Comparison of adenoma detection and miss rates between a novel balloon colonoscope and standard colonoscopy: a randomized tandem study

Background and study aims: Although colonoscopy is the "gold standard" for colorectal cancer screening, a significant number of adenomas are still missed during standard colonoscopy, often because they are hidden behind colonic folds and flexures. The aim of this study was to assess the ability of a novel balloon colonoscope (G-EYE endoscope; Smart Medical Systems, Ra'anana, Israel) to increase adenoma detection and reduce the miss rate compared with standard colonoscopy. Patients and methods: This was a multicenter, randomized, prospective, controlled study in patients (age= 40 years) undergoing colonoscopy for screening or diagnostic work-up (including surveillance). Patients underwent same-day, back-to-back tandem colonoscopy. Patients in Group A underwent standard colonoscopy followed by balloon colonoscopy, and patients in Group B underwent balloon colonoscopy followed by the standard technique. The adenoma detection and miss rates were compared between the two colonoscopy procedures. Results: A total of 126 patients were enrolled and randomized into Group A (n=60) or Group B (n= 66). The adenoma miss rate of balloon colonoscopy was significantly lower than that of standard colonoscopy (7.5% vs. 44.7 %; P= 0.0002). The detection of additional adenomas by balloon colonoscopy was significant (81.0 %; P= 0.0002), in particular, the relative amount of adenomas detected in the ascending colon by balloon colonoscopy was 41% versus 14% for standard colonoscopy. Conclusions: A novel balloon colonoscopy technique detected significantly more adenomas than standard colonoscopy, and missed fewer adenomas. Balloon colonoscopy has the potential to increase the effectiveness of colorectal cancer screening and surveillance colonoscopy.