TY - JOUR
T1 - Efficacy of autofluorescence imaging for flat neoplasm detection
T2 - a multicenter randomized controlled trial (A-FLAT trial)
AU - Takeuchi, Yoji
AU - Sawaya, Manabu
AU - Oka, Shiro
AU - Tamai, Naoto
AU - Kawamura, Takuji
AU - Uraoka, Toshio
AU - Ikematsu, Hiroaki
AU - Moriyama, Tomohiko
AU - Arao, Masamichi
AU - Ishikawa, Hideki
AU - Ito, Yuri
AU - Matsuda, Takahisa
N1 - Funding Information:
All funds of this study are self sustaining. We thank Ms. Naoko Sawada (Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine) for her assistance with data management and the members of Efficacy and Safety Assessment Committee (Prof. Hiroshi Kashida, Dr Hiroko Nebiki and Dr Kenji Watanabe) for their contribution, Prof. Yoshinori Igarashi (the president of Endoscopy Forum Japan), and all organizing committee members of Endoscopy Forum Japan for giving us the opportunity to conduct this trial. DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
Publisher Copyright:
© 2019 American Society for Gastrointestinal Endoscopy
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2019/3
Y1 - 2019/3
N2 - Background and Aims: Colorectal flat (nonpolypoid) lesions can be overlooked during colonoscopy. This study evaluated the efficacy of updated autofluorescence imaging (AFI) for detecting colorectal flat neoplasms. Methods: This was a prospective, multicenter, randomized controlled trial in 9 Japanese tertiary institutions. Patients undergoing colonoscopy because of positive fecal immunochemical tests, surveillance after polypectomy, or investigation of minor symptoms were enrolled and randomly assigned to either the white-light imaging (WLI) or the AFI group. Primary outcome measurement was number of flat neoplasms per patient. Results: From November 2015 to June 2017, 817 patients were enrolled. After excluding 15 patients, 802 were finally analyzed (404, WLI; 398, AFI). Patients’ backgrounds (sex, age, indication of colonoscopy, experience of endoscopists) and quality of colonoscopy (bowel preparation, sedative use, cecal insertion rate, insertion and withdrawal time) were not different between groups. Number of flat neoplasms in each patient was significantly higher in the AFI than in the WLI group (.87 [95% confidence interval [CI],.78-.97] vs.53 [95% CI,.46-.61]), whereas overall and polypoid neoplasm detection was not significantly different between the groups (1.33 [95% CI, 1.22-1.45] vs 1.14 [95% CI, 1.03-1.24],.46 [95% CI,.40-.53] vs.60 [95% CI,.53-.68]). Flat neoplasms were more frequently detected in the right-sided colon with AFI (.61 [95% CI,.54-.70] vs.30 [95% CI,.25-.36]) but not in the left-sided colon and rectum (.26 [95% CI,.21-.32] vs.23 [95% CI,.19-.28]). Conclusions: Updated AFI improves the detection of flat colorectal neoplasms in the right-sided colon compared with WLI. (Clinical trial registration number: UMIN000019355.)
AB - Background and Aims: Colorectal flat (nonpolypoid) lesions can be overlooked during colonoscopy. This study evaluated the efficacy of updated autofluorescence imaging (AFI) for detecting colorectal flat neoplasms. Methods: This was a prospective, multicenter, randomized controlled trial in 9 Japanese tertiary institutions. Patients undergoing colonoscopy because of positive fecal immunochemical tests, surveillance after polypectomy, or investigation of minor symptoms were enrolled and randomly assigned to either the white-light imaging (WLI) or the AFI group. Primary outcome measurement was number of flat neoplasms per patient. Results: From November 2015 to June 2017, 817 patients were enrolled. After excluding 15 patients, 802 were finally analyzed (404, WLI; 398, AFI). Patients’ backgrounds (sex, age, indication of colonoscopy, experience of endoscopists) and quality of colonoscopy (bowel preparation, sedative use, cecal insertion rate, insertion and withdrawal time) were not different between groups. Number of flat neoplasms in each patient was significantly higher in the AFI than in the WLI group (.87 [95% confidence interval [CI],.78-.97] vs.53 [95% CI,.46-.61]), whereas overall and polypoid neoplasm detection was not significantly different between the groups (1.33 [95% CI, 1.22-1.45] vs 1.14 [95% CI, 1.03-1.24],.46 [95% CI,.40-.53] vs.60 [95% CI,.53-.68]). Flat neoplasms were more frequently detected in the right-sided colon with AFI (.61 [95% CI,.54-.70] vs.30 [95% CI,.25-.36]) but not in the left-sided colon and rectum (.26 [95% CI,.21-.32] vs.23 [95% CI,.19-.28]). Conclusions: Updated AFI improves the detection of flat colorectal neoplasms in the right-sided colon compared with WLI. (Clinical trial registration number: UMIN000019355.)
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U2 - 10.1016/j.gie.2018.11.012
DO - 10.1016/j.gie.2018.11.012
M3 - Article
C2 - 30452914
AN - SCOPUS:85059804099
VL - 89
SP - 460
EP - 469
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
SN - 0016-5107
IS - 3
ER -