Clinical Endoscopy

Review

Detecting colorectal lesions with image-enhanced endoscopy: an updated review from clinical trials: Mizuki Nagai, Sho Suzuki, Yohei Minato, Fumiaki Ishibashi, Kentaro Mochida, Ken Ohata, Tetsuo Morishita; Clin Endosc 2023;56(5):553-562. Published online July 26, 2023; DOI: https://doi.org/10.5946/ce.2023.055

Colonoscopy plays an important role in reducing the incidence and mortality of colorectal cancer by detecting adenomas and other precancerous lesions. Image-enhanced endoscopy (IEE) increases lesion visibility by enhancing the microstructure, blood vessels, and mucosal surface color, resulting in the detection of colorectal lesions. In recent years, various IEE techniques have been used in clinical practice, each with its unique characteristics. Numerous studies have reported the effectiveness of IEE in the detection of colorectal lesions. IEEs can be divided into two broad categories according to the nature of the image: images constructed using narrowband wavelength light, such as narrowband imaging and blue laser imaging/blue light imaging, or color images based on white light, such as linked color imaging, texture and color enhancement imaging, and i-scan. Conversely, artificial intelligence (AI) systems, such as computer-aided diagnosis systems, have recently been developed to assist endoscopists in detecting colorectal lesions during colonoscopy. To better understand the features of each IEE, this review presents the effectiveness of each type of IEE and their combination with AI for colorectal lesion detection by referencing the latest research data.

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Original Article

Capsule enteroscopy versus small-bowel ultrasonography for the detection and differential diagnosis of intestinal diseases: Luca Elli, Erica Centorrino, Andrea Costantino, Maurizio Vecchi, Stefania Orlando, Mirella Fraquelli; Clin Endosc 2022;55(4):532-539. Published online July 28, 2022; DOI: https://doi.org/10.5946/ce.2021.224

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Background
/Aims: Capsule enteroscopy (CE) and intestinal ultrasonography (IUS) are techniques that are currently used for investigating small-bowel (SB) diseases. The aim of this study was to compare the main imaging findings and the lesion detection rate (LDR) of CE and IUS in different clinical scenarios involving the SB.
Methods
We retrospectively enrolled patients who underwent CE and IUS for obscure gastrointestinal bleeding (OGIB), complicated celiac disease (CeD), and suspected or known inflammatory bowel disease (IBD). We evaluated the LDR of both techniques. The accuracy of IUS was determined using CE as the reference standard.
Results
A total of 159 patients (113 female; mean age, 49±19 years) were enrolled. The LDR was 55% and 33% for CE and IUS (p<0.05), respectively. Subgroup analysis showed that the LDR of CE was significantly higher than that of IUS in patients with OGIB (62% vs. 14%, p<0.05) and CeD (55% vs. 35%, p<0.05). IUS showed a similar LDR to CE in patients with suspected or known IBD (51% vs. 46%, p=0.83).
Conclusions
CE should be preferred in cases of OGIB and CeD, whereas IUS should be considered an early step in the diagnosis and follow-up of IBD even in patients with a proximal SB localization of the disease.

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Reviews

Quality indicators in esophagogastroduodenoscopy: Sang Yoon Kim, Jae Myung Park; Clin Endosc 2022;55(3):319-331. Published online May 16, 2022; DOI: https://doi.org/10.5946/ce.2022.094

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Esophagogastroduodenoscopy (EGD) has been used to diagnose a wide variety of upper gastrointestinal diseases. In particular, EGD is used to screen high-risk subjects of gastric cancer. Quality control of EGD is important because the diagnostic rate is examiner-dependent. However, there is still no representative quality indicator that can be uniformly applied in EGD. There has been growing awareness of the importance of quality control in improving EGD performance. Therefore, we aimed to review the available and emerging quality indicators for diagnostic EGD.

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Quality indicators in colonoscopy: the chasm between ideal and reality: Su Bee Park, Jae Myung Cha; Clin Endosc 2022;55(3):332-338. Published online April 4, 2022; DOI: https://doi.org/10.5946/ce.2022.037

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Continuous measurement of quality indicators (QIs) should be a routine part of colonoscopy, as a wide variation still exists in the performance and quality levels of colonoscopy in Korea. Among the many QIs of colonoscopy, the adenoma detection rate, average withdrawal time, bowel preparation adequacy, and cecal intubation rate should be monitored in daily clinical practice to improve the quality of the procedure. The adenoma detection rate is the best indicator of the quality of colonoscopy; however, it has many limitations for universal use in daily practice. With the development of natural language processing, the adenoma detection rate is expected to become more effective and useful. It is important that colonoscopists do not strictly and mechanically maintain an average withdrawal time of 6 minutes but instead perform careful colonoscopy to maximally expose the colonic mucosa with a withdrawal time of at least 6 minutes. To achieve adequate bowel preparation, documentation of bowel preparation with the Boston Bowel Preparation Scale (BBPS) should be a routine part of colonoscopy. When colonoscopists routinely followed the bowel preparation protocols, ≥85% of outpatient screening colonoscopies had a BBPS score of ≥6. In addition, the cecal intubation rate should be ≥95% of all screening colonoscopies. The first step in improving colonoscopy quality in Korea is to apply these key performance measurements in clinical practice.

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Effectiveness of a novel artificial intelligence-assisted colonoscopy system for adenoma detection: a prospective, propensity score-matched, non-randomized controlled study in Korea
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Detecting colorectal lesions with image-enhanced endoscopy: an updated review from clinical trials
Mizuki Nagai, Sho Suzuki, Yohei Minato, Fumiaki Ishibashi, Kentaro Mochida, Ken Ohata, Tetsuo Morishita
Clinical Endoscopy.2023; 56(5): 553. CrossRef
AI-powered medical devices for practical clinicians including the diagnosis of colorectal polyps
Donghwan Kim, Eunsun Kim
Journal of the Korean Medical Association.2023; 66(11): 658. CrossRef

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Original Articles

Impact of Moderate versus Deep Sedation and Trainee Participation on Adenoma Detection Rate-Analysis of a Veteran Population: Hemnishil K. Marella, Nasir Saleem, Claudio Tombazzi; Clin Endosc 2021;54(2):250-255. Published online December 15, 2020; DOI: https://doi.org/10.5946/ce.2020.091

Abstract PDF PubReader ePub

Background
/Aims: The adenoma detection rate (ADR) is used as a quality indicator for screening and surveillance colonoscopy. The study aimed to determine if moderate versus deep sedation affects the outcomes of the ADR and other quality metrics in the veteran population.
Methods
A retrospective review of colonoscopies performed at Memphis Veterans Affairs Medical Center over a one-year period was conducted. A total of 900 colonoscopy reports were reviewed. After exclusion criteria, a total of 229 index, average-risk screening colonoscopies were identified. Data were collected to determine the impact of moderate (benzodiazepine plus opioids) versus deep (propofol) sedation on the ADR, polyp detection rate (PDR), and withdrawal time.
Results
Among 229 screening colonoscopies, 103 (44.9%) used moderate sedation while 126 (55%) were done under deep sedation. The ADR and PDR were not significantly different between moderate versus deep sedation at 35.9% vs. 37.3% (p=0.82) and 58.2% vs. 48.4% (p=0.13), respectively. Similarly, there was no significant difference in withdrawal time between moderate and deep sedation (13.4 min vs. 14 min, p=0.56) during screening colonoscopies.
Conclusions
In veterans undergoing index, average-risk screening colonoscopies, the quality metrics of the ADR, PDR, and withdrawal time are not influenced by deep sedation compared with moderate sedation.

Citations

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AI-powered medical devices for practical clinicians including the diagnosis of colorectal polyps
Donghwan Kim, Eunsun Kim
Journal of the Korean Medical Association.2023; 66(11): 658. CrossRef
Patient Satisfaction, at What Cost?
Byron P. Vaughn
Clinical Gastroenterology and Hepatology.2022; 20(4): e912. CrossRef
Impact of sedation type on adenoma detection rate by colonoscopy
Hawraa Tarhini, Ayman Alrazim, Wissam Ghusn, Mohammad Hosni, Anthony Kerbage, Assaad Soweid, Ala-I Sharara, Fadi Mourad, Fadi Francis, Yasser Shaib, Kassem Barada, Fady Daniel
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Safety, Efficacy and High-Quality Standards of Gastrointestinal Endoscopy Procedures in Personalized Sedoanalgesia Managed by the Gastroenterologist: A Retrospective Study
Marina Rizzi, Francesco Panzera, Demetrio Panzera, Berardino D’Ascoli
Journal of Personalized Medicine.2022; 12(7): 1171. CrossRef

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Quality Indicators for the Detection of Helicobacter pylori-Negative Early Gastric Cancer: A Retrospective Observational Study: Fumiaki Ishibashi, Konomi Kobayashi, Keita Fukushima, Ryu Tanaka, Tomohiro Kawakami, Junko Kato, Kazuaki Sugihara; Clin Endosc 2020;53(6):698-704. Published online March 13, 2020; DOI: https://doi.org/10.5946/ce.2019.203

Abstract PDF PubReader ePub

Background
/Aims: While Helicobacter pylori (HP)-negative gastric cancer is frequently reported, little is known about the predictors for detecting HP-negative early gastric cancer (EGC). We aimed to evaluate the predictors for the detection of HP-negative EGC.
Methods
We retrospectively reviewed 13,477 consecutive asymptomatic cases where upper endoscopy was performed by nine physicians from April 2017 to March 2019 and analyzed the detection rate of high-risk lesions (HRLs), including EGC, tubular adenoma, and lymphoma, according to the status of HP infection. The observation time was corrected for multiple regression analyses.
Results
For all physicians, the average observation time for screening HP-eradicated and -naïve patients was shorter than that for screening HP-positive patients (p<0.05). Multiple regression analyses revealed that the observation time in the three groups was an independent predictor for detecting HRLs in HP-eradicated patients (p=0.03106, 0.01263, and 0.02485, respectively), while experience of endoscopy was an independent predictor for detecting HRLs in HP-naïve patients (p=0.02638).
Conclusions
While observation time during screening endoscopy was a quality indicator for detecting HRLs in HP-eradicated patients, experience of endoscopy was a quality indicator for detecting HRLs in HP-naïve patients.

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Fumiaki Ishibashi, Sho Suzuki, Mizuki Nagai, Kentaro Mochida, Konomi Kobayashi, Tetsuo Morishita
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Dong Chan Joo, Gwang Ha Kim
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Youn I Choi, Jun-Won Chung, Kyoung Oh Kim, Kwang An Kwon, Yoon Jae Kim, Jung Ho Kim, Ja Young Seo, Dong Kyun Park
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Quality management system for screening esophagogastroduodenoscopy improves detection of Helicobacter pylori-negative interval gastric cancer
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Review

Endocuff-Assisted Colonoscopy—A Novel Accessory in Improving Adenoma Detection Rate: A Review of the Literature: Rashmee Patil, Mel A. Ona, Emmanuel Ofori, Madhavi Reddy; Clin Endosc 2016;49(6):533-538. Published online May 2, 2016; DOI: https://doi.org/10.5946/ce.2016.032

Abstract PDF PubReader ePub

Endocuff (Arc Medical Design) is a U.S. Food and Drug Administration-approved device that is attached like a cap to the distal tip of the colonoscope; it is used to improve adenoma detection rates during colonoscopy. The aim of this review was to summarize and evaluate the clinical and technical efficacy of Endocuff in improving adenoma detection rate. A comprehensive literature review was performed to identify studies describing this technique. In this review article, we have summarized case series and reports describing Endocuff use and results. The reported indications, results, limitations, and complications are discussed.

Citations

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Effectiveness of a novel artificial intelligence-assisted colonoscopy system for adenoma detection: a prospective, propensity score-matched, non-randomized controlled study in Korea
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M. Abdelbary, S. Hamdy, H. Shehab, N. ElGarhy, M. Menesy, R. Marzaban
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M. Abdelbary, S. Hamdy, H. Shehab, N. ElGarhy, M. Menesy, R. Marzaban
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Focused Review Series: Endoscopic Screening and Surveillance for Gastrointestinal Cancer

Colon Cancer Screening with Image-Enhanced Endoscopy: Bong Min Ko; Clin Endosc 2014;47(6):504-508. Published online November 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.6.504

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Colorectal cancer (CRC) is a major cause of cancer mortality worldwide, and this has led to an increased use of screening colonoscopy. This screening has resulted in long-term risk reduction in asymptomatic individuals. However, endoscopists may fail to detect advanced adenomas or colon cancer during screening. The reasons that adenomas or cancers are missed are thought to be associated with the location of the lesions or the skills of the endoscopist. To address the limitations of white light endoscopy (WLE) for adenoma detection, advanced endoscopic images have recently been used. Image-enhanced endoscopies (IEEs), including the use of topical dyes, optical filtering, and ultramagnification, allow for gastrointestinal lesion analysis. Many studies have compared the adenoma detection rate (ADR) obtained by using WLE and IEE, but with different results. IEE can be used to help the endoscopist to improve their ADR in screening colonoscopy. This review examines the possible roles of image-enhanced colonoscopy in CRC screening.

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전정부와 체부에서의 H. pylori 진단율과 장상피화생 ( The Detection Rate of H. pylori and Intestinal Metaplasia in the Antrum and in the Body ): Korean J Gastrointest Endosc 1999;19(1):9-17. Published online November 30, 1998

Abstract PDF: Aims: In this paper we have investigated the detection rate of each H. pylori test in the antrum and in the body for patients with nonulcer dyspepsia (NUD), duodenal ulcer (DU), benign gastric ulcer (BGU), and stomach cancer. In addition, we examined whether or not there is any relationship between the decrease of H. pylori detection rate and intestinal metaplasia in the antrum. Methods: Three different test methods for identifying H. pylori infection-CLOtest, Gram stain, H&E stain-were taken in the antrum and in the body. Results: 1) The detection rates of CLOtest, Gram stain, and H&E stain for NUD group were 88%, 75%, and 64% (mean: 76%) in the antrum, and 89%, 78%, and 67% (mean: 78%) in the body, respectively, and those of DU group were 95%, 95% and 81% (mean: 90%) in the antrum, and 97%, 87% and 64% (mean: 83%) in the body, respectively. Those of BGU group were 86%, 74%, 53% (mean: 71%) and 98%, 82%, 58% (mean: 79%), respectively, and those of stomach cancer group were 80%, 88%, 58% (mean: 75%) in the antrum, and 100%, 96%, 83% (mean: 93%) in the body, respectively. The B/A detection ratio which means the ratio of mean H. pylori detection rate of body to that of antrum was 1.03 in NUD, 0.93 in DU, 1.11 in BGU, and 1.24 in stomach cancer group. 2) The rate of intestinal metaplasia in the antrum was 12% for NUD, and 15% for DU group. Those of BGU and stomach cancer group were 47% and 72%, respectively. 3) The correlation etween B/A detection ratio and intestinal metaplasia in the antrum was good (correlation coefficient(r)=0.93). Conclusions: The result that body is more adequate for H. pylori detection in BGU and stomach cancer patients rather than antrum can be explained by the high rate of intestinal metaplasia in the antrum which is hostile surrounding for H. pylori. (Korean J Gastrointest Endosc 19: 0 ∼0, 1999)

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