S179 Enhancing Colonoscopy Outcomes: A Systematic Review of the Clinical Effectiveness of a Novel Rigidizing Overtube in Completing Difficult Colonoscopies and Achieving Complex Polyp Resection
Notice bibliographique
Résumé
Introduction: Poor scope maneuverability and loop formation are some of the reasons for incomplete colonoscopies and suboptimal polyp resection even amongst expert endoscopists. The rigidizing overtube (RO) has been reported as a useful device used to overcome difficulties during colonoscopies and assisting in the completion of technically challenging procedures. In this study, we conducted a systematic review to assess the clinical success of using the RO to complete difficult colonoscopies and achieve complex polyp removal. Methods: We used multiple electronic databases from August 2019 through May 2023 to identify studies evaluating the use of the novel RO for colonoscopies. We followed the PRISMA guidelines. Quality/risk for bias was assessed using the Newcastle-Ottawa Scale (NOS). Results: Six studies were included; one study was divided into 2 different indications with a total of 165 patients (Figure 1). In the 3 studies that the indication was difficult to complete colonoscopies involving (53 patients), the colonoscopy completion rate was 88.7% (n = 47), the procedure facilitation was reported in 2/3 studies with a 93.1% (n = 27) and 100% (n = 9) respectively. Failure in these studies were reported in 2 patients due to anatomical restrictions and no adverse events were reported. One study compared polyp resection with and without the RO, reporting similar en-bloc resection and curative rates using RO (RO-ESD) when compared with conventional ESD (C-ESD), en-bloc resection success (RO-ESD 92% vs 96% C-ESD) and curative resection (RO-ESD 88% vs 92% C-ESD). In 2 studies that evaluated RO in the removal of complex polyps (62 patients), technical success was achieved 100% for both studies. One of the studies reported clinical success of 90% (n = 52), en-bloc resection of 86.4% and R0 resection of 80%, for both studies procedure facilitation ranged from 98.3-100%. None of these studies reported adverse events (Table 1). Conclusion: Our findings suggest that using RO shows promise in enhancing the clinical success of completing difficult colonoscopies and achieving successful ESD and EMR of colonic lesions by avoiding looping and offering stability. Further randomized studies evaluating the efficacy and cost of the RO are warranted.Figure 1.: PRISMA 2020 flow diagram for new systematic reviews which included searches of databases, registers and other sources. Table 1. - General Characteristics of the Studies N Study AIM Study Type Age, mean (SD) Sex (Male) Overtube Indication Indication of Colonoscopy Change of endoscope Success Procedure Facilitation Wei et al. (2021) 29 Difficult Colonoscopies Case Series 66 (13.6) 18 (62.1%) Incomplete Colonoscopy (n = 12, 41.4%)Enhancing Insertion (n = 6, 20.7%)Stabilization during endoscopic Resection (n = 11, 37.9%) Screening (n = 3, 10.3%)Surveillance (n = 7, 24.1%)Recent large polyp (n = 10, 34.5%)IDA/GI Bleeding (n = 3, 10.3%)Recent Incomplete colonoscopy (n = 1, 3.4%) Pediatric Endoscope (n = 4 , 13.8%) Colonoscopy Completion, (n = 23, 79.3%) 27 (93.1) Park N. et al. (2022) 15 Difficult Colonoscopies Prospective descriptive 63.2 (18) NA Incomplete Colonoscopy (n = 15, 100%) Surveillance (n = 9, 60%)Recent large polyp (n = 3, 20%)Evaluation of Chron's Disease (n = 2, 13.3%)Other (n = 1, 6.7%) NA Colonoscopy Completion, (n = 15, 100%) NA Friedland (2020) 9 Difficult Colonoscopies Case Series NA NA Incomplete Colonoscopy (n = 7, 77.8%)Intraprocedure failed Colonoscopy (n = 2, 22.2%) Incomplete colonoscopy (n = 9, 100%) Pediatric colonoscope (n = 5, 55.5%)Longer enteroscope (n = 2, 22.2%) Colonoscopy Completion (n = 9, 100%) 100% Farha et al. (2022) 50 Polyp Resection (ESD) Retrospective MatchedStudy RO vs No RO 66.7 (12.1) 18 (72%) Polyp Resection using ESD (100%) Polyps (100%) NA En-bolc resection: RO-ESD 92% vs 96% C-ESDCurative Resection: RO-ESD 88% vs 92% NA Jawaid et al. (2023) 58 Challenging Polyp Removal Observational 67.6 (9.9) 28 (50%) 2 polypectomies in the cecum1 ascending colon mucosal resection1 cecal submucosal dissection Polyps (100%) Intervention changed: 6 (13.6%) Technical Success: 100%Clinical Success: 90%En-bolc resection: 86.4%R0 resection: 80% 98.30% Friedland (2020) 4 Challenging Polyp Removal Case Series NA NA Challenging Polyp Removal (100%) Polyps (100%) NA Technical Success: 100% 100%
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,011 | 0,055 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,009 | 0,011 |
| Bibliométrie | 0,008 | 0,008 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».