Diagnostic yield and miss rate of EndoRings in an organized colorectal cancer screening program: the SMART (Study Methodology for ADR-Related Technology) trial

Hassan, Cesare; Senore, Carlo; Manes, Gianpiero; Fuccio, Lorenzo; Iacopini, Federico; Ricciardiello, Luigi; Anderloni, Andrea; Frazzoni, Leonardo; Ballanti, R.; Nucci, Germana de; Colussi, Dora; Redaelli, Davide; Lorenzetti, Roberto; Devani, Massimo; Arena, Ilaria; Grossi, C.; Andrei, Fabio; Balestrazzi, Eleonora; Sharma, Prateek; Rex, Douglas K.; Repici, Alessandro

doi:10.1016/j.gie.2018.10.019

Cited by 27 publications

(37 citation statements)

References 17 publications

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“…No studies thus far have looked at the cost associated with AI assistance in colonoscopy screening, and predicted costs for AI products currently in development have not yet been announced or determined. It is worth noting that for other recent technologies shown to improve ADR, including the distal scope tip attachments Endocuff and EndoRings, adoption has been slower than might have been suspected [17,18]. While the specific effect of the incremental cost of these devices on the ▶ pattern of clinical adoption has not been evaluated, such devices provide a helpful reference point for expectations surrounding adoption of CADe technology.…”

Section: Discussionmentioning

confidence: 99%

Physician sentiment toward artificial intelligence (AI) in colonoscopic practice: a survey of US gastroenterologists

et al. 2020

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Background and study aims Early studies have shown that artificial intelligence (AI) has the potential to augment the performance of gastroenterologists during endoscopy. Our aim was to determine how gastroenterologists view the potential role of AI in gastrointestinal endoscopy. Methods In this cross-sectional study, an online survey was sent to US gastroenterologists. The survey included questions about physician level of training, experience, and practice characteristics and physician perception of AI. Descriptive statistics were used to summarize sentiment about AI. Univariate and multivariate analyses were used to assess whether background information about physicians correlated to their sentiment. Results Surveys were emailed to 330 gastroenterologists nationwide. Between December 2018 and January 2019, 124 physicians (38 %) completed the survey. Eighty-six percent of physicians reported interest in AI-assisted colonoscopy; 84.7 % agreed that computer-assisted polyp detection (CADe) would improve their endoscopic performance. Of the respondents, 57.2 % felt comfortable using computer-aided diagnosis (CADx) to support a “diagnose and leave” strategy for hyperplastic polyps. Multivariate analysis showed that post-fellowship experience of fewer than 15 years was the most important factor in determining whether physicians were likely to believe that CADe would lead to more removed polyps (odds ratio = 5.09; P = .01). The most common concerns about implementation of AI were cost (75.2 %), operator dependence (62.8 %), and increased procedural time (60.3 %). Conclusions Gastroenterologists have strong interest in the application of AI to colonoscopy, particularly with regard to CADe for polyp detection. The primary concerns were its cost, potential to increase procedural time, and potential to develop operator dependence. Future developments in AI should prioritize mitigation of these concerns.

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Section: Discussionmentioning

confidence: 99%

Physician sentiment toward artificial intelligence (AI) in colonoscopic practice: a survey of US gastroenterologists

et al. 2020

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“…25 It has recently been proposed that a clinically relevant correlation between adenoma miss and detection rates might provide further insights on how technology improves colonoscopy outcomes. 26 Unfortunately, lack of relevant studies reporting on adenoma miss rates precluded its inclusion among the endpoints in this meta-analysis. Our analysis showed that ADR was significantly higher with HD-WLE, and no improvement in MAC was evident.…”

Section: Discussionmentioning

confidence: 99%

High-definition colonoscopy for improving adenoma detection: a systematic review and meta-analysis of randomized controlled studies

Tziatzios

Gkolfakis

Lazaridis

et al. 2020

Gastrointestinal Endoscopy

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Background and Aims: Previous meta-analysis showed marginal benefit of high-definition white-light endoscopy (HD-WLE) over standard-definition colonoscopy (SDC) for adenoma detection, but with residual uncertainty due to inclusion of nonrandomized studies. We aimed to further assess the effect of HD-WLE on adenoma detection by including only randomized controlled trials (RCTs). Methods: A literature search was performed for RCTs evaluating HD-WLE versus SDC in terms of adenoma, advanced adenoma, and serrated sessile adenoma detection rates as well as the mean number of adenomas per colonoscopy (MAC), the mean number of advanced adenomas per colonoscopy (MAAC), and the mean number of sessile serrated adenomas per colonoscopy (MSSAC). The effect size on study outcomes is presented as the risk ratio (RR; 95% confidence interval [CI]) or mean difference (MD; 95% CI). We assessed the strength of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: Six RCTs involving 4594 individuals (HD-WLE, 2323; SDC, 2271) were included. Clinical indications were screening (1 study), positive result for fecal occult blood test, personal/family history of colorectal cancer (1 study), and mixed indications (4 studies). Withdrawal time was similar between the 2 arms (MD, À0.06; 95% CI, À0.25 to 0.12; P Z .50). The adenoma detection rate was significantly higher in the HD-WLE arm compared with the SDC arm (40% vs 35%; RR, 1.13; 95% CI, 1.05-1.22; P Z .001; I 2 Z 0%; GRADE, low). This effect was consistent for advanced and sessile serrated adenoma detection rates (

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“…When restricting the analysis to EAC studies[18,32], Endocuff use significantly decreased AMR compared to CC (RR = 0.23, 95%CI: 0.14-0.39). ADR and AMR being in the same outcome direction -both in favor of devise use- has been recently proposed to enhance the validity of the results regarding ADR[33].…”

Section: Discussionmentioning

confidence: 99%

Effect of Endocuff use on colonoscopy outcomes: A systematic review and meta-analysis

Triantafyllou

Gkolfakis

Tziatzios

et al. 2019

WJG

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BACKGROUND Endocuff - a plastic device with flexible projections - mounted on the distal tip of the colonoscope, promises improved colonic mucosa inspection. AIM To elucidate the effect of Endocuff on adenoma detection rate (ADR), advanced ADR (AADR) and mean number of adenomas per colonoscopy (MAC). METHODS Literature searches identified randomized-controlled trials evaluating Endocuff-assisted colonoscopy (EAC) vs conventional colonoscopy (CC) in terms of ADR, AADR and MAC. The effect size on study outcomes was calculated using fixed or random effect model, as appropriate, and it is shown as relative risk (RR) [95% confidence interval (CI)] and mean difference (MD) (95%CI). The rate of device removal in EAC arms was also calculated. RESULTS We identified nine studies enrolling 6038 patients. All studies included mixed population (screening, surveillance and diagnostic examinations). Seven and two studies evaluated the first and the second-generation device, respectively. EAC was associated with increased ADR compared to CC [RR (95%CI): 1.18 (1.05-1.32); Ι 2 = 71%]; EAC benefits more endoscopists with ADR ≤ 35% compared to those with ADR > 35% [RR (95%CI): 1.37 (1.08-1.74); Ι 2 = 49% vs 1.10 (0.99-1.24); Ι 2 = 71%]. In terms of AADR and MAC, no difference was detected between EAC and CC [RR (95%CI): 1.03 (0.85-1.25); Ι 2 = 15% and MD (95%CI): 0.30 (-0.17-0.78); Ι 2 = 99%]. Subgroup analysis did not show any difference between the two device generations regarding all three endpoints. In EAC arms, the device had to be removed in 3% (95%CI: 2%-5%) of the cases mainly due to tortuous sigmoid or presence of diverticula along it. CONCLUSION EAC increases ADR compared to CC, especially for endoscopists with lower ADR. On the other hand, no significant effect on AADR and MAC was detected.

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Diagnostic yield and miss rate of EndoRings in an organized colorectal cancer screening program: the SMART (Study Methodology for ADR-Related Technology) trial

Cited by 27 publications

References 17 publications

Physician sentiment toward artificial intelligence (AI) in colonoscopic practice: a survey of US gastroenterologists

Physician sentiment toward artificial intelligence (AI) in colonoscopic practice: a survey of US gastroenterologists

High-definition colonoscopy for improving adenoma detection: a systematic review and meta-analysis of randomized controlled studies

Effect of Endocuff use on colonoscopy outcomes: A systematic review and meta-analysis

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