Background and Aims

Many endoscopic technological innovations have claimed to increase the adenoma detection rate (ADR), but their role in population-based organized screening programs is debated.

Methods

We searched PubMed, EMBASE, and Cochrane Library databases through January 2020 for randomized controlled trials (RCTs) evaluating the role of technological innovations in fecal immunochemical test (FIT)/fecal occult blood test+ subjects. The primary outcome was ADR, and secondary outcomes were advanced ADR, proximal colon ADR, mean adenoma per procedure (MAP), and cancer detection rate. We calculated pooled proportion rates (%) or risk ratio with 95% confidence interval (CI) and degree of heterogeneity (I²).

Results

Overall, 8 high quality RCTs met inclusion criteria with 3645 patients, 1813 (49.7%) in the intervention arm (advanced imaging, 3 studies; mechanical, 5 studies) and 1832 (50.3%) in the standard colonoscopy arm (mean age, 63.6 years). Pooled ADR was 56.5% (95% CI, 49.9%-62.9%) in the intervention arm and 55.9% (95% CI, 48.6%-63%) in the standard colonoscopy arm (relative risk [RR], 1.01; 95% CI, .93-1.10; I² = 50.4%). Similarly, no difference was observed for advanced imaging studies (RR, .95; 95% CI, .85-1.07; I² = 50.4%) or those with mechanical innovations (RR, 1.04; 95% CI, .92-1.17; I² = 69.49%). The pooled MAP was 1.5 in the intervention arm (95% CI, 1.2-1.8) and 1.5 in the standard colonoscopy (95% CI, 1.1-1.8), with no significant difference (unstandardized mean difference, .04; 95% CI, –.13 to .20; I² = 53.6%). No difference in advanced ADR, proximal colon ADR, or cancer detection was found. No significant publication bias was found.

Conclusions

In our systematic review and meta-analysis, no technological improvement significantly increased detection rate of colorectal neoplasia in FIT+ subjects undergoing high-quality colonoscopy by high detectors, arguing against their implementation in organized programs.

中文翻译：

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用于组织性结直肠癌筛查程序中肿瘤形成的内窥镜技术创新：系统评价和荟萃分析。

背景和目标

许多内窥镜技术创新都声称可以提高腺瘤检出率（ADR），但它们在基于人群的有组织筛查计划中的作用尚有争议。

方法

我们搜索了2020年1月之前的PubMed，EMBASE和Cochrane库数据库，以评估技术创新在粪便免疫化学测试（FIT）/粪便潜血测试+受试者中的作用的随机对照试验（RCT）。主要结局为ADR，次要结局为晚期ADR，近端结肠ADR，平均每个手术腺瘤（MAP）和癌症检出率。我们以95％的置信区间（CI）和异质性（I ²）计算合并比例率（％）或风险率。

结果

总体而言，有8项高质量的RCT符合纳入标准，其中3645例患者在干预组（高级影像学，3项研究；机械学，5项研究）中为1813例（49.7％），在标准结肠镜检查组（平均年龄为63.6例）中为1832例（50.3％）。年份）。标准结肠镜检查组的合并ADR为56.5％（95％CI，49.9％-62.9％），标准结肠镜检查组为55.9％（95％CI，48.6％-63％）（相对风险[RR]，1.01; 95％ CI，.93-1.10； I ²  ＝ 50.4％。同样，对于高级影像学研究（RR，.95； 95％CI，.85-1.07； I ²  = 50.4％）或具有机械创新的研究（RR，1.04； 95％CI，.92-1.17；I ² = 50.4％）也没有观察到差异。我² = 69.49％）。合并的MAP在干预组为1.5（95％CI，1.2-1.8），在标准结肠镜检查中为1.5（95％CI，1.1-1.8），无显着性差异（非标准化平均差异，.04； 95％CI， –.13至.20； I ²  = 53.6％）。没有发现晚期ADR，近端结肠ADR或癌症检测的差异。没有发现明显的出版偏见。

结论

在我们的系统评价和荟萃分析中，没有技术进步会显着提高接受高检波器进行高质量结肠镜检查的FIT +受试者中大肠肿瘤的检出率，这与在有组织程序中的实施不符。