Effect of 3-Dimensional Imaging Device on Polyp and Adenoma Detection During Colonoscopy: A Randomized Controlled Trial

Abstract

BACKGROUND & AIMS To evaluate the effect of three-dimensional (3D) imaging device on polyp and adenoma detection during colonoscopy. METHODS In a single-blind, randomized controlled trial, participants aged 18-70 years who underwent diagnostic or screening colonoscopy were consecutively enrolled between August 2019 to May 2022. Each participant was randomized in 1:1 ratio to undergo either 2D-3D colonoscopy or 3D-2D colonoscopy through computer-generated random numbers. Primary outcome included polyp detection rate (PDR) and adenoma detection rate (ADR), defined as the proportion of individuals with at least 1 polyp or adenoma detected during colonoscopy. The primary analysis was intention-to-treat. RESULTS Of 1196 participants recruited, 571 in 2D-3D group and 583 in 3D-2D group were finally included after excluding those who met exclusion criteria. The PDR between 2D and 3D groups was separately 39.6% and 40.5% during phase 1 (OR=0.96, 95%CI: 0.76-1.22, P=0.801), whereas PDR was significantly higher in 3D group (27.7%) than that of 2D group (19.9%) during phase 2, with a 1.54-fold increase (1.17-2.02, P=0.002). Similarly, the ADR during phase 1 between 2D (24.7%) and 3D (23.8%) groups was not significant (OR=1.05, 0.80-1.37, P=0.788), while ADR was significantly higher in 3D group (13.8%) than that of 2D group (9.9%) during phase 2, with a 1.45-fold increase (1.01-2.08, P=0.041). Further subgroup analysis confirmed significantly higher PDR and ADR of 3D group during phase 2, particularly in midlevel and junior endoscopists. CONCLUSION The 3D imaging device could improve overall PDR and ADR during colonoscopy, particularly in midlevel and junior endoscopists. Trial number: ChiCTR1900025000.

Endoscopy: Scoping the Way Forward

“…In this special issue, we have collated practice-changing articles to optimize the endoscopic knowledge, skills, and decision making of our readers. There are numerous randomized controlled trials (3)(4)(5)(6)(7)(8) in this special issue, ranging from submucosal injection for resection of small polyps (5) to comparisons of motorized spiral vs single-balloon enteroscopy (7). The issue includes diverse articles, including a systematic review of behavioral interventions to increase the uptake of colorectal cancer screening (9), to timely reviews on topics such as colonoscopy surveillance in inflammatory bowel disease (10) and performing high-quality, safe, cost-effective, and efficient basic colonoscopy in 2023 (11).…”