Retrograde-viewing device improves adenoma detection rate in colonoscopies for surveillance and diagnostic workup

Peter D. Siersema, Amit Rastogi, Anke M. Leufkens, Paul A. Akerman, Kassem Azzouzi, Richard I. Rothstein, Frank P. Vleggaar, Alessandro Repici, Giacomo Rando, Patrick I. Okolo, Olivier Dewit, Ana Ignjatovic, Elizabeth Odstrcil, James East, Pierre H. Deprez, Brian P. Saunders, Anthony N Kalloo, Bradley Creel, Vikas Singh, Anne Marie O'Broin-LennonDaniel C. DeMarco

Research output: Contribution to journalArticle

Abstract

AIM: To determine which patients might benefit most from retrograde viewing during colonoscopy through subset analysis of randomized, controlled trial data. METHODS: The Third Eye® Retroscope® Randomized Clinical Evaluation (TERRACE) was a randomized, controlled, multicenter trial designed to evaluate the efficacy of a retrograde-viewing auxiliary imaging device that is used during colonoscopy to provide a second video image which allows viewing of areas on the proximal aspect of haustral folds and flexures that are difficult to see with the colonoscope's forward view. We performed a post-hoc analysis of the TERRACE data to determine whether certain subsets of the patient population would gain more benefit than others from use of the device. Subjects were patients scheduled for colonoscopy for screening, surveillance or diagnostic workup, and each underwent same-day tandem examinations with standard colonoscopy (SC) and Third Eye colonoscopy (TEC), randomized to SC followed by TEC or vice versa. RESULTS: Indication for colonoscopy was screening in 176/345 subjects (51.0%), surveillance after previous polypectomy in 87 (25.2%) and diagnostic workup in 82 (23.8%). In 4 subjects no indication was specified. Previously reported overall results had shown a net additional adenoma detection rate (ADR) with TEC of 23.2% compared to SC. Relative risk (RR) of missing adenomas with SC vs TEC as the initial procedure was 1.92 (P = 0.029). Post-hoc subset analysis shows additional ADRs for TEC compared to SC were 4.4% for screening, 35.7% for surveillance, 55.4% for diagnostic and 40.7% for surveillance and diagnostic combined. The RR of missing adenomas with SC vs TEC was 1.11 (P = 0.815) for screening, 3.15 (P = 0.014) for surveillance, 8.64 (P = 0.039) for diagnostic and 3.34 (P = 0.003) for surveillance and diagnostic combined. Although a multivariate Poisson regression suggested gender as a possibly significant factor, subset analysis showed that the difference between genders was not statistically significant. Age, bowel prep quality and withdrawal time did not significantly affect the RR of missing adenomas with SC vs TEC. Mean sizes of adenomas detected with TEC and SC were similar at 0.59 cm and 0.56 cm, respectively (P = NS). CONCLUSION: TEC allows detection of significantly more adenomas compared to SC in patients undergoing surveillance or diagnostic workup, but not in screening patients (ClinicalTrials.gov Identifier: NCT01044732).

Original languageEnglish (US)
Pages (from-to)3400-3408
Number of pages9
JournalWorld Journal of Gastroenterology
Volume18
Issue number26
DOIs
StatePublished - Jul 2012

Fingerprint

Colonoscopy
Adenoma
Equipment and Supplies
Randomized Controlled Trials
Colonoscopes

Keywords

  • Adenomas
  • Colonoscopy
  • Colorectal cancer
  • Miss rates
  • Retrograde-viewing

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Siersema, P. D., Rastogi, A., Leufkens, A. M., Akerman, P. A., Azzouzi, K., Rothstein, R. I., ... DeMarco, D. C. (2012). Retrograde-viewing device improves adenoma detection rate in colonoscopies for surveillance and diagnostic workup. World Journal of Gastroenterology, 18(26), 3400-3408. https://doi.org/10.3748/wjg.v18.i26.3400

Retrograde-viewing device improves adenoma detection rate in colonoscopies for surveillance and diagnostic workup. / Siersema, Peter D.; Rastogi, Amit; Leufkens, Anke M.; Akerman, Paul A.; Azzouzi, Kassem; Rothstein, Richard I.; Vleggaar, Frank P.; Repici, Alessandro; Rando, Giacomo; Okolo, Patrick I.; Dewit, Olivier; Ignjatovic, Ana; Odstrcil, Elizabeth; East, James; Deprez, Pierre H.; Saunders, Brian P.; Kalloo, Anthony N; Creel, Bradley; Singh, Vikas; O'Broin-Lennon, Anne Marie; DeMarco, Daniel C.

In: World Journal of Gastroenterology, Vol. 18, No. 26, 07.2012, p. 3400-3408.

Research output: Contribution to journalArticle

Siersema, PD, Rastogi, A, Leufkens, AM, Akerman, PA, Azzouzi, K, Rothstein, RI, Vleggaar, FP, Repici, A, Rando, G, Okolo, PI, Dewit, O, Ignjatovic, A, Odstrcil, E, East, J, Deprez, PH, Saunders, BP, Kalloo, AN, Creel, B, Singh, V, O'Broin-Lennon, AM & DeMarco, DC 2012, 'Retrograde-viewing device improves adenoma detection rate in colonoscopies for surveillance and diagnostic workup', World Journal of Gastroenterology, vol. 18, no. 26, pp. 3400-3408. https://doi.org/10.3748/wjg.v18.i26.3400
Siersema, Peter D. ; Rastogi, Amit ; Leufkens, Anke M. ; Akerman, Paul A. ; Azzouzi, Kassem ; Rothstein, Richard I. ; Vleggaar, Frank P. ; Repici, Alessandro ; Rando, Giacomo ; Okolo, Patrick I. ; Dewit, Olivier ; Ignjatovic, Ana ; Odstrcil, Elizabeth ; East, James ; Deprez, Pierre H. ; Saunders, Brian P. ; Kalloo, Anthony N ; Creel, Bradley ; Singh, Vikas ; O'Broin-Lennon, Anne Marie ; DeMarco, Daniel C. / Retrograde-viewing device improves adenoma detection rate in colonoscopies for surveillance and diagnostic workup. In: World Journal of Gastroenterology. 2012 ; Vol. 18, No. 26. pp. 3400-3408.
@article{292f68e418d44204afc7d5c58d4e8925,
title = "Retrograde-viewing device improves adenoma detection rate in colonoscopies for surveillance and diagnostic workup",
abstract = "AIM: To determine which patients might benefit most from retrograde viewing during colonoscopy through subset analysis of randomized, controlled trial data. METHODS: The Third Eye{\circledR} Retroscope{\circledR} Randomized Clinical Evaluation (TERRACE) was a randomized, controlled, multicenter trial designed to evaluate the efficacy of a retrograde-viewing auxiliary imaging device that is used during colonoscopy to provide a second video image which allows viewing of areas on the proximal aspect of haustral folds and flexures that are difficult to see with the colonoscope's forward view. We performed a post-hoc analysis of the TERRACE data to determine whether certain subsets of the patient population would gain more benefit than others from use of the device. Subjects were patients scheduled for colonoscopy for screening, surveillance or diagnostic workup, and each underwent same-day tandem examinations with standard colonoscopy (SC) and Third Eye colonoscopy (TEC), randomized to SC followed by TEC or vice versa. RESULTS: Indication for colonoscopy was screening in 176/345 subjects (51.0{\%}), surveillance after previous polypectomy in 87 (25.2{\%}) and diagnostic workup in 82 (23.8{\%}). In 4 subjects no indication was specified. Previously reported overall results had shown a net additional adenoma detection rate (ADR) with TEC of 23.2{\%} compared to SC. Relative risk (RR) of missing adenomas with SC vs TEC as the initial procedure was 1.92 (P = 0.029). Post-hoc subset analysis shows additional ADRs for TEC compared to SC were 4.4{\%} for screening, 35.7{\%} for surveillance, 55.4{\%} for diagnostic and 40.7{\%} for surveillance and diagnostic combined. The RR of missing adenomas with SC vs TEC was 1.11 (P = 0.815) for screening, 3.15 (P = 0.014) for surveillance, 8.64 (P = 0.039) for diagnostic and 3.34 (P = 0.003) for surveillance and diagnostic combined. Although a multivariate Poisson regression suggested gender as a possibly significant factor, subset analysis showed that the difference between genders was not statistically significant. Age, bowel prep quality and withdrawal time did not significantly affect the RR of missing adenomas with SC vs TEC. Mean sizes of adenomas detected with TEC and SC were similar at 0.59 cm and 0.56 cm, respectively (P = NS). CONCLUSION: TEC allows detection of significantly more adenomas compared to SC in patients undergoing surveillance or diagnostic workup, but not in screening patients (ClinicalTrials.gov Identifier: NCT01044732).",
keywords = "Adenomas, Colonoscopy, Colorectal cancer, Miss rates, Retrograde-viewing",
author = "Siersema, {Peter D.} and Amit Rastogi and Leufkens, {Anke M.} and Akerman, {Paul A.} and Kassem Azzouzi and Rothstein, {Richard I.} and Vleggaar, {Frank P.} and Alessandro Repici and Giacomo Rando and Okolo, {Patrick I.} and Olivier Dewit and Ana Ignjatovic and Elizabeth Odstrcil and James East and Deprez, {Pierre H.} and Saunders, {Brian P.} and Kalloo, {Anthony N} and Bradley Creel and Vikas Singh and O'Broin-Lennon, {Anne Marie} and DeMarco, {Daniel C.}",
year = "2012",
month = "7",
doi = "10.3748/wjg.v18.i26.3400",
language = "English (US)",
volume = "18",
pages = "3400--3408",
journal = "World Journal of Gastroenterology",
issn = "1007-9327",
publisher = "WJG Press",
number = "26",

}

TY - JOUR

T1 - Retrograde-viewing device improves adenoma detection rate in colonoscopies for surveillance and diagnostic workup

AU - Siersema, Peter D.

AU - Rastogi, Amit

AU - Leufkens, Anke M.

AU - Akerman, Paul A.

AU - Azzouzi, Kassem

AU - Rothstein, Richard I.

AU - Vleggaar, Frank P.

AU - Repici, Alessandro

AU - Rando, Giacomo

AU - Okolo, Patrick I.

AU - Dewit, Olivier

AU - Ignjatovic, Ana

AU - Odstrcil, Elizabeth

AU - East, James

AU - Deprez, Pierre H.

AU - Saunders, Brian P.

AU - Kalloo, Anthony N

AU - Creel, Bradley

AU - Singh, Vikas

AU - O'Broin-Lennon, Anne Marie

AU - DeMarco, Daniel C.

PY - 2012/7

Y1 - 2012/7

N2 - AIM: To determine which patients might benefit most from retrograde viewing during colonoscopy through subset analysis of randomized, controlled trial data. METHODS: The Third Eye® Retroscope® Randomized Clinical Evaluation (TERRACE) was a randomized, controlled, multicenter trial designed to evaluate the efficacy of a retrograde-viewing auxiliary imaging device that is used during colonoscopy to provide a second video image which allows viewing of areas on the proximal aspect of haustral folds and flexures that are difficult to see with the colonoscope's forward view. We performed a post-hoc analysis of the TERRACE data to determine whether certain subsets of the patient population would gain more benefit than others from use of the device. Subjects were patients scheduled for colonoscopy for screening, surveillance or diagnostic workup, and each underwent same-day tandem examinations with standard colonoscopy (SC) and Third Eye colonoscopy (TEC), randomized to SC followed by TEC or vice versa. RESULTS: Indication for colonoscopy was screening in 176/345 subjects (51.0%), surveillance after previous polypectomy in 87 (25.2%) and diagnostic workup in 82 (23.8%). In 4 subjects no indication was specified. Previously reported overall results had shown a net additional adenoma detection rate (ADR) with TEC of 23.2% compared to SC. Relative risk (RR) of missing adenomas with SC vs TEC as the initial procedure was 1.92 (P = 0.029). Post-hoc subset analysis shows additional ADRs for TEC compared to SC were 4.4% for screening, 35.7% for surveillance, 55.4% for diagnostic and 40.7% for surveillance and diagnostic combined. The RR of missing adenomas with SC vs TEC was 1.11 (P = 0.815) for screening, 3.15 (P = 0.014) for surveillance, 8.64 (P = 0.039) for diagnostic and 3.34 (P = 0.003) for surveillance and diagnostic combined. Although a multivariate Poisson regression suggested gender as a possibly significant factor, subset analysis showed that the difference between genders was not statistically significant. Age, bowel prep quality and withdrawal time did not significantly affect the RR of missing adenomas with SC vs TEC. Mean sizes of adenomas detected with TEC and SC were similar at 0.59 cm and 0.56 cm, respectively (P = NS). CONCLUSION: TEC allows detection of significantly more adenomas compared to SC in patients undergoing surveillance or diagnostic workup, but not in screening patients (ClinicalTrials.gov Identifier: NCT01044732).

AB - AIM: To determine which patients might benefit most from retrograde viewing during colonoscopy through subset analysis of randomized, controlled trial data. METHODS: The Third Eye® Retroscope® Randomized Clinical Evaluation (TERRACE) was a randomized, controlled, multicenter trial designed to evaluate the efficacy of a retrograde-viewing auxiliary imaging device that is used during colonoscopy to provide a second video image which allows viewing of areas on the proximal aspect of haustral folds and flexures that are difficult to see with the colonoscope's forward view. We performed a post-hoc analysis of the TERRACE data to determine whether certain subsets of the patient population would gain more benefit than others from use of the device. Subjects were patients scheduled for colonoscopy for screening, surveillance or diagnostic workup, and each underwent same-day tandem examinations with standard colonoscopy (SC) and Third Eye colonoscopy (TEC), randomized to SC followed by TEC or vice versa. RESULTS: Indication for colonoscopy was screening in 176/345 subjects (51.0%), surveillance after previous polypectomy in 87 (25.2%) and diagnostic workup in 82 (23.8%). In 4 subjects no indication was specified. Previously reported overall results had shown a net additional adenoma detection rate (ADR) with TEC of 23.2% compared to SC. Relative risk (RR) of missing adenomas with SC vs TEC as the initial procedure was 1.92 (P = 0.029). Post-hoc subset analysis shows additional ADRs for TEC compared to SC were 4.4% for screening, 35.7% for surveillance, 55.4% for diagnostic and 40.7% for surveillance and diagnostic combined. The RR of missing adenomas with SC vs TEC was 1.11 (P = 0.815) for screening, 3.15 (P = 0.014) for surveillance, 8.64 (P = 0.039) for diagnostic and 3.34 (P = 0.003) for surveillance and diagnostic combined. Although a multivariate Poisson regression suggested gender as a possibly significant factor, subset analysis showed that the difference between genders was not statistically significant. Age, bowel prep quality and withdrawal time did not significantly affect the RR of missing adenomas with SC vs TEC. Mean sizes of adenomas detected with TEC and SC were similar at 0.59 cm and 0.56 cm, respectively (P = NS). CONCLUSION: TEC allows detection of significantly more adenomas compared to SC in patients undergoing surveillance or diagnostic workup, but not in screening patients (ClinicalTrials.gov Identifier: NCT01044732).

KW - Adenomas

KW - Colonoscopy

KW - Colorectal cancer

KW - Miss rates

KW - Retrograde-viewing

UR - http://www.scopus.com/inward/record.url?scp=84863915276&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84863915276&partnerID=8YFLogxK

U2 - 10.3748/wjg.v18.i26.3400

DO - 10.3748/wjg.v18.i26.3400

M3 - Article

C2 - 22807609

AN - SCOPUS:84863915276

VL - 18

SP - 3400

EP - 3408

JO - World Journal of Gastroenterology

JF - World Journal of Gastroenterology

SN - 1007-9327

IS - 26

ER -