Thématique :
- Endoscopie/Imagerie
Originalité :
Très original
Solidité :
Très solide
Doit faire évoluer notre pratique :
Nom du veilleur :
Docteur Edouard Chabrun
Coup de coeur :
  2017 Nov;66(11):1949-1955.  
  doi: 10.1136/gutjnl-2016-311906.  
  Full-spectrum (FUSE) versus standard forward-viewing colonoscopy in an organised colorectal cancer screening programme.  
  Hassan C, Senore C, Radaelli F, De Pretis G, Sassatelli R, Arrigoni A, Manes G, Amato A, Anderloni A, Armelao F, Mondardini A, Spada C, Omazzi B, Cavina M, Miori G, Campanale C, Sereni G, Segnan N, Repici A  



Miss rate of polyps has been shown to be substantially lower with full-spectrum endoscopy (FUSE) compared with standardforward-viewing (SFV) colonoscopy in a tandem study at per polyp analysis. However, there is uncertainty on whether FUSE is also associated with a higher detection rate of colorectal neoplasia, especially advanced lesions, in per patient analysis.


Consecutive subjects undergoing colonoscopy following a positive faecal immunochemical test (FIT) by experienced endoscopists and performed in the context of a regional colorectal cancer population-screening programme were randomised between colonoscopy with either FUSE or SFV colonoscopy in seven Italian centres. Randomisation was stratified by gender, age group and screening history. Primary outcomes included detection rates of advanced adenomas (A-ADR), adenomas (ADR) and sessile-serrated polyps (SSPDR).


Of 741 eligible subjects, 658 were randomised to either FUSE (n=328) or SFV (n=330) colonoscopy and included in the analysis. Overall, 293/658 and 143/658 subjects had at least one adenoma (ADR 44.5%) and advanced adenoma (A-ADR 21.7%), respectively, while SSP was the most advanced lesion in 18 cases (SSPDR 2.7%). ADR and A-ADR were 43.6% and 19.5% in the FUSE arm, and 45.5% and 23.9% in the SFV arm, with no difference for both ADR (OR for FUSE: 0.96, 95% CI 0.81 to 1.14) and A-ADR (OR for FUSE: 0.82, 95% CI 0.61 to 1.09). No difference in SSPDR or multiplicity was detected between the two arms. In the per polyp analysis, the mean number of adenomas and proximal adenomas per patient was 0.81±1.25 and 0.47±0.93 in the FUSE arm, and 0.85±1.33 and 0.48±0.96 in the SFV colonoscopy arm (p=NS for both comparisons).


No statistically significant difference in ADR and A-ADR between FUSE and SFV colonoscopy was detected in a per patient analysis in FIT-positive patients.




Question posée
Le coloscope FUSE (Full Spectrum Endoscopy) fait-il mieux que le coloscope standard pour le taux de détection des adénomes (TDA) dans une population ayant une test FIT positif ?
Question posée
Etude randomisée multicentrique italienne. 328 patients ont eu une coloscopie avec le FUSE et 330 avec un coloscope standard. Il n’y avait aucune différence significative entre les deux techniques avec un TDA de 43.6% pour le FUSE et 45.5% pour le standard.

La technique FUSE n’améliore pas le TDA chez les patients ayant un test FIT positif.