Detection and miss rates of autofluorescence imaging of adenomatous and polypoid lesions during colonoscopy: a systematic review and meta-analysis

Abstract

Background and study aims: Autofluorescence imaging (AFI) is an endoscopic imaging technique used to increase the detection of premalignant gastrointestinal lesions, and it has gradually become popular in recent years. This meta-analysis was performed to examine whether AFI provides greater efficacy in the detection of adenomatous and polypoid lesions and can even prevent the failure to detect a single adenoma or polyp. The aim of the study was to systematically review the efficacy of AFI in increasing detection rates and decreasing miss rates. Methods: Pertinent articles were identified through a search of databases up to December 2013 that included patients who had undergone two same-day colonoscopies (AFI and white light endoscopy [WLE]), followed by polypectomy. Fixed and random effects models were used to detect significant differences between AFI and WLE in regard to adenoma detection rate (ADR), polyp detection rate (PDR), adenoma miss rate (AMR), polyp miss rate (PMR), and procedural time. Results: A total of 1199 patients from six eligible studies met the inclusion criteria. No significant differences were found in ADR (odds ratio [OR] 1.01; 95 % confidence interval [95 %CI] 0.74 – 1.37), PDR (OR 0.86; 95 %CI 0.57 – 1.30), or advanced ADR (OR 1.22; 95 %CI 0.69 – 2.17). The AMR (OR 0.62; 95 %CI 0.44 – 0.86) and PMR (OR 0.64; 95 %CI 0.48 – 0.85) by AFI were significantly lower than those by WLE. The procedural time of AFI was significantly longer than that of WLE (mean 8.00 minutes; 95 %CI 1.59 – 14.41). Subgroup meta-analysis for the other characteristics was not performed because of insufficiency of the primary data. Conclusions: AFI decreases AMR and PMR significantly compared with WLE but does not improve ADR or PDR. AMR and PMR may be decreased by using AFI in flat and small lesions or when less experienced endoscopists perform the procedure.

Impact of 2 generational improvements in colonoscopes on adenoma miss rates: results of a prospective randomized multicenter tandem study

“…For probably similar reasons, it has been difficult to consistently show improved ADR with any new technique in several studies. This was the case with HDI, 11 previous and more recent wider-angle endoscopes, 27,28,30 direct and virtual chromoendoscopy such as narrow-band imaging and others, 12,13,17 and autofluorescence, 31 but also with some mechanical methods such as transparent caps 32,33 or water infusion. 34 Whether a new endoscope will consistently improve ADR is therefore difficult to predict, and with only a single or just a few changes related to endoscope technology from one generation to the next, this seems less likely.…”

The efficacy of autofluorescence imaging in the diagnosis of colorectal diseases

“…AFI could detect all polyps, while WLE missed three adenomatous polyps [21]. The results of a metaanalysis to investigate the adenoma detection rate, polyp detection rate, adenoma miss rate, and polyp miss rate from six studies suggested that AFI decreased the miss rate for both adenomas and polyps [22].…”

“…Some studies have proposed the efficacy of AFI for detecting colorectal neoplasms [10,[20][21][22]. Matsuda et al reported a study in which a single experienced endoscopist conducted back-to-back colonoscopies of the right-sided colon using AFI and WLE.…”

Can technology increase adenoma detection rate?

“…A recent meta-analysis of six studies with 1199 colonoscopies found no significant differences in ADR or PDR in AFI compared to WLE, but reported that AFI did significantly decrease AMR (OR 0.62; 95 % CI 0.44 – 0.86) and PMR (OR 0.64; 95 % CI 0.48 – 0.85). 59 …”