Magnetic endoscopic imaging as an adjuvant to elective colonoscopy: a systematic review and meta-analysis of randomized controlled trials

Background and study aims: The use of magnetic endoscopic imaging (MEI) to visualize scope configuration in three dimensions is thought to increase procedural efficiency and diminish discomfort associated with colonoscopy. The aim of this systematic review and meta-analysis was to evaluate the performance of MEI in colonoscopy.

Methods: The electronic databases Medline, EMBASE, and the Cochrane Library of Randomized Trials were searched. Methodological quality was assessed using the Jadad score. Odds ratios (OR) or risk differences for dichotomous variables and mean differences for continuous outcomes were calculated with 95 % confidence intervals (CIs).

Results: A total of 13 randomized studies met eligibility criteria and were included in qualitative and quantitative synthesis. MEI was associated with a significantly lower risk of failed cecal intubation (risk difference 4 %, 95 %CI 0 % – 7 %; P = 0.03), lower cecal intubation time (mean difference 0.58 minutes, 95 %CI 0.28 – 0.88; P < 0.001), and lower pain scores as estimated by visual analog scales (mean difference 0.45 cm, 95 %CI 0.03 – 0.86; P = 0.03) compared with conventional colonoscopy. On subgroup stratification of outcome according to endoscopist experience, failure rates were unaffected, but experienced colonoscopists reduced intubation times with MEI (mean difference 0.78 minutes, 95 %CI 0.12 – 1.43; P = 0.02). Sensitivity analyses of high-quality studies (Jadad score ≥ 3) showed no significant difference in failure rate (risk difference 4 %, 95 %CI 0 % – 8 %; P = 0.07) or intubation time (mean difference 0.56 minutes, 95 %CI – 0.15 to 1.28; P = 0.12).

Conclusion: Adjuvant MEI is associated with a lower failure risk and shorter time to cecal intubation during elective colonoscopy compared with conventional colonoscopy.

• References

• 1 Chak A, Cooper GS, Blades EW et al. Prospective assessment of colonoscopic intubation skills in trainees. Gastrointest Endosc 1996; 44: 54-57
• 2 Thomas-Gibson S, Williams CB. Colonoscopy training – new approaches, old problems. Gastrointest Endosc Clin N Am 2005; 15: 813-827
• 3 Shah SG, Brooker JC, Thapar C et al. Patient pain during colonoscopy: an analysis using real-time magnetic endoscope imaging. Endoscopy 2002; 34: 435-440
• 4 Leung JW, Thai A, Yen A et al. Magnetic endoscope imaging (ScopeGuide) elucidates the mechanism of action of the pain-alleviating impact of water exchange colonoscopy – attenuation of loop formation. J Interv Gastroenterol 2012; 2: 142-146
• 5 Leung FW. Magnetic endoscope imaging colonoscope: a new modality for hypothesis testing in unsedated colonoscopy. Gastrointest Endosc 2012; 75: 1037-1039.e1
• 6 Kaltenbach T, Leung C, Wu K et al. Use of the colonoscope training model with the colonoscope 3D imaging probe improved trainee colonoscopy performance: A pilot study. Dig Dis Sci 2011; 56: 1496-1502
• 7 Coderre S, Anderson J, Rikers R et al. Early use of magnetic endoscopic imaging by novice colonoscopists: improved performance without increase in workload. Can J Gastroenterol 2010; 24: 727-732
• 8 Jess P, Bulut O, Almasi A et al. The usefulness of a magnetic endoscope locating device in colonoscopy in daily practice: a prospective case-controlled study. Surg Endosc 2009; 23: 1353-1355
• 9 Shah SG, Pearson HJ, Moss S et al. Magnetic endoscope imaging: a new technique for localizing colonic lesions. Endoscopy 2002; 34: 900-904
• 10 Chen Y, Duan YT, Xie Q et al. Magnetic endoscopic imaging vs standard colonoscopy: meta-analysis of randomized controlled trials. World J Gastroenterol 2013; 19: 7197-7204
• 11 Jadad AR, Moore RA, Carroll D et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials 1996; 17: 1-12
• 12 Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 2005; 5: 13
• 13 Higgins J, Green S , eds. Cochrane handbook for systematic reviews of interventions, version 5.0.2. The Cochrane Collaboration; 2009 Available from: http://handbook.cochrane.org/v5.0.2/
• 14 Bak-Christensen A, Knudsen E, Hendel J et al. Colonoscopy results are not enhanced by use of magnet endoguide in specialist practice. Dan Med J 2013; 60: 1-5
• 15 Franciosi JP, Mascarenhas M, Semeao E et al. Randomised controlled trial of paediatric magnetic positioning device assisted colonoscopy: a pilot and feasibility study. Dig Liver Dis 2009; 41: 123-126
• 16 Shah SG, Brooker JC, Williams CB et al. Effect of magnetic endoscope imaging on colonoscopy performance: a randomised controlled trial. Lancet 2000; 356: 1718-1722
• 17 Shah SG, Brooker JC, Thapar C et al. Effect of magnetic endoscope imaging on patient tolerance and sedation requirements during colonoscopy: a randomized controlled trial. Gastrointest Endosc 2002; 55: 832-837
• 18 Jelsness-Jørgensen L-, Lerang F, Sandvei P et al. Magnetic endoscopic imaging during colonoscopy is associated with less pain and decreased need of analgesia and sedation – results from a randomized controlled trial. Scand J Gastroenterol 2013; 48: 890-895
• 19 Hoff G, Bretthauer M, Dahler S et al. Improvement in caecal intubation rate and pain reduction by using 3-dimensional magnetic imaging for unsedated colonoscopy: a randomized trial of patients referred for colonoscopy. Scand J Gastroenterol 2007; 42: 885-889
• 20 Holme O, Hoie O, Matre J et al. Magnetic endoscopic imaging versus standard colonoscopy in a routine colonoscopy setting: a randomized, controlled trial. Gastrointest Endosc 2011; 73: 1215-1222
• 21 Shergill AK, McQuaid KR, Deleon A et al. Randomized trial of standard versus magnetic endoscope imaging colonoscopes for unsedated colonoscopy. Gastrointest Endosc 2012; 75: 1031-1036.e1
• 22 Szura M, Bucki K, Matyja A et al. Evaluation of magnetic scope navigation in screening endoscopic examination of colorectal cancer. Surg Endosc 2012; 26: 632-638
• 23 Saunders BP, Bell GD, Williams CB et al. First clinical results with a real time, electronic imager as an aid to colonoscopy. Gut 1995; 36: 913-917
• 24 Cheung HY, Chung CC, Kwok SY et al. Improvement in colonoscopy performance with adjunctive magnetic endoscope imaging: a randomized controlled trial. Endoscopy 2006; 38: 214-217
• 25 Dechêne A, Jochum C, Bechmann LP et al. Magnetic endoscopic imaging saves abdominal compression and patient pain in routine colonoscopies. J Dig Dis 2011; 12: 364-370
• 26 Ignjatovic A, Thomas-Gibson S, Suzuki N et al. Does scope guide improve caecal intubation? A randomized controlled trial. Gastrointest Endosc 2011; 73: AB307
• 27 Singla S, Keller D, Thirunavukarasu P et al. Splenic injury during colonoscopy – a complication that warrants urgent attention. J Gastrointest Surg 2012; 16: 1225-1234