Can we improve detection of colorectal cancer with new colonoscopy technology?

This study compared polyp and adenoma miss rates from full-spectrum endoscopy colonoscopy with those of standard colonoscopy in colorectal cancer screening.

Colonoscopy is one of many tests used to screen for cancer or adenomas (precancerous growths) in the colon or rectum. Although colonoscopy is the standard for detecting colorectal adenomas and cancers, a significant percentage of adenomas are missed due to the folds that occur naturally in the colon and stomach anatomy.

Full-spectrum endoscopy is a new test that offers a technological advancement for colonoscopy. Full-spectrum endoscopy has three cameras that allow observation of nearly twice as much surface area as observed with the standard colonoscopy, which only uses one camera. Researchers believe that this improvement of colonoscopy technique and imaging capability could improve the accuracy of this procedure and greatly reduce the number of adenomas missed.

A total of 185 patients who underwent same-day, back-to-back standard colonoscopy and full-spectrum endoscopy colonoscopy were involved in this study. 88 participants were randomly assigned to undergo standard forward-viewing colonoscopy first and 97 were randomly assigned to undergo full-spectrum endoscopy colonoscopy first. All adenomas and polyps (growths often considered non-cancerous) detected during the first test were completely removed before initiation of the second test.

The adenoma miss rate was significantly lower in the full-spectrum endoscopy group compared to the standard colonoscopy group. Full-spectrum endoscopy missed only five of 67 adenomas identified, representing a miss rate of 7%. Standard colonoscopy missed 20 of 49 adenomas identified, representing a miss rate of 41%. Of the 20 missed adenomas by standard colonoscopy, three adenomas were advanced. None of the five adenomas missed under full-spectrum endoscopy were advanced. 

Similarly, the polyp miss rate was lower in patients in the full-spectrum endoscopy group compared to the standard colonoscopy group. Standard colonoscopy missed 43% of the total polyps identified compared to 10% in those who underwent full-spectrum endoscopy.

In addition, full-spectrum colonoscopy led to significantly fewer false-negative results than did standard colonoscopy. False-negatives occur when the test indicates that the disease is not present when, in fact, it is present. None of the full-spectrum colonoscopy tests were false-negative while 6% of standard colonoscopy patients had false-negative results.

In summary, this study concluded that full-spectrum colonoscopy improves visualization during colonoscopy and therefore improves the efficacy of screening of colorectal cancer.

The endoscopist was not masked to which colonoscopy method was being used, which may have created some bias towards the newer technology.