Post written by Roupen Djinbachian, MD, from the Division of Internal Medicine, Montreal University Hospital Center (CHUM) and Montreal University Hospital Research Center (CRCHUM), Montreal, Quebec, Canada.
The focus of this study was to compare a novel endoscopic image-enhancing modality (Optivista) to an existing precursor (iScan) for optical colorectal polyp diagnosis in a randomized controlled trial. We evaluated the performance of both these modalities for assigning correct surveillance interval assignments for patients and providing correct diagnoses for colorectal polyps when compared with pathology.
The use of optical diagnosis instead of pathology evaluation has taken increasing importance in recent years for small and diminutive polyps. Studies have shown that removing the need for histologic evaluation of resected polyps can provide significant cost savings and allow for the allocation of these resources toward other healthcare needs. Optical diagnosis also allows for same-day assignment of surveillance intervals, decreasing the potential for loss of follow-up, incorrectly assigning surveillance intervals, and removing the requirement for pathology follow-up. To allow for widespread use of optical diagnosis, endoscopists need to be confident in their diagnostic abilities and in the tools provided to them to assist in performing these diagnoses. Providing better tools that increase endoscopist comfort with optical diagnosis is important, as uptake of optical diagnosis is currently exceedingly low.
Four hundred ten patients were randomized to undergo Optivista-enhanced or iScan-enhanced optical diagnosis. The primary outcome was the agreement of surveillance intervals determined when using Optivista image-enhanced endoscopy (IEE) compared to iScan IEE. We found that both achieved ASGE quality metrics for surveillance interval assignment and can be used safely for “resect and discard” strategies. Only Optivista IEE achieved ASGE quality metrics for rectosigmoid adenoma NPV, allowing its use for “diagnose and leave” strategies. Optivista IEE should therefore be the preferably used modality but combining it with iScan should be considered as a complementary modality to achieve optimal pathology prediction, NPV, and surveillance interval assignment.
This is the first study evaluating the performance of this novel IEE modality. Further studies should evaluate Optivista IEE in multicenter trials to confirm generalizability to routine clinical practice. Future developments will likely involve the use of artificial intelligence for providing optical diagnosis using these IEE modalities.
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