Original articleClinical endoscopyEffect of a retrograde-viewing device on adenoma detection rate during colonoscopy: the TERRACE study
Section snippets
Background
In a pilot study of the TER in 24 patients, Triadafilopoulos and Li9 found 11.8% additional polyps behind folds that hid them from the standard colonoscope. Waye et al10 conducted a multicenter study involving 249 subjects. The mean additional detection rates with TER compared with the colonoscope alone were 13.2% for all polyps and 11.0% for adenomas.
A multicenter study with 298 subjects by DeMarco et al11 evaluated the effect of experience with the TER on detection rates and found that after
Methods
Fifteen endoscopists at 4 European and 5 U.S. sites performed at least 10 to 15 practice cases by using the TER before starting the trial. Patients undergoing colonoscopy for screening, surveillance after previous polypectomy, or as a diagnostic workup were recruited. Exclusion criteria included a history of colonic resection, inflammatory bowel disease, polyposis syndrome, radiation therapy to the abdomen or pelvis, suspicion of colonic stricture, active diverticulitis, or concurrent
Patients
In total, 448 subjects were enrolled, of whom 53 (11.8%) had no data collected because they were withdrawn from the study because of technical error or malfunction (n = 6), inadequate bowel preparation (n = 28), previously unrecognized conditions in which back-to-back examinations might increase risk (n = 8), inability to reach the cecum (n = 7), data irretrievably lost by study site (n = 3), and consent withdrawn by patient (n = 1). These subjects did not undergo TEC, and for those who
Discussion
Colorectal cancer is the second largest cause of cancer death in the United States and Europe. In the United States, 152,000 new cases of colorectal cancer were diagnosed in 2009, with more than 50,000 deaths.13 In Western Europe, 436,000 cases were diagnosed in 2008 and 212,000 patients died of the disease.14 This malignancy can be prevented if precancerous adenomas are removed before they progress to adenocarcinomas.1, 2, 15, 16, 17, 18
Colonoscopy is currently regarded as the criterion
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DISCLOSURE: Research support for this study was provided by Avantis Medical Systems, Sunnyvale, California. All authors disclosed no financial relationships relevant to this publication. P.D. Siersema is a member of the Scientific Advisory Board of Avantis Medical Systems.