RESUMEN
Adoption of artificial intelligence (AI) in clinical medicine is revolutionizing daily practice. In the field of colonoscopy, major endoscopy manufacturers have already launched their own AI products on the market with regulatory approval in Europe and Asia. This commercialization is strongly supported by positive evidence that has been recently established through rigorously designed prospective trials and randomized controlled trials. According to some of the trials, AI tools possibly increase the adenoma detection rate by roughly 50% and contribute to a 7-20% reduction of colonoscopy-related costs. Given that reliable evidence is emerging, together with active commercialization, this seems to be a good time for us to review and discuss the current status of AI in colonoscopy from a clinical perspective. In this review, we introduce the advantages and possible drawbacks of AI tools and explore their future potential including the possibility of obtaining reimbursement.
Asunto(s)
Inteligencia Artificial/tendencias , Colonoscopios/tendencias , Colonoscopía/métodos , Colonoscopía/tendencias , Adenoma/diagnóstico , Adenoma/economía , Adenoma/cirugía , Inteligencia Artificial/economía , Colonoscopios/economía , Colonoscopía/economía , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/economía , Neoplasias Colorrectales/cirugía , Análisis Costo-Beneficio/tendencias , Humanos , Reembolso de Seguro de Salud/economía , Ensayos Clínicos Controlados Aleatorios como Asunto , Transferencia de TecnologíaRESUMEN
BACKGROUND: Colorectal cancer (CRC) is a common cause of cancer-related deaths. Early detection of precursor lesions in the adenoma-carcinoma sequence via colonoscopy can decrease mortality from CRC. SUMMARY: In this review article, we have summarized retrospective studies, prospective single center, multicenter studies and randomized controlled trials describing the efficacy of endocuff colonoscopy (EC), cap-assisted colonoscopy (CAC) and endorings colonoscopy (ERC). Indications, techniques, outcomes, limitations and complications reported are discussed. KEY MESSAGE: Use of colonoscope with cap, cuff or rings attached to its distal tip has been shown to increase the polyp detection rate and adenoma detection rate, predominantly for the small polyps (<1 cm) and proximal colon location. Evidence is uniform for EC and ERC but not for CAC. Benefits of shorter cecum intubation time, improved cecum intubation rates and decreased pain scores during colonoscopy done with assistance of cuff or cap has potential to decrease the number of incomplete colonoscopy and increase overall patient satisfaction, thus improving follow-up. In the absence of any additional adverse events, EC, CAC and ERC have potential to enhance the benefits of colonoscopy.
Asunto(s)
Adenoma/diagnóstico , Carcinoma/diagnóstico , Pólipos del Colon/diagnóstico , Colonoscopios , Colonoscopía , Neoplasias Colorrectales/diagnóstico , Estudios Clínicos como Asunto , Colonoscopios/efectos adversos , Colonoscopios/tendencias , Colonoscopía/efectos adversos , Colonoscopía/métodos , Colonoscopía/tendencias , Humanos , Resultado del TratamientoRESUMEN
Looping is a common occurrence during colonoscopy. Once a loop has occurred and the endoscopist has reduced it, abdominal pressure given by the technician will help the loop from re-forming. In this article, we discuss some of the common loops that are formed, the methods the endoscopist must employ to reduce the loop, and the type of abdominal pressure used by the technician to help prevent the loop from re-forming and, thus, help attain cecal intubation. Hand placement for abdominal pressure is discussed and illustrated to provide a visual guide for the technician.
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Colonoscopios/normas , Colonoscopía/métodos , Seguridad del Paciente , Presión , Cavidad Abdominal , Competencia Clínica , Colonoscopios/tendencias , Colonoscopía/efectos adversos , Humanos , Monitoreo Fisiológico/métodos , Medición de RiesgoAsunto(s)
Pólipos del Colon/diagnóstico , Colonografía Tomográfica Computarizada , Precisión de la Medición Dimensional , Animales , Pólipos del Colon/patología , Colonografía Tomográfica Computarizada/instrumentación , Colonografía Tomográfica Computarizada/métodos , Colonoscopios/tendencias , Aprobación de Recursos , Ensayo de Materiales , PorcinosRESUMEN
Due to the increasing demand for colonoscopy, devices to advance examination techniques are highly sought after. Several studies have examined the use of a transparent cap attached to the tip of the colonoscope, but the data are inconsistent. The aim of our study was to establish whether transparent cap colonoscopy is beneficial in the improvement of caecal intubation rate, time and polyp detection. We undertook a systematic review and meta-analysis in the form of a Cochrane review to evaluate these outcomes. We included fourteen randomised controlled trials that have been published to date. Transparent cap colonoscopy demonstrates a significant reduction in caecal intubation time, by an average of 48 s, when compared to standard colonoscopy. There was no significant difference in caecal intubation rate or polyp detection between the two groups. Despite a significant difference in caecal intubation time, the clinical significance of the transparent cap remains to be seen. We believe further research is needed to investigate this adjunct.
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Colonoscopios/tendencias , Colonoscopía/métodos , Neoplasias Colorrectales/prevención & control , Ciego , Colonoscopios/normas , Diseño de Equipo , Seguridad de Equipos , Femenino , Humanos , Intubación Gastrointestinal , Masculino , Tamizaje Masivo/efectos adversos , Tamizaje Masivo/métodos , Seguridad del Paciente , Ensayos Clínicos Controlados Aleatorios como Asunto , Estándares de Referencia , Factores de TiempoRESUMEN
BACKGROUND AND STUDY AIM: Effective colonoscopy depends on adequate visualization of the intestine, which might be ensured by intraprocedural use of a cleansing device. We investigated the performance of a novel endoscopic device with regard to cleanliness, safety, and tolerability during colonoscopy, compared with standard cleansing. PATIENTS AND METHODS: At a single center, colonoscopy patients in whom the cecum was accessed and at least one bowel segment was inadequately cleansed were assigned to either use of a disposable catheter cleansing device (JetPrep), used through the endoscope working channel, or standard manual cleansing using a 50-ml syringe. The cleansing quality, for each segment and before and after irrigation, was recorded using a 4-point scale ranging from excellent (grade 1, no more than small bits of adherent feces) to poor (grade 4, large amount of fecal residue). RESULTS: 38 patients were included, 19 in each group. Reasons for referral included colorectal cancer screening (52 %), or blood loss (31 %). Each segment showed improvement after cleansing with JetPrep. Overall cleansing grade improved by a mean of 0.74 points (standard deviation [SD] 0.82) in the investigation group compared with 0.19 (0.40) in the control group (P < 0.0001), and right colon cleansing improved by 1.59 points (0.71) versus 0.31 (0.48) in the controls (P < 0.0001). There was no significant difference in procedure time between the groups. No adverse events or side effects were encountered. CONCLUSIONS: The JetPrep disposable catheter device is safe and efficient for intraprocedural cleansing of a suboptimally prepared colon, allowing higher quality colonoscopy.
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Colonoscopios/tendencias , Colonoscopía , Neoplasias Colorrectales/diagnóstico , Hemorragia Gastrointestinal/diagnóstico , Cuidados Intraoperatorios , Irrigación Terapéutica , Anciano , Catéteres , Colon/patología , Colonoscopía/instrumentación , Colonoscopía/métodos , Investigación sobre la Eficacia Comparativa , Equipos Desechables , Diseño de Equipo , Femenino , Humanos , Cuidados Intraoperatorios/instrumentación , Cuidados Intraoperatorios/métodos , Masculino , Persona de Mediana Edad , Jeringas , Irrigación Terapéutica/instrumentación , Irrigación Terapéutica/métodos , Irrigación Terapéutica/tendencias , Resultado del TratamientoRESUMEN
Suboptimal bowel cleansing prior to colonoscopy impairs the efficacy and safety of the procedure. A new system for intracolonic cleansing has been developed, which includes a disposable catheter device that is inserted through the working channel of a standard colonoscope and an irrigation unit with predefined pressure and flow rate. The aim of the current study was to assess the safety and efficacy of this novel system for the improvement of bowel cleansing during colonoscopy. A total of 42 patients with suboptimal bowel preparation were systematically allocated, in a 1:1 ratio, to either the study group (JetPrep system, n = 21) or the control group (syringe irrigation, n = 21). The cleansing efficacy was evaluated using a segmental scoring scale to rate the bowel preparation level before and after irrigation. One patient from the study group was excluded from the efficacy analysis due to treatment with both techniques. The JetPrep system was significantly superior to syringe irrigation (P = 0.0001). No adverse events were reported. This study suggests that the safety profile of the JetPrep system is comparable to standard irrigation and shows that the device significantly improves suboptimal bowel preparation.
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Enfermedades del Colon/diagnóstico , Colonoscopios/tendencias , Colonoscopía , Cuidados Preoperatorios , Irrigación Terapéutica , Catéteres , Protocolos Clínicos , Colonoscopía/instrumentación , Colonoscopía/métodos , Investigación sobre la Eficacia Comparativa , Equipos Desechables , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios/instrumentación , Cuidados Preoperatorios/métodos , Jeringas , Irrigación Terapéutica/instrumentación , Irrigación Terapéutica/métodos , Irrigación Terapéutica/tendencias , Resultado del TratamientoRESUMEN
Although colonoscopy is a very commonly carried out procedure, it is not without its problems, including a risk of perforation and significant patient discomfort, especially associated with looping formation. Furthermore, looping formation may prevent a complete colonoscopy from being carried out in certain patients. The conventional colonoscope has not changed very much since its original introduction. We review promising technologies that are being promoted as a way to address the problems with current colonoscopy. There are some methods to prevent looping formation, including overtube, variable stiffness, computer-guided scopes, Aer-O-Scope, magnetic endoscopic imaging and the capsule endoscope. In recent years, with the progress of microelectromechanical and microelectronic technologies, many biomedical and robotic researchers are developing autonomous endoscopes with miniaturization of size and integration functionality that represent state of the art of the micro-robotic endoscope. The initial results by using aforementioned methods seem promising; however, there are some conflicting reports of clinical trials with the overtube colonoscope, the computer-guided scope and the variable stiffness colonoscope. There are also some limitations in the use of the Aer-o-scope and the capsule endoscope. The autonomous endoscope is based on a self-propelling property that is able to avoid looping completely. This novel technology could potentially become the next generation endoscope; however, there are still critical techniques to be approached in order to develop the effective and efficient novel endoscope.
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Enfermedades del Colon/diagnóstico , Colonoscopios/tendencias , Colonoscopía/tendencias , Enfermedades del Recto/diagnóstico , Diseño de Equipo , Humanos , Robótica/instrumentaciónRESUMEN
Colon cancer screening is arguably the most important activity performed by gastroenterologists. Recent decreases in rates of death from colorectal cancer indicate that screening methods such as colonoscopy have a positive impact. There is still room for improvement, however, particularly in prevention of right-sided colon cancer. Practice issues, such as making colonoscopy more comfortable, safer, and less costly, are keys to continued success in cancer prevention. Colonoscopy techniques, technologies, and quality control measures have advanced to improve detection, classification, and removal of early neoplasias. In particular, slow, careful inspection of the colon by gastroenterologists who have been trained in lesion recognition has improved rates of detection of polypoid and flat neoplasias. Image enhancement methods such as chromoendoscopy have greatly improved neoplasia detection in patients with chronic colitis, but are not widely used because they are perceived as inconvenient. More convenient methods, such as "digital" chromoendoscopy, show promise but have had mixed results. Ultra-high magnification systems, including optical magnification and confocal endomicroscopy, can be used during the colonoscopy examination to evaluate small polyps, allowing physicians to make immediate diagnoses and decisions about whether to remove polyps. In patients with inflammatory bowel disease, improved imaging techniques could eliminate the needs for analysis of randomly selected biopsy samples and resection of all (neoplastic and non-neoplastic) polyps. It is important to maintain high standards of quality for colonoscopy examination, detection, and removal of high-risk lesions, as well as to make colon cancer screening more widely accepted and affordable for the entire at-risk population.
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Colon/patología , Pólipos del Colon/diagnóstico , Colonoscopía/tendencias , Neoplasias Colorrectales/diagnóstico , Tamizaje Masivo/tendencias , Lesiones Precancerosas/diagnóstico , Colon/diagnóstico por imagen , Colonoscopios/tendencias , Detección Precoz del Cáncer , Endosonografía/tendencias , Diseño de Equipo , Humanos , Interpretación de Imagen Asistida por Computador , Tamizaje Masivo/instrumentación , Valor Predictivo de las PruebasRESUMEN
BACKGROUND: Adenoma detection rate (ADR) has shown to be an independent predictor, to reduce the rate of interval colorectal cancer. Endocuff Vision is a relatively new device that has shown promise to improve the ADR. The primary objective was to conduct a randomized controlled trial to compare Endocuff Vision-assisted colonoscopy (EVAC) with standard colonoscopy (SC). The primary outcome of the study is ADR and the secondary outcomes are caecal intubation rate, terminal ileum intubation rate, scope withdrawal time, quality of bowel preparation and adverse events. METHODS: A randomized controlled trial was performed to compare EVAC versus SC. All patients who presented to the endoscopy suite at the Queen Elizabeth Hospital were assessed for eligibility. Patients were recruited from 15 June 2016 to 20 January 2017. A total of 360 patients were included; 40 were excluded. The patients were randomized using block randomization; 138 patients were recruited to SC and 182 to EVAC. RESULTS: A total of 231 polyps were retrieved during the study period. Polyp detection rate (PDR) was high in both groups: 53% in the EVAC group versus 41.1% in SC. This was statistically significant with a P-value of 0.035. ADR was similarly high in both groups: 36.81% in EVAC group versus 28.99% in SC group. ADR did not reach statistical significance. CONCLUSIONS: EVAC does improve the PDR. Though the ADR did not reach statistical significance, there is a trend towards improved adenoma detection and there is statistical significance in the overall PDR.
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Neoplasias del Colon/diagnóstico , Colonoscopios/tendencias , Colonoscopía/instrumentación , Neoplasias Colorrectales/diagnóstico , Detección Precoz del Cáncer/instrumentación , Diseño de Equipo , Centros Médicos Académicos , Adenoma/diagnóstico , Anciano , Australia , Pólipos del Colon/diagnóstico , Colonoscopios/normas , Intervalos de Confianza , Detección Precoz del Cáncer/métodos , Femenino , Humanos , Aumento de la Imagen/instrumentación , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Seguridad del Paciente , Mejoramiento de la CalidadRESUMEN
Colonoscopy has been established as a screening tool for colorectal cancer and precursors in some countries. Efforts to improve instrument performance as well as patient comfort, safety and compliance have led to modifications of existing endoscopes as well as to the development of new scopes with different working mechanisms, including the colon capsule. While the former have not substantially changed performance, the true value of new scopes - partially single use and/or self propelling - can not be fully assessed, since they are either still under development and/or tested only in animals and in small groups of patients or volunteers. The colon capsule holds promise but has a too complicated preparatory regimen and too low a sensitivity at the moment. Future developments and further studies will show which of these techniques may complement or even replace traditional screening colonoscopy.
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Colonoscopios/tendencias , Neoplasias Colorrectales/diagnóstico , Endoscopía Capsular , Colonoscopía/métodos , Neoplasias Colorrectales/patología , Diagnóstico Diferencial , Diseño de Equipo , Humanos , Tamizaje Masivo/instrumentaciónRESUMEN
The main purpose of this article is to outline various devices of varying practicality that have been described that might allow the examination of the colon by other means. These methods include tip propulsion by various methods, robotics, wireless endoscopy, free capsule endoscopy, specialized overtube use, and toposcopy.
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Colonoscopios , Colonoscopía , Colonoscopios/tendencias , Colonoscopía/tendencias , Desinfección , Diseño de Equipo , Predicción , Fricción , HumanosRESUMEN
Performing high-quality colonoscopy is one of the important goals of gastroenterology practices and requires achieving a high level of bowel cleansing, performing good and safe polypectomy, and detecting all polyps present in the colon. This article summarizes currently available techniques and technologies to maximize mucosal visualization. Several maneuvers can be applied during insertion and withdrawal of the colonoscope to optimize mucosal visualization and decrease the number of missed polyps. Newly developed technologies support the endoscopist in the detection of polyps. Each technique is reviewed, with emphasis on the impact on colorectal polyp detection.
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Colon/patología , Pólipos del Colon/diagnóstico , Colonoscopios/tendencias , Colonoscopía/métodos , Gastroenterología/métodos , Membrana Mucosa/patología , Colonoscopía/tendencias , Gastroenterología/tendencias , HumanosRESUMEN
Modern strategies for the treatment of ulcerative colitis require more accurate tools for gastrointestinal imaging to better assess mucosal disease activity and long-term prognostic clinical outcomes. Recent advances in gastrointestinal luminal endoscopy are radically changing the role of endoscopy in every-day clinical practice and research trials. Advanced endoscopic imaging techniques including high-definition endoscopes, optical magnification endoscopy, and various chromoendoscopy techniques have remarkably improved endoscopic assessment of ulcerative colitis. More recently, optical biopsy techniques with either endocytoscopy or confocal laser endomicroscopy have shown great potential in predicting several histological changes in real time during ongoing endoscopy. Here, we review current applications of advanced endoscopic imaging techniques in ulcerative colitis and present the most promising upcoming headways in this field.
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Colitis Ulcerosa/patología , Colon/patología , Colonoscopía/tendencias , Biopsia/tendencias , Compuestos Cromogénicos , Colonoscopios/tendencias , Colonoscopía/instrumentación , Colonoscopía/métodos , Difusión de Innovaciones , Diseño de Equipo , Predicción , Humanos , Aumento de la Imagen , Microscopía Confocal/tendencias , Imagen Molecular/tendencias , Valor Predictivo de las Pruebas , PronósticoAsunto(s)
Colonoscopios , Colonoscopía/métodos , Neoplasias Colorrectales/cirugía , Robótica , Colonoscopios/historia , Colonoscopios/tendencias , Colonoscopía/historia , Neoplasias Colorrectales/diagnóstico , Diseño de Equipo/historia , Diseño de Equipo/tendencias , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Robótica/métodosAsunto(s)
Ingeniería Biomédica/instrumentación , Enfermedades del Colon/diagnóstico , Colonoscopios/tendencias , Colonoscopía/métodos , Dolor/prevención & control , Colonoscopía/efectos adversos , Descontaminación/métodos , Contaminación de Equipos , Diseño de Equipo , Fricción , Humanos , Dolor/etiología , DocilidadRESUMEN
In the past few years, several groups of investigators have developed colonoscopic instruments or accessories to speed up the examination and make it more tolerable for patients. The NeoGuide Endoscopy System has the computer processing ability to direct each 8-cm segment of its colonoscope to bend at the exact place where the leading segment turned around a corner. This follow-the-leader system is intended to reduce loops and ensure comfort through preventing excess pressure on the colon wall by making a turn without the usual maneuver of pushing on the wall to advance the scope.