Background and study aims: High definition colonoscopy may improve adenoma detection rates but studies report
conflicting results. The aim of this meta-analysis was to compare the diagnostic yield
of colonic polyps between high definition colonoscopy and standard video endoscopy
(SVE).
Methods: Various electronic databases were searched for articles reporting on high definition
colonoscopy. The pooled incremental yield and pooled weighted mean difference of high
definition colonoscopy over SVE for polyp detection was determined.
Results: Five studies involving 4422 patients provided data on the total number of polyps
detected. The incremental yield of high definition colonoscopy for the detection of
any polyp was 3.8 % (95 % confidence interval [CI] 1 % – 6.7 %) with a number needed
to treat (NNT) of 26. For the detection of adenomatous polyps the incremental yield
was 3.5 % (95 %CI 0.9 % – 6.1 %) with an NNT of 28. There were no differences between
high definition and SVE in the detection of high risk adenomas, with an incremental
yield of –0.1 % (95 %CI –1.7 % to 1.6 %). When grouped according to the overall adenoma
detection rate of the studies (> 50 % or < 50 %) the pooled weighted mean difference
in small adenoma detection was better with high definition colonoscopy (P = 0.035).
Conclusions: There were marginal differences between high definition colonoscopy and SVE for the
detection of colonic polyps/adenomas. High definition colonoscopy did not improve
the detection of high risk adenomas. Due to differences in the adenoma detection rate
between the studies and the nonrandomized study design of three of the five studies,
these results need to be interpreted with caution. Prospective randomized trials looking
at long term outcomes such as rates of interval or missed cancers are needed to clarify
the clinical implications.
References
- 1
Citarda F, Tomaselli G, Capocaccia R et al.
Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal
cancer incidence.
Gut.
2001;
48
812-815
- 2
Muller A D, Sonnenberg A.
Prevention of colorectal cancer by flexible endoscopy and polypectomy. A case-control
study of 32,702 veterans.
Ann Intern Med.
1995;
123
904-910
- 3
Winawer S J, Zauber A G, O'brien M J et al.
Randomized comparison of surveillance intervals after colonoscopic removal of newly
diagnosed adenomatous polyps. The National Polyp Study Workgroup.
N Engl J Med.
1993;
328
901-906
- 4
van Rijn J C, Reitsma J B, Stoker J et al.
Polyp miss rate determined by tandem colonoscopy: a systematic review.
Am J Gastroenterol.
2006;
101
343-350
- 5
Singh H, Turner D, Xue L et al.
Risk of developing colorectal cancer following a negative colonoscopy examination:
evidence for a 10-year interval between colonoscopies.
JAMA.
2006;
295
2366-2373
- 6
Matsushita M, Hajiro K, Okazaki K et al.
Efficacy of total colonoscopy with a transparent cap in comparison with colonoscopy
without the cap.
Endoscopy.
1998;
30
444-447
- 7
Rex D K, Chadalawada V, Helper D J.
Wide angle colonoscopy with a prototype instrument: impact on miss rates and efficiency
as determined by back-to-back colonoscopies.
Am J Gastroenterol.
2003;
98
2000-2005
- 8
East J E, Suzuki N, Arebi N et al.
Position changes improve visibility during colonoscope withdrawal: a randomized, blinded,
crossover trial.
Gastrointest Endosc.
2007;
65
263-269
- 9
Triadafilopoulos G, Watts H D, Higgins J et al.
A novel retrograde-viewing auxiliary imaging device (Third Eye Retroscope) improves
the detection of simulated polyps in anatomic models of the colon.
Gastrointest Endosc.
2007;
65
139-144
- 10
Le Rhun M, Coron E, Parlier D et al.
High resolution colonoscopy with chromoscopy versus standard colonoscopy for the detection
of colonic neoplasia: a randomized study.
Clin Gastroenterol Hepatol.
2006;
4
349-354
- 11
Rex D K, Helbig C C.
High yields of small and flat adenomas with high-definition colonoscopes using either
white light or narrow band imaging.
Gastroenterology.
2007;
133
42-47
- 12
Buchner A M, Shahid M W, Heckman M G et al.
High-definition colonoscopy detects colorectal polyps at a higher rate than standard
white-light colonoscopy.
Clin Gastroenterol Hepatol.
2010;
8
364-370
- 13
Burke C A, Choure A G, Sanaka M R, Lopez R.
A Comparison of high-definition versus conventional colonoscopes for polyp detection.
Dig Dis Sci.
2010;
55
1716-1720
- 14
East J E, Stavrindis M, Thomas-Gibson S et al.
A comparative study of standard vs. high definition colonoscopy for adenoma and hyperplastic
polyp detection with optimized withdrawal technique.
Aliment Pharmacol Ther.
2008;
28
768-776
- 15
Pellise M, Fernandez-Esparrach G, Cardenas A et al.
Impact of wide-angle, high-definition endoscopy in the diagnosis of colorectal neoplasia:
a randomized controlled trial.
Gastroenterology.
2008;
135
1062-1068
- 16
Tribonias G, Theodoropoulou A, Konstantinidis K et al.
Comparison of standard vs high-definition, wide-angle colonoscopy for polyp detection:
a randomized controlled trial.
Colorectal Dis.
2009;
[Epub ahead of print.]
DOI: 10.1111/j.1463-1318.2009.02145.x
- 17
Brown S R, Baraza W, Hurlstone P.
Chromoscopy versus conventional endoscopy for the detection of polyps in the colon
and rectum.
Cochrane Database Syst Rev
2007;
CD006439
- 18
Adler A, Pohl H, Papanikolaou I S et al.
A prospective randomised study on narrow-band imaging versus conventional colonoscopy
for adenoma detection: does narrow-band imaging induce a learning effect?.
Gut.
2008;
57
59-64
- 19
Adler A, Aschenbeck J, Yenerim T et al.
Narrow-band versus white-light high definition television endoscopic imaging for screening
colonoscopy: a prospective randomized trial.
Gastroenterology.
2009;
136
410-416
- 20
Hoffman A, Sar F, Goetz M et al.
High definition colonoscopy combined with i-Scan is superior in the detection of colorectal
neoplasias compared to standard video colonoscopy.
Endoscopy.
2010;
42
827-833
- 21
Aminalai A, Rosch T, Aschenbeck J et al.
Live image processing does not increase adenoma detection rate during colonoscopy:
a randomized comparison between FICE and conventional imaging (Berlin Colonoscopy
Project 5, BECOP-5).
Am J Gastroenterol.
2010;
105
2383-2388
- 22
DerSimonian R, Laird N.
Meta-analysis in clinical trials.
Control Clin Trials.
1986;
7
177-188
- 23
Cochrane W G.
The combination of estimates from different experiments.
Biometrics.
1954;
10
101-129
- 24
Higgins J P, Thompson S G, Deeks J J, Altman D G.
Measuring inconsistency in meta-analyses.
BMJ.
2003;
327
557-560
- 25
Egger M, Davey S G, Schneider M, Minder C.
Bias in meta-analysis detected by a simple, graphical test.
BMJ.
1997;
315
629-634
- 26
Whiting P, Rutjes A W, Reitsma J B et al.
The development of QUADAS: a tool for the quality assessment of studies of diagnostic
accuracy included in systematic reviews.
BMC Med Res Methodol.
2003;
3
25
- 27
Thompson S G, Higgins J P.
How should meta-regression analyses be undertaken and interpreted?.
Stat Med.
2002;
21
1559-1573
- 28
Deenadayalu V P, Chadalawada V, Rex D K.
170 degrees wide-angle colonoscope: effect on efficiency and miss rates.
Am J Gastroenterol.
2004;
99
2138-2142
- 29
Fatima H, Rex D K, Rothstein R et al.
Cecal insertion and withdrawal times with wide-angle versus standard colonoscopes:
a randomized controlled trial.
Clin Gastroenterol Hepatol.
2008;
6
109-114
V. SubramanianMD
Nottingham Digestive Diseases Centre
Nottingham University Hospitals NHS Trust
Nottingham
United Kingdom
Telefon: +44-115-8231039
Fax: +44-115-8231409
eMail: V.Subramanian@nottingham.ac.uk
