Comparing the Safety and Efficacy of Two Commercially Available Single-Use Duodenoscopes: A Multicenter Study.

INTRODUCTION: Single-use disposable duodenoscopes (SDD) have been developed to mitigate infectious risks related to reusable duodenoscopes. The aim of this study is to compare the safety and efficacy of the two available SDDs in the United States. METHODS: We conducted a comparative study of 2 SDD in consecutive ERCP procedures performed by expert endoscopists from 9 academic centers. Performance ratings, procedure details, and adverse events were collected. RESULTS: A total of 201 patients were included: 129 patients underwent ERCP with Exalt (mean age 63, Males- 66 (51%), 72 with aScope Duodeno (mean age 65, males=30 (42%). A majority of endoscopists had performed >2000 ERCPs in both groups (71% Exalt, 93% aScope Duodeno). Technical success was 92% in both groups (n=119 Exalt-group, n=66 aScope-Duodeno-group). The procedural complexity for the ERCP cases performed were: Grade 1: 35 cases (18%), Grade 2: 83 cases (41%), Grade 3: 65 cases (32%), and Grade 4: 18 cases (9%). Thirteen patients (10%) from the Exalt group and 16 patients (22%) from the aScope Duodeno group required conversion to a reusable duodenoscope. On a scale of 1 to 5, Exalt and aScope Duodeno, respectively, were rated: 2.31 versus 2.60 for location and visualization quality, 1.38 versus 1.57 for maneuverability based on papillary orientation, 1.48 versus 1.15 for suction/air control, and 2.31 versus 2.34 for elevator efficiency. None of the adverse events were related to the SDDs. CONCLUSIONS: The 2 SDDs were comparable. Further ongoing enhancements to these devices will improve maneuverability and clinical effectiveness.

Prevalence of Advanced, Precancerous Colorectal Neoplasms in Black and White Populations: A Systematic Review and Meta-analysis.

BACKGROUND & AIMS: Colorectal cancer incidence and mortality are higher in black vs white populations. The reasons for these disparities are not clear, yet some guidelines recommend screening black persons for colorectal cancer starting at 40-45 years of age. We performed a systematic review and meta-analysis to compare the prevalence of advanced adenomas (AAs) and advanced precancerous colorectal neoplasms (ACNs) between asymptomatic black and white screen-eligible adults. METHODS: We searched Ovid MEDLINE, PubMed, Embase, and the Cochrane Library to identify articles (published from 1946 through June 2017) that reported prevalence values of AA or ACN in average-risk black and white individuals undergoing screening colonoscopy. Two authors independently assessed study quality and risk for bias using a modified validated quality assessment instrument. In accord with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 2 authors independently abstracted descriptive and quantitative data from each study. We performed a random-effects meta-analysis to determine risk differences and odds ratios (ORs). RESULTS: Of 1653 articles, we identified 9 studies for analysis that included 302,128 individuals. Six of the 9 studies were of high methodologic quality, and had a low risk for bias. In these 9 studies, the overall prevalence values for AA and ACN did not differ significantly between black (6.57%) and white (6.20%) screened individuals (OR 1.03; 95% confidence interval [CI] 0.81-1.30). In a subgroup of 5 studies, the prevalence of proximal AA and ACN was significantly higher in black (3.30%) than in white (2.42%) screened individuals (OR 1.20; 95% CI 1.12-1.30). Excluding the largest study did not affect overall prevalence (OR 0.99; CI 0.73-1.34) but did eliminate the difference in prevalence of proximal AA or ACN (OR 1.48; 95% CI 0.87-2.52). CONCLUSIONS: In this meta-analysis, we found the overall prevalence of AA and ACN did not differ significantly between average-risk black and white persons, indicating that the age at which to begin colorectal cancer screening need not differ based on race alone.