Impact of endoscopy system, high definition, and virtual chromoendoscopy in daily routine colonoscopy: a randomized trial

Abstract

Background To improve detection of mucosal lesions during colonoscopy a number of imaging modalities have been suggested, including high definition and virtual chromoendoscopy. Given the theoretical advantage of these new imaging techniques, we aimed to investigate their use for the detection of polyps in patients referred for colonoscopy in a large tertiary hospital. Methods Demographic, endoscopic, and histological data from 1855 consecutive patients undergoing colonoscopy were collected prospectively. Patients were randomly assigned to three endoscopy systems (Fujinon, Olympus, or Pentax) in combination with four modalities: conventional white-light colonoscopy (n = 505), high definition white-light colonoscopy (n = 582), virtual chromoendoscopy (n = 285) and high definition virtual chromoendoscopy (n = 483). Results The mean adenoma detection rate (ADR) was 34.9 %, and the adenoma per colonoscopy rate (APCR) was 2.1. No significant differences were noted between the three endoscopy systems. Moreover, no differences in ADR or APCR were observed between the four imaging modalities. High definition white-light colonoscopy resulted in a significantly higher detection of sessile serrated adenomas (8.2 % vs. 3.8 %; P < 0.01) and adenocarcinomas (2.6 % vs. 0.5 %; P < 0.05) compared with the conventional procedure. Conclusions No significant differences in ADR or APCR between different endoscopy systems, high definition, and/or virtual chromoendoscopy could be observed in routine colonoscopies in the general population. High definition endoscopy was associated with a significantly higher detection rate of serrated adenomas and adenocarcinomas.

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

“…Thus, 11 articles were considered eligible for full-text assessment. Among these, a further 5 were excluded for various reasons, leaving 6 studies [11][12][13][14][15][16] to be included in the systematic review and meta-analysis. A flowchart of the selection process is shown in Figure 1.…”

Optimal Endoscopic Treatment and Surveillance of Serrated Polyps

“…14 They are more common in the right side of colon where less good preparation can make detection challenging. Detection can be improved by withdrawing slowly, using high definition colonoscope 15 and chromoendoscopy (dye spray) ( Table 1). [16][17][18] Some early data suggests the use of Endocuff may support SSL (SSA/ P) detection with a 15% detection rate with Endocuff versus a 3% rate with standard colonoscopy (p=0.001).…”

Distal attachments for adenoma detection go head‐to‐head: Cap or cuff?

“…16.9%), although statistically not significant, and the low rate of serrated lesions detected in this study. Serrated lesion detection can be enhanced by use of high definition colonoscopes and dye‐based chromoendoscopy and neither were applied consistently in this study. The value of distal cap attachments for detection of serrated polyps outside of polyposis syndromes remains unclear.…”

“…The study is welcome in that direct RCT comparisons of endoscopic devices are rare in endoscopic research but are a superior method to network metanalysis and should increasingly be the gold‐standard method by which we assess novel technology in endoscopy …”

“…The study is welcome in that direct RCT comparisons of endoscopic devices are rare in endoscopic research 5,6 but are a superior method to network metanalysis and should increasingly be the gold-standard method by which we assess novel technology in endoscopy. 7 The study was however carried out in an academic setting with a high level of endoscopic expertise and where TAC use in routine colonoscopy is standard care.…”