G-EYE colonoscopy is superior to standard colonoscopy for increasing adenoma detection rate: an international randomized controlled trial (with videos)

Abstract

Background and Aims: Colorectal cancer (CRC) is largely preventable with routine screening and surveillance colonoscopy; however, interval cancers arising from precancerous lesions missed by standard colonoscopy still occur. An increased adenoma detection rate (ADR) has been found to be inversely associated with interval cancers. The G-EYE device includes a reusable balloon integrated at the distal tip of a standard colonoscope, which flattens haustral folds, centralizes the colonoscope's optics, and reduces bowel slippage. The insufflated balloon also aims to enhance visualization of the colon during withdrawal, thereby increasing the ADR. Methods: In this randomized, controlled, international, multicenter study (11 centers), patients (aged !50 years) referred to colonoscopy for screening, surveillance, or changes in bowel habits were randomized to undergo either balloon-assisted colonoscopy by using an insufflated balloon during withdrawal or standard highdefinition colonoscopy. The primary endpoint was the ADR. Results: One thousand patients were enrolled between May 2014 and September 2016 to undergo colonoscopy by experienced endoscopists; 803 were finally analyzed (standard colonoscopy n Z 396; balloon-assisted colonoscopy n Z 407). Baseline parameters were similar in both groups. Balloon-assisted colonoscopy provided a 48.0% ADR compared with 37.5% in the standard colonoscopy group (28% increase; P Z .0027). Additionally, balloonassisted colonoscopy provided for a significant increase in detection of advanced (P Z .0033) flat adenomas (P < .0001) and sessile serrated adenomas/polyps (P Z .0026). Conclusion: Balloon-assisted colonoscopy yielded a higher ADR and increased the detection of advanced, flat, and sessile serrated adenomas/polyps when compared with standard colonoscopy. Improved detection by the G-EYE device could impact the quality of CRC screening by reducing miss rates and consequently reducing interval cancer incidence.

Optimal Endoscopic Treatment and Surveillance of Serrated Polyps

“…19 A colonoscope with a large balloon at the bending section which slows withdrawal and compresses folds (G-EYE colonoscope; Smart Medical Systems Ltd., Ra'anana, Israel) also improved serrated lesion detection rates in a large randomized controlled study (2.7% vs 0.8%, p=0.036). 20 A study that looked at narrow-band imaging (NBI; Olympus, Tokyo, Japan) for serrated polyp detection suggested a statistical trend toward improved detection with a mean number of serrated lesions proximal to the sigmoid of 0.51 with NBI versus 0.39 for white light (p=0.085). 21 A subsequent metaanalysis of NBI for detection of non-adenomatous (serrated) lesions suggested significantly improved detection with either first or second generation "Bright" NBI.…”

The Role of Behind Folds Visualizing Techniques and Technologies in Improving Adenoma Detection Rate

“…WT was significantly different in four studies; in three studies, WT was longer in the BFT group [21,24,27], and in 1 study, WT was longer in the CC group [28]. Mean WT was 7.8 versus 7.7 min for BFT and CC, respectively (P G 0.05, mean difference 0.08 min).…”

Frontiers of Robotic Colonoscopy: A Comprehensive Review of Robotic Colonoscopes and Technologies

“…The G-Eye endoscope (NaviAid G-EYE, SMART Medical Systems Ltd., Ra’anana, Israel) has an integrated (moderately inflated) balloon serving as its bending part, which allows both the withdrawal and instrument stabilization together with flattening the haustral folds and inhibiting the slippage of the bowel ( Figure 2 D). A recent study by Shirin et al [ 57 ] found that the technique yielded a higher detection rate of adenomas/polyps (ADR and PDR), including well-formed, flat and sessile serrated ones, when compared to SC. When meta-analysed with a previously published paper by Halpern et al [ 58 ], Keulen et al [ 59 ] discovered that ADR by means of the G-Eye endoscope is 30% higher than SC.…”