@article{3126210,
    title = "Lower adenoma miss rate with FUSE vsconventional colonoscopy with proximal retroflexion: A randomized back-to-back trial",
    author = "Papanikolaou, I.S. and Apostolopoulos, P. and Tziatzios, G. and Vlachou, E. and Sioulas, A.D. and Polymeros, D. and Karameris, A. and Panayiotides, I. and Alexandrakis, G. and Dimitriadis, G.D. and Triantafyllou, K.",
    journal = "Gastrointestinal Endoscopy",
    year = "2017",
    volume = "49",
    number = "5",
    pages = "468-475",
    publisher = "Georg Thieme Verlag",
    issn = "0016-5107",
    doi = "10.1055/s-0042-124415",
    keywords = "adult;  Article;  ascending colon;  colon adenoma;  colon polyp;  colonoscope;  colonoscopy;  colorectal cancer;  controlled study;  crossover procedure;  false negative result;  female;  full spectrum colonoscopy;  human;  major clinical study;  male;  middle aged;  polypectomy;  priority journal;  prospective study;  randomized controlled trial;  sensitivity analysis;  adenoma;  aged;  clinical trial;  colon tumor;  colonoscopy;  comparative study;  diagnostic imaging;  early cancer diagnosis;  health survey;  multicenter study;  procedures;  time factor;  transverse colon, Adenoma;  Aged;  Colon, Ascending;  Colon, Transverse;  Colonic Neoplasms;  Colonoscopy;  Cross-Over Studies;  Early Detection of Cancer;  False Negative Reactions;  Female;  Humans;  Male;  Middle Aged;  Population Surveillance;  Prospective Studies;  Time Factors",
    abstract = "Background and study aims Full-spectrum colonoscopy (FSC) promises to increase adenoma detection by providing a wider field of view. The aim of this study was to compare adenoma miss rates of FSC with those of conventional colonoscopy complemented by right-colon re-examination using scope retroflexion (CC/R). Patients and methods At two tertiary endoscopy facilities, patients who were scheduled for colonoscopy for the assessment of symptoms or for colorectal cancer screening/surveillance were randomized (1:1) to undergo same-day, back-to-back colonoscopies (FSC or CC/R first), performed by one of five endoscopists who had documented adenoma detection rates >35%. Per-protocol data were analyzed. Results We randomized 220 patients. There were five FSC technical failures (three air pump and two left screen); therefore, 107 and 108 cases were analyzed in the FSC and CC/R index procedure arms, respectively. Withdrawal times were similar for FSC and CC/R (7.7 minutes vs. 7.6 minutes). Overall, we detected 3 cancers and 153 adenomas (FSC=92; CC/R=61); 81 were detected in the proximal colon, 3 of which were detected by retroflexed examination. By per-lesion analysis, FSC showed a significantly lower adenoma miss rate compared with CC/R overall (10.9% [95% confidence interval (CI) 3.8 to 18.1] vs. 33.7% [95%CI 23.4 to 44.1]) and in the proximal colon (13.9% [95%CI 2.6 to 25.2] vs. 42.2% [95%CI 27.8 to 56.7]). The advanced adenoma miss rate was lower with FSC overall (4.3% [95%CI-4.0 to 12.7] vs. 25.9% [95%CI 9.4 to 42.5]). There were no adverse events. Conclusions FSC outperformed conventional colonoscopy with right-colon scope retroflexion in the detection of missed adenomas, both overall and in the proximal colon, even when performed by experienced endoscopists. Trial registered at ClinicalTrials.gov (NCT02117674). © 2017 Published by Elsevier B.V."
}