Becker's ASC Review

12 EXECUTIVE BRIEFING 1 EXECUTIVE BRIEFING 1 Haeffele P. What leaders are saying about colonoscopies. Becker's ASC Review. https://www.beckersasc.com/gastroenterology-and- endoscopy/what-leaders-are-saying-about-colonoscopies.html. Published July 9, 2024. Accessed August 7, 2024. 2 Zauber AG, Winawer SJ, O'Brien MJ, Lansdorp-Vogelaar I, van Ballegooijen M, Hankey BF, Shi W, Bond JH, Schapiro M, Panish JF, Stewart ET, Waye JD. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012 Feb 23;366(8):687-96. doi: 10.1056/NEJMoa1100370. PMID: 22356322; PMCID: PMC3322371. 3 Cleveland Clinic Research Reveals Unique Tumor-Related Bacteria Tied to Young-Onset Colorectal Cancer. Cleveland Clinic. https://newsroom.clevelandclinic.org/2024/02/05/cleveland-clinic-research-reveals-unique-tumor-related-bacteria-tied-to-young-onset- colorectal-cancer. Published February 5, 2024. Accessed August 7, 2024. 4 Zhang C, Cheng X, Chen H, Hu Y, Wang Y & Wu Z. (2019). Magnitude, Risk Factors, and Factors Associated With Adenoma Miss Rate of Tandem Colonoscopy: A Systematic Review and Meta-analysis. Gastroenterology. 2019 Feb 6; 156(6), 1651-1664. doi: 10.1053/j.gastro.2019.02.034 I ncreased demand for colonoscopies has prompted healthcare leaders to hone preventive screening, service delivery and innovation strategies in recent years. 1 While the detection of polyps during colonoscopies can reduce mortality, 2 precancerous lesions are often minuscule and easy to miss when using conventional endoscopic screening technology. Olympus is working to improve endoscopic screening with two novel tools that can improve detection of precancerous polyps while improving the ease of operations for clinicians. Becker's Healthcare recently spoke with Noel Martins, MD, Division Chief of Gastroenterology at St. Luke's University Health Network (Bethlehem, PA), and Davinderbir Pannu, MD, Director of Endoscopy unit at McLeod Digestive Health Center (Florence, SC), about challenges they have faced in detecting polyps and the benefits of Olympus' innovative technologies. Main themes from the conversation are summarized below. New, advanced tools help physicians address operational challenges in colonoscopy Colonoscopy is a common, well-established procedure used to detect precancerous polyps — the most common of which are called adenomas and can progress to colorectal cancer. A healthcare provider's adenoma detection rate (ADR) measures the rate at which endoscopists identify such polyps during colonoscopy in their patient population. Given the notable increase in colon cancer rates in recent years, especially among people younger than age 50, 3 increasing the ADR is critical to catching potential problems early, preventing complications and reducing mortality. While colonoscopies are considered relatively simple screening procedures, they are not without challenges. The most pressing clinical challenges include maintaining and improving the quality of the exam, decreasing the incidence of missed lesions, improving the ADR and performing a complete endoscopic mucosal resection to remove abnormal tissues from the lining of the colon. If endoscopists have difficulty maneuvering the colonoscope to visualize the front and back of each fold in the colon, they may miss polyps, Dr. Martins noted, and the consequences of that may be dangerous. "Those missed polyps could continue to grow and turn into cancer before the next colonoscopy is performed," he said. Such challenges can be addressed if endoscopists have better visualization and scope control than what conventional technology affords. Two innovative technologies offered by Olympus — the ENDOCUFF VISION ™ device and Texture and Color Imaging (TXI ™ ) technology — bring the clarity and operational flexibility that physicians need. These tools are complementary, and both have been shown to help increase the endoscopist's ADR. The ENDOCUFF VISION device is a distal attachment for the colonoscope that increases mucosal exposure by flattening mucosal folds, whereas TXI technology is a post-processing feature on Olympus' EVIS X1 ™ CV-1500 video system center that enhances an image's texture, color contrast and brightness. When used in combination, they allow the user to increase mucosal exposure and see more detail of the exposed mucosa. "I find several advantages to using the ENDOCUFF VISION device, including my ability to visualize behind folds using the fingers of the device to slow the withdrawal and decrease the tendency of the scope to fall back in difficult areas," Dr. Pannu said. "Enhancing the exam further with TXI [technology] has been the icing on the cake." Dr. Pannu described how using these tools in tandem has proven helpful, as well. "A major benefit of using these technologies in combination is that the ENDOCUFF VISION device allows you to anchor in one place, giving TXI [technology] a few seconds for image processing of the segment of colon being examined," he said. The ENDOCUFF VISION device and TXI technology may assist physicians in finding more precancerous polyps — thereby benefiting patients Improving ADR is one of the main goals of colonoscopy, yet a systematic review and meta-analysis has shown that up to 26% of adenomas are missed with standard colonoscopy. 4 Improving polyp detection in colonoscopy: How two physician leaders are driving ADR with innovation " I find several advantages to using the ENDOCUFF VISION device, including my ability to visualize behind folds using the fingers of the device…. Enhancing the exam further with TXI [technology] has been the icing on the cake." Dr. Davinderbir Pannu

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