New endoscopic device improves detection of polyps in colon

2 June 2008

A multi-institutional study has shown that a new device, the third eye retroscope developed by Avantis Medical Systems, improves the ability of physicians to visualize abnormalities in the colon.

The study shows that when used in combination with a standard colonoscope, the device detects a significantly higher number of adenomas and other polyps than the colonoscope alone. It has been cleared for use in the US by the Food and Drug Administration (FDA).

Avantis says that the third eye retroscope is designed to complement, not to replace, standard colonoscopes. Therefore it does not alter existing procedural infrastructure or referral patterns. The device can be used with most of the adult colonoscopes currently produced by the leading manufacturers, as well as some paediatric colonoscopes.

Colorectal cancer is the second greatest cause of cancer death in the US. However, most cancers of the lower gastrointestinal (GI) tract can be completely cured if they are detected early. Even more cases can be completely prevented if pre-cancerous polyps can be removed before they become malignant.

Principal Investigator Dr Waye, of Mount Sinai Hospital in New York, presented the study at the Digestive Disease Week conference in San Diego on 21 May. The multi-centre study has evaluated 214 patients to date at eight sites across the US. During the study, patients were examined using the retroscope in combination with a standard colonoscope.

"Colonoscopy is currently considered the best method for colorectal cancer screening. However, it is well-established from previous research that lesions may be missed, especially on the proximal aspect of haustral folds and flexures or behind the ileocecal valve," said Dr. Waye.

Used during colonoscopy, the retroscope is an auxiliary imaging device that provides retrograde illumination and visualisation of the colon for diagnostic purposes. The device is passed through the instrument channel of a standard colonoscope until it extends beyond the tip of the colonoscope. As it emerges, the device automatically turns around 180 degrees to provide a continuous retrograde view while the colonoscope is being withdrawn.

Colonoscopy is widely regarded as the 'gold standard' for detection of abnormalities in the colon. However, previous research has revealed that 12-24% of polyps and a significant number of cancers can be missed during colonoscopy, especially if they lie behind folds in the colon wall [1, 2, 3]. This new device is designed to solve this problem by allowing the physician to view the opposite side of those folds during the procedure.

The study (which is still active) has found that, in combination with a standard colonoscope, the device detected 13.3% additional polyps, and 12.4% additional adenomas, compared with the colonoscope alone. Polyps detected with the device were comparable in size to those seen with the colonoscope.

"Our investigators are finding that the third eye retroscope is a promising new technology for improving visualization during colonoscopy," continued Dr Waye. "During the study, the Third Eye revealed areas that are often hidden from the forward-viewing colonoscope, and it allowed a significant increase in detection of adenomas and other polyps."

In the 214 patients studied to date, 203 polyps were identified with the standard colonoscope. With the new device, an additional 27 polyps were detected, an increase of 13.3%. With the standard colonoscope, 105 adenomas were found; and with the retroscope, an additional 13 adenomas were detected, an increase of 12.4%. Mean size for polyps found by the colonoscope alone was 0.49 cm, and mean size for polyps found by the retroscope was virtually identical, at 0.47 cm.

In 21 patients (9.8%), at least one additional polyp was found with the use of the retroscope, and in seven patients (3.3%), the polyp detected with the retroscope was the only one found. 

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