P0346 - Utilization of Endocuff-Assisted Colonoscopy and Computer-Aided Detection in Optimizing Colonoscopies in the Elderly

Iktej Jabbal, MD¹, Rohin Patel, ², Francesco Ferretti, MD², Martin Avalos, MD, FACG², Pankaj Patel, MD^2
1AdventHealth, Sebring, FL; ²Surgical and Endoscopy Center, Sebring, FL

Introduction: Both computer-aided detection (CAD)-assisted and Endocuff-assisted (ECV) colonoscopies have been found to increase adenoma detection in the colon. Given their age and comorbidities, the elderly population is known to undergo lesser colonoscopies due to their comorbid illnesses. It is thereby imperative to optimize the procedures that older adults undergo to maximize detection. We investigated the performance of the combination of the two tools compared with ECV alone to detect colorectal adenoma and neoplasia during both screening and diagnostic colonoscopy in older adults.

Methods: N = 70 patients (50% female) aged 75 years and above undergoing colonoscopy at The Surgery and Endoscopy Center of Sebring were enrolled. Patients were randomly assigned to colonoscopy with the combinations of CADe (GI-genius Medtronic) and a mucosal exposure device (Endocuff Vision [ECV]; Olympus) (treatment group) or to a mucosal exposure device alone (control group). All detected lesions were removed and sent to histopathology for diagnosis. The primary outcome was the adenoma detection rate (percentage of patients with at least one histologically proven adenoma or carcinoma). Secondary outcomes were total adenomas detected per colonoscopy, advanced adenomas, serrated lesions, and colon cancer.

Results: From Nov 1, 2022, to May 31, 2023, there were 70 subjects randomized and eligible for analysis; 39 (55.7%) to the treatment group and 31 (55.7%) to the control group. The median age of the population was 77 years. The adenoma detection rate was found to be significantly higher in the treatment group (84.6%) than in the control group (58.1%) (p = 0.013). While adenomas detected per colonoscopy were significantly higher in the treatment group (mean ± SD, 1.41 ± 0.93) than in the control group (1.06 ± 0.21), this did not achieve statistical significance (p = 0.165), probably due to the smaller sample size. However, neither of the two groups differed regarding detecting advanced adenomas and serrated lesions.

Discussion: Redundant colon, colonic spasms, improper distensibility, and fair preparation limit visibility in detecting adenomas less than 1 centimeter, especially in the left colon of the elderly population. The combination of CADe and ECV during colonoscopy increases the adenoma detection rate, thus optimizing these procedures. Moreover, we believe that in the absence of the availability of CADe, even only an ECV-assisted colonoscopy in this population would be of benefit by improving adenoma detection.



Disclosures:


Iktej Jabbal, MD¹, Rohin Patel, ², Francesco Ferretti, MD², Martin Avalos, MD, FACG², Pankaj Patel, MD². P0346 - Utilization of Endocuff-Assisted Colonoscopy and Computer-Aided Detection in Optimizing Colonoscopies in the Elderly, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.