LAUSR

BACKGROUND AND AIMS The evidence for modification of conventional colonoscopy using either "distal attachments" (endocap, endocuff, and endoring) or "electronic chromoendoscopy" (narrow-band imaging, I-Scan, blue light imaging, auto-fluorescence imaging, and linked color imaging) to improve the detection of serrated adenomas during colonoscopy has shown conflicting results. METHODS A comprehensive literature search was performed using Medline, Google Scholar, Embase, and Cochrane Library based on PRISMA guidelines. Randomized controlled trials (RCT) comparing any distal attachment (DA) or electronic chromoendoscopy (EC) to high-definition white-light colonoscopy (HD-WLE) for detection of serrated adenomas (sessile serrated adenoma/polyp- SSA/P and traditional serrated adenoma/TSA) were included. The primary outcome was serrated adenoma detection rate (SADR) defined as number of patients with at least 1 serrated adenoma out of total patients in that group. The secondary outcome was the number of serrated adenoma per subject (SAPS). Pooled rates were reported using risk ratio (RR) with 95% confidence interval (CI). RESULTS A total of 17 studies with 13,631 patients (males 56%, age range 50-66 years) met the inclusion criteria. The use of DA (RR, 1.21; p = 0.45) and EC (RR, 1.29; p = 0.09) during colonoscopy did not show a significant improvement in SADR. The SADR rate using EC was 6.9% (4 studies) whereas with NBI alone was 3.7% (3 studies). CONCLUSION The results indicate that except NBI, the use of distal attachments or electronic chromoendoscopy during colonoscopy do not improve detection of serrated adenomas in the colon. More RCT evaluating NBI are needed to explore the effect.