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Full-spectrum (FUSE) versus standard forward-viewing colonoscopy in an organised colorectal cancer screening programme
  1. Cesare Hassan1,
  2. Carlo Senore2,
  3. Franco Radaelli3,
  4. Giovanni De Pretis4,
  5. Romano Sassatelli5,
  6. Arrigo Arrigoni6,
  7. Gianpiero Manes7,
  8. Arnaldo Amato3,
  9. Andrea Anderloni8,
  10. Franco Armelao4,
  11. Alessandra Mondardini6,
  12. Cristiano Spada9,
  13. Barbara Omazzi7,
  14. Maurizio Cavina5,
  15. Gianni Miori4,
  16. Chiara Campanale9,
  17. Giuliana Sereni5,
  18. Nereo Segnan2,
  19. Alessandro Repici8,10
  1. 1Endoscopy Unit, Ospedale Nuovo Regina Margherita, Rome, Italy
  2. 2AOU Città della Salute e della Scienza, CPO Piemonte, Turin, Italy
  3. 3Endoscopy Unit, Ospedale Valduce, Como, Italy
  4. 4Endoscopy Unit, Ospedale S Chiara, Trento, Italy
  5. 5Endoscopy Unit, Ospedale ASMN Reggio Emilia, Reggio Emilia, Italy
  6. 6AOU Città della Salute e della Scienza di Torino, SC Gastroenterologia U, Endoscopia Presidio S.Giovanni A.S., Torino, Italy
  7. 7Endoscopy Unit, ASST-Rhodense, Garbagnate Milanese e Rho, Milan, Italy
  8. 8Digestive Endoscopy Unit, Humanitas Research Hospital, Milan, Italy
  9. 9Endoscopy Unit, Catholic University, Rome, Italy
  10. 10Digestive Endoscopy Unit, Humanitas Unversity, Milan, Italy
  1. Correspondence to Dr Carlo Senore, Center for Epidemiology and Prevention in Oncology, CPO Piedmont, University Hospital ‘Città della Salute e della Scienza di Torino’, Turin 10123, Italy; carlo.senore{at}


Objective Miss rate of polyps has been shown to be substantially lower with full-spectrum endoscopy (FUSE) compared with standard forward-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.

Methods 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).

Results 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).

Conclusions 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.

Trial registration number ISRCTN10357435.


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