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The incremental yield of adenoma detection with I-Scan versus high-definition white light colonoscopy—a systematic review and meta-analysis of randomized studies

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A Correction to this article was published on 10 October 2023

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Abstract

Introduction

The incremental yield of I-Scan virtual chromoendoscopy compared to high-definition white light endoscopy (HD-WLE) in detection of colorectal adenomas has not been thoroughly elucidated.

Methods

A systematic search from inception to April 2023 was conducted to identify randomized controlled trials (RCTs) comparing I-Scan to HD-WLE for detection of adenomas. A random effects model was used to compute risk difference (RD) with corresponding 95% confidence intervals in adenoma detection rate (ADR). Influence analysis was done to assess robustness of findings. The number needed to diagnose was computed. Heterogeneity was assessed using the I2 statistic and explored further by subgroup analyses defined a priori. Certainty in effect estimates was assessed using the GRADE approach.

Results

We identified four studies (I-Scan n = 730, HD-WLE n = 765). I-Scan increased adenoma detection by 9% (risk difference (RD), 0.09; 0.04, 0.14; I2 02%; certainty, low). Influence analysis revealed that the gain in yield remained statistically significant with exclusion of all but one study. The number needed to capture one additional adenomatous polyp with I-Scan use was 11.2. I-Scan 1 use was associated with a statistically significant gain in ADR, whereas no significant difference in ADR was noted with I-Scan use on subgroup analysis.

Discussion

In conclusion, I-Scan increases the yield of adenoma detection by 9% compared to HD-WLE, with low certainty in the estimate of this effect. Data on the gain in yield of detecting large polyps, sessile serrated lesions, and on the impact of formally training endoscopists and trainees in I-Scan use and similar technology on adenoma detection rate are needed.

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Data availability

No data/code availability for this study.

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Acknowledgements

We would like to acknowledge contributions from Ali Hussain in organizing tables for this project.

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Author notes

  1. Maryam R. Hussain and Faisal S. Ali are co-first authors.

Authors and Affiliations

  1. Department of Population Health and Health Disparities/School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA

    Maryam R. Hussain

  2. Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas Health Science Center, Houston, TX, USA

    Faisal S. Ali

  3. Department of Internal Medicine, Woodhull Hospital, New York, NY, USA

    Apoorva Tangri

  4. Center for Interventional Gastroenterology at UTHealth (iGUT), Department of Surgery, Division of Endoluminal Surgery and Interventional Gastroenterology, McGovern Medical School at UTHealth, Houston, TX, USA

    Shahrooz Rashtak, Mairin Joseph-Talreja, Pritesh R. Mutha, Vaibhav Wadhwa, Sushovan Guha, Roy Tomas DaVee & Nirav Thosani

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Contributions

Study conception and design: Nirav Thosani, Tomas DaVee, Maryam R Hussain, and Faisal S. Ali. Data extraction and analysis: Maryam R. Hussain, Faisal S. Ali, and Apoorva Tangri. Manuscript writing: Maryam R. Hussain and Faisal S. Ali. Critical review and editing of the manuscript data: Maryam R Hussain, Faisal S Ali, Apoorva Tangri, Shahrooz Rashtak, Mairin Joseph-Talreja, Pritesh R. Mutha, Vaibhav Wadhwa, Sushovan Guha, Roy Tomas DaVee, and Nirav Thosani. Finalization of the manuscript: Maryam R Hussain, Faisal S Ali, Apoorva Tangri, Shahrooz Rashtak, Mairin Joseph-Talreja, Pritesh R. Mutha, Vaibhav Wadhwa, Sushovan Guha, Roy Tomas DaVee, and Nirav Thosani.

Corresponding authors

Correspondence to Faisal S. Ali or Nirav Thosani.

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Competing interests

The authors declare no competing interests. Dr. Nirav Thosani is a consultant for Pentax America and Boston Scientific Corporation, a speaker for Abbvie, and receives royalty from UpToDate. All other authors have no conflicts of interest or financial ties to disclose.

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Hussain, M.R., Ali, F.S., Tangri, A. et al. The incremental yield of adenoma detection with I-Scan versus high-definition white light colonoscopy—a systematic review and meta-analysis of randomized studies. Int J Colorectal Dis 38, 240 (2023). https://doi.org/10.1007/s00384-023-04533-3

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