High-definition colonoscopy for improving adenoma detection: a systematic review and meta-analysis of randomized controlled studies

Abstract

Background and Aims: Previous meta-analysis showed marginal benefit of high-definition white-light endoscopy (HD-WLE) over standard-definition colonoscopy (SDC) for adenoma detection, but with residual uncertainty due to inclusion of nonrandomized studies. We aimed to further assess the effect of HD-WLE on adenoma detection by including only randomized controlled trials (RCTs). Methods: A literature search was performed for RCTs evaluating HD-WLE versus SDC in terms of adenoma, advanced adenoma, and serrated sessile adenoma detection rates as well as the mean number of adenomas per colonoscopy (MAC), the mean number of advanced adenomas per colonoscopy (MAAC), and the mean number of sessile serrated adenomas per colonoscopy (MSSAC). The effect size on study outcomes is presented as the risk ratio (RR; 95% confidence interval [CI]) or mean difference (MD; 95% CI). We assessed the strength of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: Six RCTs involving 4594 individuals (HD-WLE, 2323; SDC, 2271) were included. Clinical indications were screening (1 study), positive result for fecal occult blood test, personal/family history of colorectal cancer (1 study), and mixed indications (4 studies). Withdrawal time was similar between the 2 arms (MD, À0.06; 95% CI, À0.25 to 0.12; P Z .50). The adenoma detection rate was significantly higher in the HD-WLE arm compared with the SDC arm (40% vs 35%; RR, 1.13; 95% CI, 1.05-1.22; P Z .001; I 2 Z 0%; GRADE, low). This effect was consistent for advanced and sessile serrated adenoma detection rates (

Implementation and results of a gastrointestinal cancer screening program in an Amazon rainforest village: A descriptive study

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AGA Clinical Practice Update on Strategies to Improve Quality of Screening and Surveillance Colonoscopy: Expert Review

“…A recent meta-analysis of randomized controlled trials confirms a definite, but modest, impact on adenoma, serrated polyp, and advanced adenoma detection rates with the use of high-definition colonoscopes. 35 Although high-definition imaging is now a standard feature of newergeneration endoscopes, many legacy lower-definition instruments still remain in circulation. Available evidence suggests that upgrading older equipment to high-definition colonoscopes is likely an effective strategy for endoscopy units to improve the quality of screening and surveillance colonoscopy.…”

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“…190 The use of high definition scopes over standard definition has been shown to help in adenoma detection and is now being preferred at many facilities. 191 Chromoendoscopy (use of dyes) in increasing detection of polyps has been studied the screening population with some benefit. 192 Most studies, however, compared chromoendoscopy with standard definition scopes and not high definition colonoscopy, which is currently the standard for use in screening colonoscopy.…”