scholarly journals A comparison of 9 minutes colonoscopy withdrawal time and 6 mins colonoscopy withdrawal time: A systematic review and meta‐analysis

2021 ◽  
Author(s):  
Abhishek Bhurwal ◽  
Puru Rattan ◽  
Avik Sarkar ◽  
Anish Patel ◽  
Shahid Haroon ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Withdrawal Time

scholarly journals Effect of dynamic position changes on adenoma detection rate during colonoscope withdrawal: systematic review and meta-analysis

2020 ◽  
Vol 08 (12) ◽  
pp. E1842-E1849
Author(s):  
Venkat Nutalapati ◽  
Madhav Desai ◽  
Vivek Sandeep Thoguluva-Chandrasekar ◽  
Mojtaba Olyaee ◽  
Amit Rastogi
Keyword(s):  
Systematic Review ◽  
Detection Rate ◽  
Meta Analysis ◽  
Lateral Position ◽  
Adenoma Detection Rate ◽  
Position Change ◽  
Withdrawal Time ◽  
Left Lateral Position ◽  
Adenoma Detection ◽  
Withdrawal Phase

Abstract Background and study aims The adenoma detection rate (ADR) is an important quality metric of colonoscopy. Higher ADR correlates with lower incidence of interval colorectal cancer. ADR is variable between endoscopists and depends upon the withdrawal technique amongst other factors. Dynamic position change (lateral rotation of patients with a view to keep the portion of the colon being inspected at a higher level) helps with luminal distension during the withdrawal phase. However, impact of this on ADR is not known in a pooled sample. We performed a systematic review and meta-analysis to study the impact of dynamic position changes during withdrawal phase of colonoscopy on ADR Methods A comprehensive search of MEDLINE, EMBASE, Google Scholar, and the Cochrane Database was conducted from each database’s inception to search for studies comparing dynamic position changes during colonoscope withdrawal with static left lateral position (control). The primary outcome of interest was ADR. Other studied outcomes were polyp detection rate (PDR) and withdrawal time. Outcomes were reported as pooled odds ratio (OR) with 95 % confidence intervals (CI) with statistical significance (P < 0.05). RevMan 5.3 software was used for statistical analysis. Results Six studies were included in our analysis with 2860 patients. Of these, dynamic position change was implemented in 1177 patients while 1183 patients served as the controls. ADR was significantly higher in the dynamic position change group with pooled OR 1.36 (95 % CI, 1.15–1.61; P < 0.01). There was low heterogeneity in inclusion studies (I2 = 0 %). PDR was numerically higher in position change group (53.4 % vs 49.6 %) but not statistically significant (P = 0.16). Mean withdrawal time did not significantly change with dynamic position change (12.43 min vs 11.46 min, P = 0.27). Conclusion Position change during the withdrawal phase of colonoscopy can increase the ADR compared to static left lateral position. This is an easy and practical technique that can be implemented to improve ADR.

scholarly journals A65 ENDOSCOPIST-TARGETED INTERVENTIONS TO OPTIMIZE ADENOMA DETECTION RATE - A SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 25-26
Author(s):  
A Arora ◽  
C McDonald ◽  
A Iansavitchene ◽  
M Brahmania ◽  
M Sey
Keyword(s):  
Systematic Review ◽  
Publication Bias ◽  
Detection Rate ◽  
Meta Analysis ◽  
Report Card ◽  
Adenoma Detection Rate ◽  
Report Cards ◽  
Withdrawal Time ◽  
Adenoma Detection ◽  
Statistical Heterogeneity

Abstract Background Adenoma detection rate (ADR) has emerged as the strongest quality assurance metric that has consistently been shown to be inversely associated with the development of colorectal cancer after colonoscopy. Unfortunately, marked variability in ADR exists among endoscopists. A multitude of interventions targeted at endoscopists to optimize their ADR have been reported, including but not limited to withdrawal time, in room observers, physician report cards, and quality improvement and training programs. However, it is unclear which of them are truly effective. Aims We performed a systematic review and meta-analysis of the literature to evaluate the effectiveness of endoscopist-targeted interventions to improve adenoma detection rate (ADR) or polyp detection rate (PDR). Methods Systematic searches of major databases were conducted through to March 2018 to identify potentially relevant studies. Both randomized controlled trials and observational studies were included. Data for ADR and PDR were analyzed on the log-odds scale using a random-effects meta-analysis model using restricted maximum likelihood (with Mantel-Haenszel fixed-effect meta-analysis used for fewer than 4 studies). Statistical effect-size heterogeneity was assessed using a Chi2 test and quantifying the relative proportion of variation using the I2 statistic. Publication bias was assessed by the Harbord regression test. Results From 4299 initial studies, 24 were included in the systematic review and 13 were included in the meta-analysis representing a total of 55,090 colonoscopies. Physician report card interventions (7 studies) and withdrawal time focused interventions (6 studies) were meta-analyzed. The pooled odds ratio for ADR for report card interventions was 1.31 (95% CI: 1.15, 1.50; p&lt;0.0001), favoring report cards to detect more adenomas. Statistical heterogeneity was detected with substantial relative effect-size variability (Chi2, p&lt;0.0001; I2=80.1%). No statistical evidence of publication bias was found. 6 studies reported data for PDR using withdrawal time focused interventions, with 3 of these reporting data on ADR. The pooled odds ratio for ADR was 1.02 (95% CI: 0.86, 1.22; p=0.81) and for PDR was 1.07 (95% CI: 0.88, 1.31; p=0.51) which were not statistically significant. Statistical heterogeneity was detected in both groups (Chi2, p&lt;0.001; I2=82.2% for ADR and I2=89.4% for PDR) and there was statistical evidence of publication bias. Figures 1 and 2 represent Forest plots for the effect of pre-and post-report card and withdrawal time focused interventions on ADR. Conclusions Our study provides evidence that the distribution of colonoscopy quality report cards to physicians significantly improves overall ADR and should strongly be considered as part of quality improvement programs aimed at optimizing colonoscopy performance. Funding Agencies None

scholarly journals Impact of real-time use of artificial intelligence in improving adenoma detection during colonoscopy: A systematic review and meta-analysis

2021 ◽  
Vol 09 (04) ◽  
pp. E513-E521
Author(s):  
Munish Ashat ◽  
Jagpal Singh Klair ◽  
Dhruv Singh ◽  
Arvind Rangarajan Murali ◽  
Rajesh Krishnamoorthi
Keyword(s):  
Artificial Intelligence ◽  
Systematic Review ◽  
Meta Analysis ◽  
Screening Colonoscopy ◽  
Average Risk ◽  
Polyp Detection ◽  
Withdrawal Time ◽  
Detection Rates ◽  
Adenoma Detection ◽  
The Impact

Abstract Background and study aims With the advent of deep neural networks (DNN) learning, the field of artificial intelligence (AI) is rapidly evolving. Recent randomized controlled trials (RCT) have investigated the influence of integrating AI in colonoscopy and its impact on adenoma detection rates (ADRs) and polyp detection rates (PDRs). We performed a systematic review and meta-analysis to reliably assess if the impact is statistically significant enough to warrant the adoption of AI -assisted colonoscopy (AIAC) in clinical practice. Methods We conducted a comprehensive search of multiple electronic databases and conference proceedings to identify RCTs that compared outcomes between AIAC and conventional colonoscopy (CC). The primary outcome was ADR. The secondary outcomes were PDR and total withdrawal time (WT). Results Six RCTs (comparing AIAC vs CC) with 5058 individuals undergoing average-risk screening colonoscopy were included in the meta-analysis. ADR was significantly higher with AIAC compared to CC (33.7 % versus 22.9 %; odds ratio (OR) 1.76, 95 % confidence interval (CI) 1.55–2.00; I2 = 28 %). Similarly, PDR was significantly higher with AIAC (45.6 % versus 30.6 %; OR 1.90, 95 %CI, 1.68–2.15, I2 = 0 %). The overall WT was higher for AIAC compared to CC (mean difference [MD] 0.46 (0.00–0.92) minutes, I2 = 94 %). Conclusions There is an increase in adenoma and polyp detection with the utilization of AIAC.

scholarly journals Association between Endoscopist Specialty and Colonoscopy Quality: Protocol for a Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Nauzer Forbes ◽  
Matthew Mazurek ◽  
Alistair Murray ◽  
Yibing Ruan ◽  
Robert J Hilsden ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Systematic Review ◽  
Meta Analysis ◽  
A Priori ◽  
Study Data ◽  
Related Factors ◽  
Withdrawal Time ◽  
Adenoma Detection ◽  
Meta Analyses ◽  
Colonoscopy Quality

Abstract Background Colonoscopy is an important modality in the provision of colorectal cancer screening. Though effective and safe, the performance of screening-related colonoscopy is variable in terms of its overall quality, with endoscopist-related factors playing an important role in this variation. The purpose of this study is to systematically review the association between endoscopist specialty and colonoscopy quality and outcomes. Methods A comprehensive electronic search will be carried out to determine the association between endoscopist specialty and colonoscopy quality metrics and/or outcomes in adult patients undergoing colonoscopy. Two abstracters will independently determine study eligibility, assess study quality, and abstract study data. The primary outcome will be the adenoma detection rate (ADR); secondary outcomes will include cecal intubation rate (CIR), withdrawal time (WT), adverse events (AEs) and post-colonoscopy colorectal cancer (PCCRC). Rates of the above metrics and outcomes will also be compared between clinically relevant subgroups determined a priori. DerSimonian and Laird models will be used to perform meta-analyses for each outcome. Sources of heterogeneity will be explored via meta-regression analyses, if possible. Discussion Given the significant established variation in colonoscopy quality, endoscopist-related factors need to be explored. Our meta-analysis will address the important question of whether the specialty of the endoscopist impacts colonoscopy quality and/or outcomes. Systematic Review Registration PROSPERO CRD42021226251.

scholarly journals A147 ENDOSCOPIST FEEDBACK IS ASSOCIATED WITH IMPROVEMENTS IN COLONOSCOPY QUALITY INDICATORS: A SYSTEMATIC REVIEW AND META-ANALYSIS

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 10-11
Author(s):  
K Bishay ◽  
N Calo ◽  
M A Scaffidi ◽  
C M Walsh ◽  
J Anderson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Quality Indicators ◽  
Meta Analysis ◽  
Audit And Feedback ◽  
Screening Colonoscopy ◽  
Withdrawal Time ◽  
Random Effects Models ◽  
Manual Search ◽  
Adenoma Detection ◽  
Colonoscopy Quality

Abstract Background Colonoscopy quality indicators such as adenoma detection rate (ADR) are surrogates for the effectiveness of screening-related colonoscopy. Endosocpist feedback may be associated with improvements in ADR and other quality indicators. Aims To conduct a systematic review and meta-analysis to determine whether an association exists between endoscopist feedback and improvements in colonoscopy quality indicators. Methods An electronic and manual search was conducted through May 2019 for studies reporting on endoscopist feedback and associations with ADR or other colonoscopy quality indicators. Studies primarily assessing the effect of audit and feedback on trainees and studies that included interventions other then feedback were excluded from the analysis. Pooled rate ratios (RR) and weighted mean differences (WMD) were calculated using DerSimonian and Laird random effects models. Subgroup, sensitivity and meta-regression analyses were performed to assess for potential methodological or clinical factors associated with outcomes. Results Of 1,326 initial studies, 12 studies were included in the meta-analysis for ADR, representing 33,184 colonoscopies. Endoscopist feedback was associated with an improvement in ADR (RR 1.21, 95% confidence interval, CI, 1.09 to 1.34). Low performers derived a greater benefit from feedback (RR 1.62, 95% CI 1.18 to 2.23) compared to moderate performers (RR 1.19, 95% CI 1.11 to 1.29), while high performers did not derive a significant benefit (RR 1.06, 95% CI 0.99 to 1.13). Feedback was not associated with increases in withdrawal time (WMD +0.43 minutes, 95% CI -0.50 to +1.36 minutes) or improvements in cecal intubation rate (RR 1.00, 95% CI 0.99 to 1.01). Conclusions Endoscopist feedback is associated with modest improvements in ADR. Routine audit and feedback may be a feasible strategy to optimize outcomes in screening colonoscopy. Funding Agencies None

The effects of low-ratio n-6/n-3 PUFA on biomarkers of inflammation: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Yali Wei ◽  
Yan Meng ◽  
Na Li ◽  
Qian Wang ◽  
Liyong Chen
Keyword(s):  
Systematic Review ◽  
Fatty Acid ◽  
Polyunsaturated Fatty Acid ◽  
Meta Analysis ◽  
Chain Polyunsaturated Fatty Acid ◽  
Inflammation Markers ◽  
Pufa Supplementation ◽  
Long Chain

The purpose of the systematic review and meta-analysis was to determine if low-ratio n-6/n-3 long-chain polyunsaturated fatty acid (PUFA) supplementation affects serum inflammation markers based on current studies.

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