Original article
Clinical endoscopy
Comparison of standard forward-viewing mode versus ultrawide-viewing mode of a novel colonoscopy platform: a prospective, multicenter study in the detection of simulated polyps in an in vitro colon model (with video)

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Background

Although colonoscopy is the criterion standard for detecting colorectal adenomas and cancers, a significant percentage of adenomas are missed.

Objective

To compare forward-viewing with ultrawide-viewing colonoscopy in the detection of simulated colon polyps in an in vitro colon model.

Design

Prospective, multicenter.

Setting

Six endoscopy units (3 in the United States and 3 in Israel).

Patients

In vitro colon model with simulated colon polyps (n = 21 metallic beads).

Interventions

Detection of simulated colon polyps on colonoscope withdrawal.

Main Outcome Measurements

Incremental detection of simulated colon polyps and endoscopist evaluation of the usability, visibility, and maneuverability of ultrawide-viewing colonoscopy.

Results

On forward-viewing colonoscopy, the number of simulated polyps (mean ± standard deviation) detected per endoscopist was 11.1 ± 2.3 polyps, a 52.9% detection rate. Simulated polyp detection rates per colon segment were 3.0 ± 0.93 (60.0%) right colon, 2.4 ± 0.87 (48.0%) transverse colon, and 5.7 ± 1.5 (51.8%) left colon. On ultrawide-viewing colonoscopy, the simulated polyp detection rate per endoscopist significantly increased to 18.0 ± 1.98 polyps, an overall 85.7% polyp detection rate (P < .001). Simulated polyp detection rates were also significantly higher by using the ultrawide-viewing mode in each colon segment, 4.5 ± 0.65 polyps (90.0%) right colon, 4.0 ± 0.87 (80.0%) polyps transverse colon, and 9.6 ± 1.28 polyps (87.3%) left colon (all comparisons, P < .001). Importantly, the ultrawide-viewing mode detected significantly more “hidden” simulated polyps (81.9% vs 31.9%, P < .0001).

Limitations

Nonrandomized design, use of a colon model, and “simulated” colon polyps.

Conclusions

Ultrawide-view colonoscopy significantly improved simulated polyp detection in a colon model. Clinical studies in human subjects should be pursued to further evaluate this new endoscopic technology.

Section snippets

Methods and materials

This was a multicenter, prospective study whereby gastroenterologists, experienced in performing colonoscopy, were asked to complete a standard colonoscopy screening procedure in a medical facility procedure room by using a silicone colon model and to identify “simulated” colon polyps attached to the colon model wall.

Results

In total, 37 endoscopists (32 male, 49.2 ± 8.7 years old, 16.7 ± 11.1 years in practice) participated at 6 centers located in the United States (n = 3) and Israel (n = 3). All 37 endoscopists (100%) successfully inserted and advanced the PeerScope System Model B colonoscope to the cecum. On colonoscope withdrawal by using the forward-viewing mode, the number of simulated polyps (mean ± standard deviation) detected per endoscopist was 11.1 ± 2.3 polyps, a 52.9% simulated polyp detection rate.

Discussion

Multiple studies, in varied patient populations, have shown significant adenoma miss rates during forward-viewing, optical colonoscopy.5, 6, 7, 8, 9, 10, 11 Rex et al6 performed back-to-back colonoscopies on 183 patients and reported a 24% adenoma miss rate. This included miss rates of 27% for adenomas 5 mm or smaller, 13% for adenomas 6 to 9 mm, and even a 6% miss rate for adenomas 10 mm or larger. Moreover, adenoma miss rates varied widely even among senior endoscopists, ranging from 17% to

Acknowledgments

We thank and acknowledge all of the participating endoscopists: Drs Abittan, Anikin, Ascunce, Bedmanrek, Bernstein, Bouck, Carr-Locke, Chowers, Cohen, Dekel, Dickstein, Fenster, Nascembeni Ferran, Halak, Halpern, Kadish, Karaban, Kasmin, Khamyasi, Lachter, Lewis, Merdler, Milham, Milkes, Novelrudsky, Rattner, Santo, Scapa, Shapil, Shapira, Sloyer, Suissa, Talansky, Ugran, Yanay, Yassin, and Zeitan.

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  • Cited by (0)

    DISCLOSURE: Drs Gralnek, Halpern, Siersema, Carr-Locke, Segol, and Suissa are consultants for Peer Medical Ltd. Dr Segev is the Medical Director of Peer Medical Ltd. This study was sponsored by Peer Medical Ltd, Caesaria, Israel.

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