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Endoscopy 2019; 51(03): 237-243
DOI: 10.1055/a-0755-7471
Original article
© Georg Thieme Verlag KG Stuttgart · New York

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

Philip Roelandt
1   Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
2   Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
,
Ingrid Demedts
1   Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
2   Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
,
Hilde Willekens
1   Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
,
Talat Bessissow
1   Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
,
Lieve Braeye
1   Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
,
Georges Coremans
1   Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
2   Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
,
Pieter-Jan Cuyle
1   Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
,
Marc Ferrante
1   Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
2   Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
,
Anne-Marie Gevers
1   Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
,
Martin Hiele
1   Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
2   Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
,
Maggy Osselaer
1   Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
,
Jan Tack
1   Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
2   Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
,
Sabine Tejpar
1   Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
3   Department of Oncology, KU Leuven, Leuven, Belgium
,
Marijke Ulenaers
1   Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
,
Gert Van Assche
1   Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
2   Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
,
Eric Van Cutsem
1   Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
3   Department of Oncology, KU Leuven, Leuven, Belgium
,
Stijn Van Gool
1   Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
,
Jaarke Vannoote
1   Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
,
Severine Vermeire
1   Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
2   Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
,
Raf Bisschops
1   Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
2   Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
› Author AffiliationsTRIAL REGISTRATION: Diagnostic interventional randomized (parallel assignment) single-center trial NCT03243669 at clinicaltrials.gov
Further Information

Publication History

submitted 18 February 2018

accepted after revision 25 September 2018

Publication Date:
15 January 2019 (online)

Also available at
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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.

Fig. e1, Table e3, e5–e7

Refers to:

All endoscopes are equal, but some are more equal than othersEndoscopy 2019; 51(03): 217-218
DOI: 10.1055/a-0829-6426

Refers to:

Video Comment on Philip Roelandt et al.Endoscopy 2019; 51(03): v3-v3
DOI: 10.1055/a-0832-5851

 

  • References

  • 1 van Rijn JC, Reitsma JB, Stoker J. et al. Polyp miss rate determined by tandem colonoscopy: a systematic review. Am J Gastroenterol 2006; 101: 343-350
    CrossrefPubMedSearch in Google Scholar
  • 2 Bressler B, Paszat LF, Chen Z. et al. Rates of new or missed colorectal cancers after colonoscopy and their risk factors: a population-based analysis. Gastroenterology 2007; 132: 96-102
    CrossrefPubMedSearch in Google Scholar
  • 3 Mandel JS, Bond JH, Church TR. et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med 1993; 328: 1365-1371
    CrossrefPubMedSearch in Google Scholar
  • 4 Hardcastle JD, Chamberlain JO, Robinson MH. et al. Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet 1996; 348: 1472-1477
    CrossrefPubMedSearch in Google Scholar
  • 5 Kronborg O, Fenger C, Olsen J. et al. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet 1996; 348: 1467-1471
    CrossrefPubMedSearch in Google Scholar
  • 6 Kaminski MF, Wieszczy P, Rupinski M. et al. Increased rate of adenoma detection associates with reduced risk of colorectal cancer and death. Gastroenterology 2017; 153: 98-105
    CrossrefPubMedSearch in Google Scholar
  • 7 Gono K. Narrow band imaging: technology basis and research and development history. Clin Endosc 2015; 48: 476-480
    CrossrefPubMedSearch in Google Scholar
  • 8 Parra-Blanco A, Jiménez A, Rembacken B. et al. Validation of Fujinon intelligent chromoendoscopy with high definition endoscopes in colonoscopy. World J Gastroenterol 2009; 15: 5266-5273
    CrossrefPubMedSearch in Google Scholar
  • 9 Kodashima S, Fujishiro M. Novel image-enhanced endoscopy with i-scan technology. World J Gastroenterol 2010; 16: 1043-1049
    CrossrefPubMedSearch in Google Scholar
  • 10 Nagorni A, Bjelakovic G, Petrovic B. Narrow band imaging versus conventional white light colonoscopy for the detection of colorectal polyps. Cochrane Database Syst Rev 2012; 1: CD008361
    PubMedSearch in Google Scholar
  • 11 Pasha SF, Leighton JA, Das A. et al. Comparison of the yield and miss rate of narrow band imaging and white light endoscopy in patients undergoing screening or surveillance colonoscopy: a meta-analysis. Am J Gastroenterol 2012; 107: 363-370
    CrossrefPubMedSearch in Google Scholar
  • 12 Omata F, Ohde S, Deshpande GA. et al. Image-enhanced, chromo, and cap-assisted colonoscopy for improving adenoma/neoplasia detection rate: a systematic review and meta-analysis. Scand J Gastroenterol 2014; 49: 222-237
    CrossrefPubMedSearch in Google Scholar
  • 13 East JE, Vleugels JL, Roelandt P. et al. Advanced endoscopic imaging: European Society of Gastrointestinal Endoscopy (ESGE) Technology Review. Endoscopy 2016; 48: 1029-1045
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Lai EJ, Calderwood AH, Doros G. et al. The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research. Gastrointest Endosc 2009; 69: 620-625
    CrossrefPubMedSearch in Google Scholar
  • 15 Snover D, Ahnen D, Burt R. et al. Serrated polyps of the colon and rectum and serrated polyposis. In: Bosman F, Carneiro F, Hruban R, Theise N. WHO classification of tumours of the digestive system. 4th Edn, Lyon: International Agency for Research on Cancer; 2010: 160-165
    Search in Google Scholar
  • 16 Do A, Weinberg J, Kakkar A. et al. Reliability of adenoma detection rate is based on procedural volume. Gastrointest Endosc 2013; 77: 376-380
    CrossrefPubMedSearch in Google Scholar
  • 17 Barclay RL, Vicari JJ, Doughty AS. et al. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med 2006; 355: 2533-2541
    CrossrefPubMedSearch in Google Scholar
  • 18 Shaukat A, Rector TS, Church TR. et al. Longer withdrawal time is associated with a reduced incidence of interval cancer after screening colonoscopy. Gastroenterology 2015; 149: 952-957
    CrossrefPubMedSearch in Google Scholar
  • 19 Jover R, Zapater P, Bujanda L. et al. Endoscopist characteristics that influence the quality of colonoscopy. Endoscopy 2016; 48: 241-247
    Thieme ConnectPubMedSearch in Google Scholar
  • 20 Lee CK, Cha JM, Kim WJ. Endoscopist fatigue may contribute to a decline in the effectiveness of screening colonoscopy. J Clin Gastroenterol 2015; 49: e51-56
    CrossrefPubMedSearch in Google Scholar
  • 21 Oh CH, Lee CK, Kim JW. et al. Suboptimal bowel preparation significantly impairs colonoscopic detection of non-polypoid colorectal neoplasms. Dig Dis Sci 2015; 60: 2294-2303
    CrossrefPubMedSearch in Google Scholar
  • 22 Subramanian V, Mannath J, Hawkey CJ. et al. High definition colonoscopy vs. standard video endoscopy for the detection of colonic polyps: a meta-analysis. Endoscopy 2011; 43: 499-505
    PubMedSearch in Google Scholar
  • 23 Gómez V, Racho RG, Heckman MG. et al. High-definition white-light (HDWL) colonoscopy and higher adenoma detection rate and the potential for paradoxical over surveillance. Dig Dis Sci 2014; 59: 2749-2756
    CrossrefPubMedSearch in Google Scholar
  • 24 Klare P, Haller B, Wormbt S. et al. Narrow-band imaging vs. high definition white light for optical diagnosis of small colorectal polyps: a randomized multicenter trial. Endoscopy 2016; 48: 909-915
    Thieme ConnectPubMedSearch in Google Scholar
  • 25 Pontone S, Hassan C, Maselli R. et al. Multiple, zonal and multi-zone adenoma detection rates according to quality of cleansing during colonoscopy. United European Gastroenterol J 2016; 4: 778-783
    CrossrefPubMedSearch in Google Scholar
  • 26 von Renteln D, Robertson DJ, Bensen S. et al. Prolonged cecal insertion time is associated with decreased adenoma detection. Gastrointest Endosc 2017; 85: 574-580
    CrossrefPubMedSearch in Google Scholar
  • 27 Kahi CJ, Li X, Eckert GJ. et al. High colonoscopic prevalence of proximal colon serrated polyps in average-risk men and women. Gastrointest Endosc 2012; 75: 515-520
    CrossrefPubMedSearch in Google Scholar
  • 28 Kamiński MF, Hassan C, Bisschops R. et al. Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2014; 46: 435-449
    Thieme ConnectPubMedSearch in Google Scholar
  • 29 Bisschops R, Tejpar S, Willekens H. et al. Virtual chromoendoscopy (I-SCAN) detects more polyps in patients with Lynch syndrome: a randomized controlled crossover trial. Endoscopy 2017; 49: 342-350
    Thieme ConnectPubMedSearch in Google Scholar
  • 30 Rembacken B, Hassan C, Riemann JF. et al. Quality in screening colonoscopy: position statement of the European Society of Gastrointestinal Endoscopy (ESGE). Endoscopy 2012; 44: 957-968
    Thieme ConnectPubMedSearch in Google Scholar
  • 31 Kaminski MF, Thomas-Gibson S, Bugajski M. et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2017; 49: 378-397
    Thieme ConnectPubMedSearch in Google Scholar
  • 32 Rex DK, Schoenfeld PS, Cohen J. et al. Quality indicators for colonoscopy. Gastrointest Endosc 2015; 81: 31-53
    CrossrefPubMedSearch in Google Scholar
  • 33 Vavricka SR, Sulz MC, Degen L. et al. Monitoring colonoscopy withdrawal time significantly improves the adenoma detection rate and the performance of endoscopists. Endoscopy 2016; 48: 256-262
    Thieme ConnectPubMedSearch in Google Scholar
  • 34 Øines M, Helsingen LM, Bretthauer M. et al. Epidemiology and risk factors of colorectal polyps. Best Pract Res Clin Gastroenterol 2017; 31: 419-424
    CrossrefPubMedSearch in Google Scholar
  • 35 Anderson JC, Weiss JE, Robinson CM. et al. Adenoma detection rates for screening colonoscopies in smokers and obese adults: data from the New Hampshire Colonoscopy Registry. J Clin Gastroenterol 2017; 51: e95-e100
    CrossrefPubMedSearch in Google Scholar