Added value with CAD and mucosal exposure device for identification of adenomas

A researcher reported that the use of a mucosal exposure device alone, or in combination with computer-assisted detection (CADe), resulted in improvements in all adenoma detection parameters during standard colonoscopy.

In a study of 942 patients, Endocuff Vision-assisted colonoscopy (EAC) alone (47%), CADe alone (55%), or CADe-EAC (59%) had an aspiration adenoma detection rate (ADR) greater than 40% for ADR reagents. High versus standard colonoscopy (41%) (s<0.01), according to Krittaya Mekritthikrai, MD, of King Chulalongkorn Memorial Hospital in Bangkok.

And the proximal ADRs (pADRs) for CADe, EAC, and CADe-EAC were significantly higher than the control group (30%, 35%, 37%, and 24%, respectively, s< 0.05), stated in a presentation at Gastroenterology week Virtual meeting.

“Our study showed that in high-reactivity detectors, the use of Endocuff alone or in combination with CADe can significantly improve all indicators of adenomas,” McCritthecray said. “However, the use of CADe can significantly improve the number of adenomas and nearby adenomas detected during colonoscopy.”

Mekritthikrai and colleagues also found that the mean number of adenomas per colonoscopy (APC) and proximal APC (pAPC) per colonoscopy were all significantly higher than the control group:

  • CADe: 1.05 for APC and 0.68 pAPC
  • EAC: 1.19 and 0.75
  • CADe plus EAC: 1.28 and 0.78
  • Control: 0.69 and 0.36

Advances in endoscopic technology have improved adenoma detection rates over the past decade, and researchers have suggested that a mucosal device could help detect adenomas that remain hidden “behind the colonic fold.” CADe is believed to increase the discovery ofsoft adenoma“And those that are not recognized by endoscopy specialists,” Mekritthikrai explained. For screening, CADe and EAC both improve detection of adenoma, but comparative data are not currently available to support individual use or combined use of the two techniques.

“The efficacy of combining these two techniques has never been studied,” she added.

Mekritthikrai and colleagues enrolled patients who underwent colonoscopy from September 2020 to November 2021. They randomly assigned 237 patients to CADe alone, 235 to EAC alone, 233 to CADe-EAC and 237 to standard colonoscopy. All groups received high-resolution, white-light colonoscopy by the interns or endoscopy specialists. Prior to insertion, the Endocuff-Vision (ARV 110, Olympus) was attached to the end of the colonoscope, while the CADe (CAD EYE, Fujifilm) came with a digital box and voice arm activated prior to insertion.

Overall, 60% of the patients were female and the mean age was 61. The mean BMI was 24. The mean Boston bowel preparation score was 8 and 12.5% ​​of patients had a family history of colorectal cancer. About 14% of the total study population were smokers and about 14% had a positive fecal occult blood test. The mean procedure withdrawal time was 7.8 minutes and the cyclic intubation time was 5.7 minutes.

Between the EAC group and the control group, significant increases in ADR and pADR were seen even after adjusting for multiple comparisons. Also, increases in ADR and pADR were also seen between the CADe-EAC group and the control group, but not when comparing the CADe group to the control group.

Notably, the adjusted detection rates for APC and pAPC were also greater in the CADe (1.43, 1.70), EAC (1.85, 2.16), and CADe-EAC (1.94, 2.30) groups versus the control group.

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    Zina Hamza He is a writer for MedPage Today, covering gastroenterology and infectious diseases. She resides in Chicago.

Disclosures

Mekritthikrai and the co-authors have not disclosed any ties to the industry.