Colonoscopy is considered the “gold standard” for detecting cancers and pre-cancerous polyps called “adenomas” in the colon. However, colonoscopy is not perfect, and even under the best of circumstances, standard colonoscopy misses many adenomas,1-3 including larger lesions that are more likely to transform into cancer.4,5 Due in part to such missed lesions, 7% to 14% of all cases of CRC in the U.S. are “interval cancers” that are found within a few years after the patient has had a colonoscopy.6-8
Approximately 2/3 of adenomas that are missed are located behind folds in the wall of the colon,9 where they are very difficult to detect with the forward-viewing colonoscope. Avantis was one of the first companies to focus on improving visualization behind folds and flexures (tight turns), areas where adenomas often hide and are difficult to see.
Avantis recently launched its newest generation product, the Third Eye® Panoramic™ device, which is a wide-angle visualization tool designed to provide gastroenterologists and other endoscopists a better look at areas where cancers and pre-cancerous polyps may be hidden from the view of a traditional colonoscope alone, such as behind folds and flexures.
1. Rex DK, Cutler CS, Mark DG, et al. Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology 1997;112:24-8.
2. Van Rijn JC, Reitsma JB, Dekker E, et al. Polyp Miss Rate Determined by Tandem Colonoscopy: A Systemic Review. Am J Gastroenterol 2006;101:343-50.
3. Heresbach D, Barrioz T, Ponchon T, et al. Miss rate for colorectal neoplastic polyps: a prospective multicenter study of back-to-back video colonoscopies. Endoscopy 2008;40:284-90.
4. Hewett DG, Rex DK. Miss rate of right-sided colon examination during colonoscopy defined by retroflexion: an observational study. Gastrointest Endosc 2011;74:246-52.
5. Siersema PD, Rastogi A, DeMarco DC, et al. Retrograde viewing device improves adenoma detection rate in colonoscopies for surveillance and diagnostic workup. World J Gastroenterol 2012;18:3400-8.
6. Cooper GS, Xu F, Barnholtz-Sloan JS, et al. Prevalence and Predictors of Interval Colorectal Cancers in Medicare Beneficiaries. Cancer 2012;118:3044-52.
7. Robertson DJ, Lieberman DA, Winawer SJ, et al. Interval Cancer After Total Colonoscopy: Results from a Pooled Analysis of Eight Studies. Gastroenterology 2008;134:A111-2.
8. Goyal J, Feldman PA. Prevalence and Characteristics of Patients Diagnosed with Interval Colorectal Cancer: The Miami Veterans Affairs Medical Center Experience. World Congress of Gastroenterology at American College of Gastroenterology 2017 Meeting Abstract No. P1813.
9. Pickhardt PJ, Nugent PA, Mysliwiec PA, et al. Location of adenomas missed by optical colonoscopy. Ann Intern Med 2004;141:352-9.
Modern colonoscopes are high-quality instruments with outstanding optics and excellent handling characteristics. However, they contain a single video camera with an angle of view ranging from 140° to 170°, and this limits their ability to see behind folds and flexures.
With the Third Eye Panoramic device, there are now two side-viewing cameras that supplement the colonoscope’s forward view to create a panoramic video image (approximately 330°) that reveals areas behind folds and flexures. The device works with all standard adult or pediatric colonoscopes from the three major manufacturers, so endoscopists can continue using the scopes that they prefer.
How It Works
The slim, sleek Third Eye Panoramic device is attached to the tip of the colonoscope prior to beginning the procedure. The examination technique is identical to standard colonoscopy except that the endoscopist now has superior visualization.
The Third Eye Panoramic device connects to a video processing unit that enables the left, middle and right images to be viewed on a single flat panel video monitor.
Our device can be used with standard colonoscopes manufactured by Olympus®, Pentax®and Fujinon® in both adult and pediatric sizes.* The device is resposable, which means it can be cleaned and reused multiple times prior to disposal, offering up to 100 cost-effective enhanced screenings with just one unit.
These 3 brief video clips from a single procedure show detection of 5 adenomas located behind folds, where the endoscopist could not see them with the colonoscope until he first found them in the Third Eye Panoramic device’s left lateral view and then used the tip of the colonoscope or a snare to roll back the edges of the folds.
00:02 – The left lateral camera of the Panoramic device reveals 2 polyps that are located behind a fold that hides them from the forward view of the colonoscope’s camera.
00:12 – Deflection of the tip of the colonoscope to the extreme left allows the endoscopist to roll back the edge of the fold so he can see and remove the polyps.
00:15 – A much more subtle polyp appears in the 11 o’clock position in the left lateral camera’s view, so the endoscopist again reaches behind the fold to view the polyp with the colonoscope’s camera.
00:35 – The left lateral camera reveals a polyp hidden between 2 folds that are close together. Because he wasn’t able to get the tip of the colonoscope between the folds, we see that he has inserted a snare and is using the tip of its sheath to push back the fold, revealing a second smaller polyp.
01:04 – The endoscopist extends the snare beyond the sheath and performs a polypectomy.
* Olympus® is a registered trademark of Olympus Corporation (Tokyo, Japan), Olympus America Inc. or their affiliated entities.
Fujinon® is a registered trademark of Fujifilm Corporation.
Pentax® is a registered trademark of Pentax Medical, a division of HOYA Group.