Back-to-Back Comparison of Auto-Fluorescence Imaging (AFI) Versus High Resolution White Light Colonoscopy for Adenoma Detection

Abstract

BackgroundSome patients under close colonoscopic surveillance still develop colorectal cancer, thus suggesting the overlook of colorectal adenoma by endoscopists. AFI detects colorectal adenoma as a clear magenta, therefore the efficacy of AFI is expected to improve the detection ability of colorectal adenoma. The aim of this study is to determine the efficacy of AFI in detecting colorectal adenoma.MethodsThis study enrolled 88 patients who underwent colonoscopy at Asahikawa Medical University and Kushiro Medical Association Hospital. A randomly selected colonoscopist first observed the sigmoid colon and rectum with conventional high resolution endosopy (HRE). Then the colonoscopist changed the mode to AFI and handed to the scope to another colonoscopist who knew no information about the HRE. Then the second colonoscopist observed the sigmoid colon and rectum. Each colonoscopist separately recorded the findings. The detection rate, miss rate and procedural time were assessed in prospective manner.ResultsThe detection rate of flat and depressed adenoma, but not elevated adenoma, by AFI is significantly higher than that by HRE. In less-experienced endoscopists, AFI dramatically increased the detection rate (30.3%) and reduced miss rate (0%) of colorectal adenoma in comparison to those of HRE (7.7%, 50.0%), but not for experienced endoscopists. The procedural time of HRE was significantly shorter than that of AFI.ConclusionsAFI increased the detection rate and reduced the miss rate of flat and depressed adenomas. These advantages of AFI were limited to less-experienced endoscopists because experienced endoscopists exhibited a substantially high detection rate for colorectal adenoma with HRE.

Endoscopic Improvement of the Adenoma Detection Rate during Colonoscopy - Where Do We Stand in 2015?

“…Two consecutive same-day colonoscopies were performed in a total of 183 patients and the overall miss rate for adenomas was 24% showing superiority in adenoma detection by back-to-back colonoscopy. This technique is now often used in studies comparing new endoscopic devices for adenoma detection improvement to overcome the lack of study blinding [59,60,61,62]. In another large multicenter study conducted in 2008 by Heresbach et al [63] with same-day back-to-back video colonoscopy done by 2 different operators in a randomized order and blinded to the other examination, 20% of adenomas that were missed at first colonoscopy could additionally be detected.…”

Screening colonoscopy: What is the most reliable modality for the detection and characterization of colorectal lesions?

“…42, 43 We previously reported the usefulness of AFI for the detection of colon polyps compared with conventional high-definition white light, a prospective study based on a single center. 44 In this pilot study, the miss rate for all polyps with AFI (30%) was significantly less than that with conventional high-definition white light (49%) (P = 0.01).…”

The efficacy of autofluorescence imaging in the diagnosis of colorectal diseases

“…We compared the rates at which experienced and less-experienced endoscopists detected adenomas using AFI and conventional high-resolution endoscopy (HRE). Among less-experienced endoscopists (but not experienced endoscopists), AFI was found to dramatically increase the detection rate (30.3 %) and reduce the miss rate (0 %) of colorectal adenoma in comparison to HRE (7.7, 50.0 %) [20]. McCallum et al compared the detection rates in 54 adenomatous polyps, including 32 tubular polyps, four villous polyps, and 18 tubulovillous polyps (median size, 4 mm) using AFI and WLE.…”

“…Some studies have proposed the efficacy of AFI for detecting colorectal neoplasms [10,[20][21][22]. Matsuda et al reported a study in which a single experienced endoscopist conducted back-to-back colonoscopies of the right-sided colon using AFI and WLE.…”