Relative Efficacies of Interventions to Improve the Quality of Screening-related Colonoscopy: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials.

Colonoscopy adenoma colorectal cancer screening

Journal

Gastroenterology
ISSN: 1528-0012
Titre abrégé: Gastroenterology
Pays: United States
ID NLM: 0374630

Informations de publication

Date de publication:
19 Mar 2024
Historique:
received: 02 08 2023
revised: 11 03 2024
accepted: 12 03 2024
medline: 22 3 2024
pubmed: 22 3 2024
entrez: 21 3 2024
Statut: aheadofprint

Résumé

Significant variability exists in colonoscopy quality indicators including adenoma detection rate (ADR). We synthesized evidence from randomized trials in a network meta-analysis on interventions to improve colonoscopy quality. We included trials from database inceptions to September 25, 2023 of patients undergoing screening-related colonoscopy and presented efficacies of interventions within domains (periprocedural parameters, endoscopist-directed interventions, intraprocedural techniques, endoscopic technologies, distal attachment devices, and additive substances) compared to standard colonoscopy. The primary outcome was ADR. We employed a Bayesian random effects model using Markov-chain Monte-Carlo simulation, with 10,000 burn-ins and 100,000 iterations. We calculated odds ratios with 95% credible intervals and presented surface under the cumulative ranking (SUCRA) curves. We included 124 trials evaluating 37 interventions for the primary outcome. Nine interventions resulted in statistically significant improvements in ADR compared to standard colonoscopy (9-minute withdrawal time, dual observation, water exchange, iScan™, linked color imaging, computer-aided detection, Endocuff™, Endocuff Vision™, and oral methylene blue). Dual observation (SUCRA=0.84) and water exchange (SUCRA=0.78) ranked highest among intraprocedural techniques, iScan™ (SUCRA=0.95), linked color imaging (SUCRA=0.85), and computer-aided detection (SUCRA=0.78) among endoscopic technologies, WingCap (SUCRA=0.87) and Endocuff™ (SUCRA 0.85) among distal attachment devices, and oral methylene blue (SUCRA= 0.94) among additive substances. No interventions improved detection of advanced adenomas, and only narrow-band imaging improved detection of serrated lesions (odds ratio 2.94, 95% credible interval 1.46 to 6.25). Several interventions are effective in improving adenoma detection and overall colonoscopy quality, many of which are cost-free. These results can inform endoscopists, unit managers, and endoscopy societies on relative efficacies.

Sections du résumé

BACKGROUND & AIMS OBJECTIVE
Significant variability exists in colonoscopy quality indicators including adenoma detection rate (ADR). We synthesized evidence from randomized trials in a network meta-analysis on interventions to improve colonoscopy quality.
METHODS METHODS
We included trials from database inceptions to September 25, 2023 of patients undergoing screening-related colonoscopy and presented efficacies of interventions within domains (periprocedural parameters, endoscopist-directed interventions, intraprocedural techniques, endoscopic technologies, distal attachment devices, and additive substances) compared to standard colonoscopy. The primary outcome was ADR. We employed a Bayesian random effects model using Markov-chain Monte-Carlo simulation, with 10,000 burn-ins and 100,000 iterations. We calculated odds ratios with 95% credible intervals and presented surface under the cumulative ranking (SUCRA) curves.
RESULTS RESULTS
We included 124 trials evaluating 37 interventions for the primary outcome. Nine interventions resulted in statistically significant improvements in ADR compared to standard colonoscopy (9-minute withdrawal time, dual observation, water exchange, iScan™, linked color imaging, computer-aided detection, Endocuff™, Endocuff Vision™, and oral methylene blue). Dual observation (SUCRA=0.84) and water exchange (SUCRA=0.78) ranked highest among intraprocedural techniques, iScan™ (SUCRA=0.95), linked color imaging (SUCRA=0.85), and computer-aided detection (SUCRA=0.78) among endoscopic technologies, WingCap (SUCRA=0.87) and Endocuff™ (SUCRA 0.85) among distal attachment devices, and oral methylene blue (SUCRA= 0.94) among additive substances. No interventions improved detection of advanced adenomas, and only narrow-band imaging improved detection of serrated lesions (odds ratio 2.94, 95% credible interval 1.46 to 6.25).
CONCLUSIONS CONCLUSIONS
Several interventions are effective in improving adenoma detection and overall colonoscopy quality, many of which are cost-free. These results can inform endoscopists, unit managers, and endoscopy societies on relative efficacies.

Identifiants

DOI: 10.1053/j.gastro.2024.03.018 PMID: 38513744
pubmed: 38513744
pii: S0016-5085(24)00301-9
doi: 10.1053/j.gastro.2024.03.018
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved.

Auteurs

Rishad Khan (R)

Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.

Yibing Ruan (Y)

Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, AB, Canada.

Yuhong Yuan (Y)

Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, ON, Canada; Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada.

Kareem Khalaf (K)

Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.

Nasruddin S Sabrie (NS)

Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.

Nikko Gimpaya (N)

Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.

Michael A Scaffidi (MA)

Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, ON, Canada.

Rishi Bansal (R)

Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.

Marcus Vaska (M)

Knowledge Resource Service, Alberta Health Services, Calgary, AB, Canada.

Darren R Brenner (DR)

Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, AB, Canada; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.

Robert J Hilsden (RJ)

Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.

Steven J Heitman (SJ)

Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.

Grigorios I Leontiadis (GI)

Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, ON, Canada; Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada.

Samir C Grover (SC)

Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON, Canada.

Nauzer Forbes (N)

Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada. Electronic address: nauzer.forbes@ucalgary.ca.

Classifications MeSH