and the cecal intubation rate.

          RESULTS:

          A total of 61 volunteers participated (34 men and 27 women; mean age 57.5 years). The cecum was reached in 60 volunteers (cecal intubation rate of 98.4%). The median time to reach the cecum was 15 min (range 7–53.5). Sedation was given in three individuals (4.9%). On withdrawal (median time 15 min), the material for histological evaluation was obtained from 33 polyps (mean size 4.8 mm) in 23 people by biopsy forceps or snare. No device-related complications were encountered.

          CONCLUSIONS:

          A new computer-assisted colonoscope, controlled using a handheld device, showed excellent cecal intubation rates during screening examinations, with sedation required in only ∼5% of screenees. Further clinical and comparative studies are warranted.

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          Most cited references14

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          Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology.

          In the United States, colorectal cancer (CRC) is the third most common cancer diagnosed among men and women and the second leading cause of death from cancer. CRC largely can be prevented by the detection and removal of adenomatous polyps, and survival is significantly better when CRC is diagnosed while still localized. In 2006 to 2007, the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology came together to develop consensus guidelines for the detection of adenomatous polyps and CRC in asymptomatic average-risk adults. In this update of each organization's guidelines, screening tests are grouped into those that primarily detect cancer early and those that can detect cancer early and also can detect adenomatous polyps, thus providing a greater potential for prevention through polypectomy. When possible, clinicians should make patients aware of the full range of screening options, but at a minimum they should be prepared to offer patients a choice between a screening test that primarily is effective at early cancer detection and a screening test that is effective at both early cancer detection and cancer prevention through the detection and removal of polyps. It is the strong opinion of these 3 organizations that colon cancer prevention should be the primary goal of screening.
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            High yields of small and flat adenomas with high-definition colonoscopes using either white light or narrow band imaging.

            Detection of adenomas is an important goal of colonoscopy. Narrow band imaging (NBI) might highlight adenomas and lead to higher rates of adenoma detection. This was a randomized controlled trial of colonoscopy withdrawal in white light versus NBI in 434 patients aged 50 years or older with intact colons. All examinations were performed by a single experienced endoscopist with a known high detection rate of adenomas using high-definition, wide-angle (170 degrees field of view) colonoscopes. There was no difference in the percent of patients with >or=1 adenoma for the entire cohort in white light (67%) versus NBI (65%) (P = .61) or in the subset of 257 patients with indication screening (58% vs 57%; P = .91). Both the prevalences of adenomas and the numbers of adenomas per colonoscopy are the highest ever reported in colonoscopy studies. The high prevalence rates of adenomas were accounted for by detection of large numbers of adenomas, including flat adenomas, which were
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              Narrow-band versus white-light high definition television endoscopic imaging for screening colonoscopy: a prospective randomized trial.

              Narrow-band imaging (NBI) has been implemented in gastrointestinal endoscopy to improve the contrast of endoluminal pathologic structures, one of the aims being to increase colonic adenoma detection. Previous studies from referral centers have yielded variable and conflicting results with regard to improvement in adenoma detection rates by using NBI. The present large randomized trial was designed to finally settle this issue. In a prospective study performed exclusively in a multicenter private practice setting involving 6 examiners with substantial lifetime experience (>10,000 colonoscopies), 1256 patients (men:women, 47%:53%; mean age, 64.4 y) were randomized to HDTV screening colonoscopy with either NBI or white-light imaging on instrument withdrawal. The primary outcome measure was the adenoma detection rate (ie, number of adenomas/total number of patients). There was no difference between the 2 groups in terms of the general adenoma detection rate (0.32 vs 0.34), the total number of adenomas (200 vs 216), or in detection in subgroups of adenomas. This was despite a minimal, but significantly longer, withdrawal time in the NBI group (8.5 vs 7.9 min; P < .05). Only hyperplastic polyps were found more frequently in the NBI group (P = .03). This large randomized trial in a homogeneous private practice screening setting could not show any objective advantage of the NBI technique over white-light high definition television imaging in terms of improved adenoma detection rate. Contrast enhancement therefore likely will not contribute to a reduction in adenoma miss rates among experienced colonoscopists.
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                Author and article information

                Journal
                Am J Gastroenterol
                The American Journal of Gastroenterology
                Nature Publishing Group
                0002-9270
                1572-0241
                June 2011
                08 March 2011
                : 106
                : 6
                : 1075-1080
                Affiliations
                [1 ]simpleDepartment of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf , Hamburg, Germany
                [2 ]simpleDepartment of Gastroenterology, Indiana University Hospital , Indianapolis, Indiana, USA
                [3 ]simpleGastroenterology Practice at Bethanien Hospital , Frankfurt, Germany
                Author notes
                [* ]simpleDepartment of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf , Martinistr. 52, Hamburg 20246, Germany. E-mail: t.roesch@ 123456uke.de
                Article
                ajg201152
                10.1038/ajg.2011.52
                3185926
                21386833
                801185a9-5ec5-4add-b278-79307ea89c8c
                Copyright © 2011 American College of Gastroenterology

                This work is licensed under the Creative Commons Attribution-NonCommercial-No Derivative Works 3.0 License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/3.0/

                History
                : 21 September 2010
                : 26 January 2011
                Categories
                Endoscopy

                Gastroenterology & Hepatology
                Gastroenterology & Hepatology

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