ASGE Technology Committee systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting real-time endoscopic assessment of the histology of diminutive colorectal polyps

Dayyeh, Barham K. Abu; Thosani, Nirav; Konda, Vani J.; Wallace, Michael B.; Rex, Douglas K.; Chauhan, Shailendra S.; Hwang, Joo Ha; Komanduri, Sri; Manfredi, Michael A.; Maple, John T.; Murad, Faris; Siddiqui, Uzma D.; Banerjee, Subhas

doi:10.1016/j.gie.2014.12.022

Cited by 321 publications

(274 citation statements)

References 60 publications

Supporting

Mentioning

266

Contrasting

Unclassified

Order By: Relevance

“…Ziel der Zoomendoskopie ist es, anhand der "pit-pattern"-Klassifikation zwischen hyperplastischen und neoplastischen Läsionen zu unterscheiden, um ohne Histologie festzustellen, welche Läsionen endoskopisch abgetragen werden müssen. In letzter Zeit hat sich aber die Auflösung von HD-Endoskopen mit oder ohne Bildnachbearbeitung in einer Weise verbessert, dass eine Vergrößerungsendoskopie nicht mehr obligat erscheint [491]. So wurden auch neue Klassifikationen vorgeschlagen, z.…”

Section: Level Of Evidence 1bunclassified

“…Es gibt zahlreiche Veröffentlichungen zu der Überlegung einer endoskopischen Polypendifferenzialdiagnose ("endoskopische Histologie") [491] mit dem Ziel, kleinere abgetragene Polypen nicht mehr histologisch untersuchen zu lassen ("Resect and Discard" [493,494], kurz DISCARD policy) -vorwiegend aus Kostengründen [495,496]. Die Nachsorgeempfehlungen richten sich dann hauptsächlich nach der endoskopischen Differenzialdiagnose zwischen Adenomen und hyperplastischen Läsionen, da keine Histologie mehr vorliegt.…”

Section: Level Of Evidence 1bunclassified

See 1 more Smart Citation

S3-Leitlinie – Kolorektales Karzinom

Schmiegel

Buchberger

Follmann³

et al. 2017

Z Gastroenterol

151

View full text Add to dashboard Cite

Section: Level Of Evidence 1bunclassified

S3-Leitlinie – Kolorektales Karzinom

Schmiegel

Buchberger

Follmann³

et al. 2017

Z Gastroenterol

151

View full text Add to dashboard Cite

“…[42][43][44]149 For example, the ASGE Technology Committee conducted a systematic review to examine whether NBI, i-scan or FICE met the PIVI performance thresholds and, therefore, whether or not the evidence supported a 'diagnosis-and-leave' approach (ASGE Technology Committee, 2015, p. 1). 149 Literature searches were done on a number of standard health research databases, up to May 2014 (thus the search is around 2 years older than our literature search). For NBI the review included 19 studies giving estimates of NPVs and 10 studies giving estimates of agreement in post-polypectomy surveillance intervals.…”

Section: Doi: 103310/hta21790 Health Technology Assessment 2017 Volmentioning

confidence: 99%

“…In the ASGE systematic review 149 the pooled random-effects NPV for studies in which an optical characterisation of diminutive polyps with NBI was made with high confidence was 93% (95% CI 90% to 96%). This increased to 95% (95% CI 92% to 98%) when high-confidence characterisations were made by endoscopists experienced in optical assessment of colorectal polyps.…”

Section: Doi: 103310/hta21790 Health Technology Assessment 2017 Volmentioning

confidence: 99%

Virtual chromoendoscopy for the real-time assessment of colorectal polyps in vivo: a systematic review and economic evaluation

Picot

Rose

Cooper

et al. 2017

Health Technol Assess

View full text Add to dashboard Cite

BackgroundCurrent clinical practice is to remove a colorectal polyp detected during colonoscopy and determine whether it is an adenoma or hyperplastic by histopathology. Identifying adenomas is important because they may eventually become cancerous if untreated, whereas hyperplastic polyps do not usually develop into cancer, and a surveillance interval is set based on the number and size of adenomas found. Virtual chromoendoscopy (VCE) (an electronic endoscopic imaging technique) could be used by the endoscopist under strictly controlled conditions for real-time optical diagnosis of diminutive (≤ 5 mm) colorectal polyps to replace histopathological diagnosis.ObjectiveTo assess the clinical effectiveness and cost-effectiveness of the VCE technologies narrow-band imaging (NBI), flexible spectral imaging colour enhancement (FICE) and i-scan for the characterisation and management of diminutive (≤ 5 mm) colorectal polyps using high-definition (HD) systems without magnification.DesignSystematic review and economic analysis.ParticipantsPeople undergoing colonoscopy for screening or surveillance or to investigate symptoms suggestive of colorectal cancer.InterventionsNBI, FICE and i-scan.Main outcome measuresDiagnostic accuracy, recommended surveillance intervals, health-related quality of life (HRQoL), adverse effects, incidence of colorectal cancer, mortality and cost-effectiveness of VCE compared with histopathology.Data sourcesElectronic bibliographic databases including MEDLINE, EMBASE, The Cochrane Library and Database of Abstracts of Reviews of Effects were searched for published English-language studies from inception to June 2016. Bibliographies of related papers, systematic reviews and company information were screened and experts were contacted to identify additional evidence.Review methodsSystematic reviews of test accuracy and economic evaluations were undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Meta-analyses were conducted, where possible, to inform the independent economic model. A cost–utility decision-analytic model was developed to estimate the cost-effectiveness of VCE compared with histopathology. The model used a decision tree for patients undergoing endoscopy, combined with estimates of long-term outcomes (e.g. incidence of colorectal cancer and subsequent morbidity and mortality) derived from University of Sheffield School of Health and Related Research’s bowel cancer screening model. The model took a NHS perspective, with costs and benefits discounted at 3.5% over a lifetime horizon. There were limitations in the data on the distribution of adenomas across risk categories and recurrence rates post polypectomy.ResultsThirty test accuracy studies were included: 24 for NBI, five for i-scan and three for FICE (two studies assessed two interventions). Polyp assessments made with high confidence were associated with higher sensitivity and endoscopists experienced in VCE achieved better results than those without experience. Two economic evaluations were included. NBI, i-scan and FICE are cost-saving strategies compared with histopathology and the number of quality-adjusted life-years gained was similar for histopathology and VCE. The correct surveillance interval would be given to 95% of patients with NBI, 94% of patients with FICE and 97% of patients with i-scan.LimitationsLimited evidence was available for i-scan and FICE and there was heterogeneity among the NBI studies. There is a lack of data on longer-term health outcomes of patients undergoing VCE for assessment of diminutive colorectal polyps.ConclusionsVCE technologies, using HD systems without magnification, could potentially be used for the real-time assessment of diminutive colorectal polyps, if endoscopists have adequate experience and training.Future workFuture research priorities include head-to-head randomised controlled trials of all three VCE technologies; more research on the diagnostic accuracy of FICE and i-scan (when used without magnification); further studies evaluating the impact of endoscopist experience and training on outcomes; studies measuring adverse effects, HRQoL and anxiety; and longitudinal data on colorectal cancer incidence, HRQoL and mortality.Study registrationThis study is registered as PROSPERO CRD42016037767.FundingThe National Institute for Health Research Health Technology Assessment programme.

show abstract

“…Detection of flat, subtle lesions in the colon, including serrated adenomas/polyps, remains a challenge depending on a careful operator technique. Appropriate endoscopist performance characteristics with meticulous inspection and an adequate withdrawal time increase colonoscopy yield, reducing the substantial miss rate reported with standard resolution white light colonoscopies (SRWL) (13,14).…”

Section: Introductionmentioning

confidence: 99%

Enhanced flat adenoma detection rate with high definition colonoscopy plus i-scan for average-risk colorectal cancer screening

A¹,

Saperas²

2016

Rev Esp Enferm Dig

View full text Add to dashboard Cite

Background and aim:The usefulness of high definition colonoscopy plus i-scan (HD+i-SCAN) for average-risk colorectal cancer screening has not been fully assessed. The detection rate of adenomas and other measurements such as the number of adenomas per colonoscopy and the flat adenoma detection rate have been recognized as markers of colonoscopy quality. The aim of the present study was to compare the diagnostic performance of an HD+i-SCAN with that of standard resolution white-light colonoscope.Methods: This is a retrospective analysis of a prospectively collected screening colonoscopy database. A comparative analysis of the diagnostic yield of an HD+i-SCAN or standard resolution colonoscopy for average-risk colorectal screening was conducted.Results: During the period of study, 155/163 (95.1%) patients met the inclusion criteria. The mean age was 56.9 years. Sixty of 155 (39%) colonoscopies were performed using a HD+i-SCAN. Adenoma-detection-rates during the withdrawal of the standard resolution versus HD+i-SCAN colonoscopies were 29.5% and 30% (p = n.s.). Adenoma/colonoscopy values for standard resolution versus HD+i-SCAN colonoscopies were 0.46 (SD = 0.9) and 0.72 (SD = 1.3) (p = n.s.). A greater number of flat adenomas were detected in the HD+i-SCAN group (6/60 vs. 2/95) (p < .05). Likewise, serrated adenomas/polyps per colonoscopy were also higher in the HD+i-SCAN group.Conclusions: A HD+i-SCAN colonoscopy increases the flat adenoma detection rate and serrated adenomas/polyps per colonoscopy compared to a standard colonoscopy in averagerisk screening population. HD+i-SCAN is a simple, available procedure that can be helpful, even for experienced providers. The performance of HD+i-SCAN and substantial prevalence of flat lesions in our average-risk screening cohort support its usefulness in improving the efficacy of screening colonoscopies.

show abstract

ASGE Technology Committee systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting real-time endoscopic assessment of the histology of diminutive colorectal polyps

Cited by 321 publications

References 60 publications

S3-Leitlinie – Kolorektales Karzinom

S3-Leitlinie – Kolorektales Karzinom

Virtual chromoendoscopy for the real-time assessment of colorectal polyps in vivo: a systematic review and economic evaluation

Enhanced flat adenoma detection rate with high definition colonoscopy plus i-scan for average-risk colorectal cancer screening

Contact Info

Product

Resources

About