Your browser doesn't support javascript.
loading
Relative Efficacies of Interventions to Improve the Quality of Screening-Related Colonoscopy: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.
Khan, Rishad; Ruan, Yibing; Yuan, Yuhong; Khalaf, Kareem; Sabrie, Nasruddin S; Gimpaya, Nikko; Scaffidi, Michael A; Bansal, Rishi; Vaska, Marcus; Brenner, Darren R; Hilsden, Robert J; Heitman, Steven J; Leontiadis, Grigorios I; Grover, Samir C; Forbes, Nauzer.
Afiliação
  • Khan R; Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
  • Ruan Y; Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Alberta, Canada.
  • Yuan Y; Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
  • Khalaf K; Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
  • Sabrie NS; Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
  • Gimpaya N; Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
  • Scaffidi MA; Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada.
  • Bansal R; Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
  • Vaska M; Knowledge Resource Service, Alberta Health Services, Calgary, Alberta, Canada.
  • Brenner DR; Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, C
  • Hilsden RJ; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
  • Heitman SJ; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
  • Leontiadis GI; Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
  • Grover SC; Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada.
  • Forbes N; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address: nauzer.forbes@ucalgary.ca.
Gastroenterology ; 167(3): 560-590, 2024 Aug.
Article em En | MEDLINE | ID: mdl-38513744
ABSTRACT
BACKGROUND &

AIMS:

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:

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 used 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 present surface under the cumulative ranking (SUCRA) curves.

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, i-SCAN [Pentax Ltd], linked color imaging, computer-aided detection, Endocuff [Olympus Corp], Endocuff Vision [Olympus Corp], and oral methylene blue). Dual observation (SUCRA, 0.84) and water exchange (SUCRA, 0.78) ranked highest among intraprocedural techniques; i-SCAN (SUCRA, 0.95), linked color imaging (SUCRA, 0.85), and computer-aided detection (SUCRA, 0.78) among endoscopic technologies; WingCap (A&A Medical Supply LLC) (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, 1.46-6.25).

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.
Assuntos
Palavras-chave

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Adenoma / Ensaios Clínicos Controlados Aleatórios como Assunto / Colonoscopia / Detecção Precoce de Câncer / Metanálise em Rede Limite: Humans Idioma: En Revista: Gastroenterology Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Canadá

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Adenoma / Ensaios Clínicos Controlados Aleatórios como Assunto / Colonoscopia / Detecção Precoce de Câncer / Metanálise em Rede Limite: Humans Idioma: En Revista: Gastroenterology Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Canadá