Paul P. Shao, MD, MS1, Richard Shao, MD2, Felix W. Leung, MD3; 1VAGLAHS, David Geffen School of Medicine at UCLA, Los Angeles, CA; 2Chang Gung Memorial Hospital, LinKou, Taoyuan, Taiwan; 3VAGLAHS, David Geffen School of Medicine at UCLA, North Hills, CA
Introduction: Recent studies suggest that sessile serrated adenoma/polyps (SSA/Ps) may significantly contribute to the burden of colorectal cancer (CRC). SSA/Ps posses distinct molecular pathways that are different from the traditional adenoma-carcinoma sequence, and account for up to 35% of all CRCs. Detection of serrated polyps at baseline screening is associated with an increased risk of interval neoplasia on surveillance colonoscopy. Patients with SSA/Ps are at increased risks for CRC. SSA/Ps are typically flat with indistinct border and difficult to detect. Water exchange (WE) has been shown to significantly increase adenoma detection in multiple RCTs. We compared the impacts on SSA/P detection between WE, Endocuff and cap colonoscopy using air insufflation (AI) as the common comparator. Methods: A literature search was done to identify all relevant randomized controlled trials (RCTs) comparing WE, Endocuff and cap colonoscopy with AI published since 2000 as full text in English and reported sessile serrated polyp/adenoma detection rate as an outcome. Medline, EMBASE and Cochrane Library were search systematically for all RCTs that included the following terms: water exchange colonoscopy, cap colonoscopy or Endocuff. Tandem studies and studies that included pediatric patients, patients with serrated polyposis syndrome or patients with irritable bowel diseases were excluded. We performed Fisher’s tests to compare SSA/P detection rates of the study groups with that of the control (AI). Results: A total of 531 articles resulted from initial keywords search. 38 articles were identified based on titles and abstracts alone. After thorough review of full texts, 11 RCTs were included in the analysis. A total of 7856 patients underwent AI, WE, Endocuff or cap colonoscopy. SSA/P detection rates of WE, Endocuff and cap were compared to AI as the control group. Water exchange (6.4% vs 11.7%, P=0.0006) and Endocuff (10.8% vs. 33.1%, p< 0.0001) significantly increased SSA/P detection rate when compared to AI. Cap colonoscopy did not significantly impact SSA/P detection (3.2% vs. 4.9%, p=0.49). SSA/P detection rate as a percent change of AI in WE, Endocuff and cap were 83.5%, 206.5% and 52.6%, respectively. Discussion: WE and Endocuff significantly increased detection of SSA/P. Endocuff achieved the most prominent increase in SSA/P detection whereas WE may be more effective in patient cohort with lower SSA/P detection rates.
Disclosures: Paul Shao indicated no relevant financial relationships. Richard Shao indicated no relevant financial relationships. Felix Leung indicated no relevant financial relationships.