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

World Journal of Gastroenterology 2012年第26期18卷 3400-3408页

作者： 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 Lennon Daniel C DeMarco Department of Gastroenterology and Hepatology University Medical Center Utrecht3508 GA UtrechtThe Netherlands Division of Gastroenterology and Hepatology Kansas City Veterans Administration Medical CenterKansas CityMO 64128United States Department of Gastroenterology Bayside Endoscopy Center33 Staniford StreetProvidenceRI 02905United States Department of Gastroenterology Cliniques Universitaires Saint-LucUniversité Catholique de LouvainB-1200 BrusselsBelgium Department of Gastroenterology and Hepatology Dartmouth-Hitchcock Medical CenterOne Medical Center DriveLebanonNH 03756United States Department of Gastroenterology Istituto Clinico Humanitas20089 RozzanoItaly Department of Internal Medicine Division of Gastroenterology and HepatologyJohns Hopkins HospitalBaltimoreMD 21205United States Wolfson Unit for Endoscopy St.Mark's HospitalHarrow HA1 3UJUnited Kingdom Department of Internal Medicine Division of GastroenterologyBaylor University Medical CenterDallasTX 75246United States

AIM:To determine which patients might benefit most from retrograde viewing during colonoscopy through subset analysis of randomized,controlled trial ***: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 *** 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 *** 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 ***: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 *** reported overall results had shown a net additional adenoma detection rate(ADR) with TEC of 23.2% compared to *** 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 *** 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 *** a multivariate Poisson regression suggested gender as a possibly significant factor,subset analysis showed that the difference between genders was not statistically ***

关键词： Colonoscopy Colorectal cancer Adenomas Miss rates Retrograde-viewing

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