Full-spectrum (FUSE) versus standard forwardviewing colonoscopy in an organised colorectal cancer screening programme

Cesare Hassan, Carlo Senore, Franco Radaelli, Giovanni De Pretis, Romano Sassatelli, Arrigo Arrigoni, Gianpiero Manes, Arnaldo Amato, Andrea Anderloni, Franco Armelao, Alessandra Mondardini, Cristiano Spada, Barbara Omazzi, Maurizio Cavina, Gianni Miori, Chiara Campanale, Giuliana Sereni, Nereo Segnan, Alessandro Repici

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Abstract

Objective Miss rate of polyps has been shown to be substantially lower with full-spectrum endoscopy (FUSE) compared with standard forward-viewing (SFV) colonoscopy in a tandem study at per polyp analysis. However, there is uncertainty on whether FUSE is also associated with a higher detection rate of colorectal neoplasia, especially advanced lesions, in per patient analysis. Methods Consecutive subjects undergoing colonoscopy following a positive faecal immunochemical test (FIT) by experienced endoscopists and performed in the context of a regional colorectal cancer population-screening programme were randomised between colonoscopy with either FUSE or SFV colonoscopy in seven Italian centres. Randomisation was stratified by gender, age group and screening history. Primary outcomes included detection rates of advanced adenomas (A-ADR), adenomas (ADR) and sessile-serrated polyps (SSPDR). Results Of 741 eligible subjects, 658 were randomised to either FUSE (n=328) or SFV (n=330) colonoscopy and included in the analysis. Overall, 293/658 and 143/658 subjects had at least one adenoma (ADR 44.5%) and advanced adenoma (A-ADR 21.7%), respectively, while SSP was the most advanced lesion in 18 cases (SSPDR 2.7%). ADR and A-ADR were 43.6% and 19.5% in the FUSE arm, and 45.5% and 23.9% in the SFV arm, with no difference for both ADR (OR for FUSE: 0.96, 95% CI 0.81 to 1.14) and A-ADR (OR for FUSE: 0.82, 95% CI 0.61 to 1.09). No difference in SSPDR or multiplicity was detected between the two arms. In the per polyp analysis, the mean number of adenomas and proximal adenomas per patient was 0.81±1.25 and 0.47±0.93 in the FUSE arm, and 0.85±1.33 and 0.48 ±0.96 in the SFV colonoscopy arm (p=NS for both comparisons). Conclusions No statistically significant difference in ADR and A-ADR between FUSE and SFV colonoscopy was detected in a per patient analysis in FIT-positive patients. Trial registration number ISRCTN10357435.

Original languageEnglish
JournalGut
DOIs
Publication statusAccepted/In press - Aug 9 2016

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Colonoscopy
Early Detection of Cancer
Colorectal Neoplasms
Adenoma
Polyps
Population Control
Random Allocation
Endoscopy
Uncertainty
Age Groups
History
Neoplasms

ASJC Scopus subject areas

  • Medicine(all)
  • Gastroenterology

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Full-spectrum (FUSE) versus standard forwardviewing colonoscopy in an organised colorectal cancer screening programme. / Hassan, Cesare; Senore, Carlo; Radaelli, Franco; Pretis, Giovanni De; Sassatelli, Romano; Arrigoni, Arrigo; Manes, Gianpiero; Amato, Arnaldo; Anderloni, Andrea; Armelao, Franco; Mondardini, Alessandra; Spada, Cristiano; Omazzi, Barbara; Cavina, Maurizio; Miori, Gianni; Campanale, Chiara; Sereni, Giuliana; Segnan, Nereo; Repici, Alessandro.

In: Gut, 09.08.2016.

Research output: Contribution to journalArticle

Hassan, C, Senore, C, Radaelli, F, Pretis, GD, Sassatelli, R, Arrigoni, A, Manes, G, Amato, A, Anderloni, A, Armelao, F, Mondardini, A, Spada, C, Omazzi, B, Cavina, M, Miori, G, Campanale, C, Sereni, G, Segnan, N & Repici, A 2016, 'Full-spectrum (FUSE) versus standard forwardviewing colonoscopy in an organised colorectal cancer screening programme', Gut. https://doi.org/10.1136/gutjnl-2016-311906
Hassan, Cesare ; Senore, Carlo ; Radaelli, Franco ; Pretis, Giovanni De ; Sassatelli, Romano ; Arrigoni, Arrigo ; Manes, Gianpiero ; Amato, Arnaldo ; Anderloni, Andrea ; Armelao, Franco ; Mondardini, Alessandra ; Spada, Cristiano ; Omazzi, Barbara ; Cavina, Maurizio ; Miori, Gianni ; Campanale, Chiara ; Sereni, Giuliana ; Segnan, Nereo ; Repici, Alessandro. / Full-spectrum (FUSE) versus standard forwardviewing colonoscopy in an organised colorectal cancer screening programme. In: Gut. 2016.
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title = "Full-spectrum (FUSE) versus standard forwardviewing colonoscopy in an organised colorectal cancer screening programme",
abstract = "Objective Miss rate of polyps has been shown to be substantially lower with full-spectrum endoscopy (FUSE) compared with standard forward-viewing (SFV) colonoscopy in a tandem study at per polyp analysis. However, there is uncertainty on whether FUSE is also associated with a higher detection rate of colorectal neoplasia, especially advanced lesions, in per patient analysis. Methods Consecutive subjects undergoing colonoscopy following a positive faecal immunochemical test (FIT) by experienced endoscopists and performed in the context of a regional colorectal cancer population-screening programme were randomised between colonoscopy with either FUSE or SFV colonoscopy in seven Italian centres. Randomisation was stratified by gender, age group and screening history. Primary outcomes included detection rates of advanced adenomas (A-ADR), adenomas (ADR) and sessile-serrated polyps (SSPDR). Results Of 741 eligible subjects, 658 were randomised to either FUSE (n=328) or SFV (n=330) colonoscopy and included in the analysis. Overall, 293/658 and 143/658 subjects had at least one adenoma (ADR 44.5{\%}) and advanced adenoma (A-ADR 21.7{\%}), respectively, while SSP was the most advanced lesion in 18 cases (SSPDR 2.7{\%}). ADR and A-ADR were 43.6{\%} and 19.5{\%} in the FUSE arm, and 45.5{\%} and 23.9{\%} in the SFV arm, with no difference for both ADR (OR for FUSE: 0.96, 95{\%} CI 0.81 to 1.14) and A-ADR (OR for FUSE: 0.82, 95{\%} CI 0.61 to 1.09). No difference in SSPDR or multiplicity was detected between the two arms. In the per polyp analysis, the mean number of adenomas and proximal adenomas per patient was 0.81±1.25 and 0.47±0.93 in the FUSE arm, and 0.85±1.33 and 0.48 ±0.96 in the SFV colonoscopy arm (p=NS for both comparisons). Conclusions No statistically significant difference in ADR and A-ADR between FUSE and SFV colonoscopy was detected in a per patient analysis in FIT-positive patients. Trial registration number ISRCTN10357435.",
author = "Cesare Hassan and Carlo Senore and Franco Radaelli and Pretis, {Giovanni De} and Romano Sassatelli and Arrigo Arrigoni and Gianpiero Manes and Arnaldo Amato and Andrea Anderloni and Franco Armelao and Alessandra Mondardini and Cristiano Spada and Barbara Omazzi and Maurizio Cavina and Gianni Miori and Chiara Campanale and Giuliana Sereni and Nereo Segnan and Alessandro Repici",
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T1 - Full-spectrum (FUSE) versus standard forwardviewing colonoscopy in an organised colorectal cancer screening programme

AU - Hassan, Cesare

AU - Senore, Carlo

AU - Radaelli, Franco

AU - Pretis, Giovanni De

AU - Sassatelli, Romano

AU - Arrigoni, Arrigo

AU - Manes, Gianpiero

AU - Amato, Arnaldo

AU - Anderloni, Andrea

AU - Armelao, Franco

AU - Mondardini, Alessandra

AU - Spada, Cristiano

AU - Omazzi, Barbara

AU - Cavina, Maurizio

AU - Miori, Gianni

AU - Campanale, Chiara

AU - Sereni, Giuliana

AU - Segnan, Nereo

AU - Repici, Alessandro

PY - 2016/8/9

Y1 - 2016/8/9

N2 - Objective Miss rate of polyps has been shown to be substantially lower with full-spectrum endoscopy (FUSE) compared with standard forward-viewing (SFV) colonoscopy in a tandem study at per polyp analysis. However, there is uncertainty on whether FUSE is also associated with a higher detection rate of colorectal neoplasia, especially advanced lesions, in per patient analysis. Methods Consecutive subjects undergoing colonoscopy following a positive faecal immunochemical test (FIT) by experienced endoscopists and performed in the context of a regional colorectal cancer population-screening programme were randomised between colonoscopy with either FUSE or SFV colonoscopy in seven Italian centres. Randomisation was stratified by gender, age group and screening history. Primary outcomes included detection rates of advanced adenomas (A-ADR), adenomas (ADR) and sessile-serrated polyps (SSPDR). Results Of 741 eligible subjects, 658 were randomised to either FUSE (n=328) or SFV (n=330) colonoscopy and included in the analysis. Overall, 293/658 and 143/658 subjects had at least one adenoma (ADR 44.5%) and advanced adenoma (A-ADR 21.7%), respectively, while SSP was the most advanced lesion in 18 cases (SSPDR 2.7%). ADR and A-ADR were 43.6% and 19.5% in the FUSE arm, and 45.5% and 23.9% in the SFV arm, with no difference for both ADR (OR for FUSE: 0.96, 95% CI 0.81 to 1.14) and A-ADR (OR for FUSE: 0.82, 95% CI 0.61 to 1.09). No difference in SSPDR or multiplicity was detected between the two arms. In the per polyp analysis, the mean number of adenomas and proximal adenomas per patient was 0.81±1.25 and 0.47±0.93 in the FUSE arm, and 0.85±1.33 and 0.48 ±0.96 in the SFV colonoscopy arm (p=NS for both comparisons). Conclusions No statistically significant difference in ADR and A-ADR between FUSE and SFV colonoscopy was detected in a per patient analysis in FIT-positive patients. Trial registration number ISRCTN10357435.

AB - Objective Miss rate of polyps has been shown to be substantially lower with full-spectrum endoscopy (FUSE) compared with standard forward-viewing (SFV) colonoscopy in a tandem study at per polyp analysis. However, there is uncertainty on whether FUSE is also associated with a higher detection rate of colorectal neoplasia, especially advanced lesions, in per patient analysis. Methods Consecutive subjects undergoing colonoscopy following a positive faecal immunochemical test (FIT) by experienced endoscopists and performed in the context of a regional colorectal cancer population-screening programme were randomised between colonoscopy with either FUSE or SFV colonoscopy in seven Italian centres. Randomisation was stratified by gender, age group and screening history. Primary outcomes included detection rates of advanced adenomas (A-ADR), adenomas (ADR) and sessile-serrated polyps (SSPDR). Results Of 741 eligible subjects, 658 were randomised to either FUSE (n=328) or SFV (n=330) colonoscopy and included in the analysis. Overall, 293/658 and 143/658 subjects had at least one adenoma (ADR 44.5%) and advanced adenoma (A-ADR 21.7%), respectively, while SSP was the most advanced lesion in 18 cases (SSPDR 2.7%). ADR and A-ADR were 43.6% and 19.5% in the FUSE arm, and 45.5% and 23.9% in the SFV arm, with no difference for both ADR (OR for FUSE: 0.96, 95% CI 0.81 to 1.14) and A-ADR (OR for FUSE: 0.82, 95% CI 0.61 to 1.09). No difference in SSPDR or multiplicity was detected between the two arms. In the per polyp analysis, the mean number of adenomas and proximal adenomas per patient was 0.81±1.25 and 0.47±0.93 in the FUSE arm, and 0.85±1.33 and 0.48 ±0.96 in the SFV colonoscopy arm (p=NS for both comparisons). Conclusions No statistically significant difference in ADR and A-ADR between FUSE and SFV colonoscopy was detected in a per patient analysis in FIT-positive patients. Trial registration number ISRCTN10357435.

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