Post written by Toyoki Kudo, MD, PhD, from the Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.

Although colonoscopy is the gold standard for detection of colorectal adenomas, some adenomas are missed. Full-spectrum endoscopy (FUSE) allows for observation with a 330° angle of view, which is expected to decrease the miss rate. However, no consensus has been reached regarding the superiority of FUSE over standard forward-viewing colonoscopy (SFVC) for detection of adenomas; we therefore compared new-generation FUSE and SFVC regarding colorectal adenoma miss rate (AMR) in the first reported randomized control trial using new-generation FUSE.

AMR per patient (AMR-PP) was significantly lower with FUSE (11.7%; 95% CI, 8.0%–15.4%) than with SFVC (22.9%; 95% CI, 17.5%–28.3%; P < 0.001). AMR-PP for lesions ≤5 mm in size was significantly lower with FUSE (10.4%; 95% CI, 6.5%–14.3%) than SFVC (20.0%; 95% CI, 14.4%–25.6%; P = 0.0057). Furthermore, AMR-PP in the ascending colon was significantly lower with FUSE (4.3%; 95% CI, 1.4%–7.2%) than with SFVC (10.6%; 95% CI, 6.1%–15.1%; P = 0.0212). Consequently, FUSE is superior to SFVC regarding both AMR-PP and AMR; additionally, AMR-PP were both significantly lower with FUSE than SFVC for lesions ≤5 mm in size and in the ascending colon.

In a prospective study comparing FUSE with conventional standard forward-viewing colonoscopy (SFVC) with an angle of view of 140°–170°, FUSE significantly decreased the AMR; FUSE, 7% vs. SFVC, 41%; P < 0.001. However, in contrast, a follow-up study found no significant difference in adenoma detection rate (ADR) between FUSE and SFVC. Opinions regarding the usefulness of FUSE for detecting adenomas are therefore mixed and further multicenter prospective trials are needed. The present multicenter, prospective, randomized, comparative trial in Japan incorporated back-to-back tandem colonoscopies with the aim of comparing efficacy of adenoma detection between new-generation FUSE and SFVC.

We found that AMR-PP and AMR with FUSE are superior to those with SFVC. Furthermore, the rates of altering surveillance colonoscopy interval recommendation according to both USA and EU guidelines were significantly lower with FUSE than with SFVC, and AMR-PP for lesions ≤5 mm in size and in the ascending colon were both significantly lower with FUSE. AMR-PP and polyp miss rate per patient (PMR-PP) were both significantly lower with FUSE than with SFVC without a cap. However, AMR-PP and PMR-PP did not differ significantly between SFVC with a cap and FUSE, and no significant difference was found for advanced or large adenomas; additionally, the average time to the cecum was significantly longer with FUSE than with SFVC.

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