Subscribe to RSS
DOI: 10.1055/s-2007-995339
© Georg Thieme Verlag KG Stuttgart · New York
Colonoscopy, tumors, and inflammatory bowel disease
Publication History
Publication Date:
05 December 2007 (online)
![](https://www.thieme-connect.de/media/endoscopy/200802/lookinside/thumbnails/10.1055-s-2007-995339-1.jpg)
Virtual chromoscopy during colonoscopy
Narrow-band imaging (NBI) is a new technique that allows us to distinguish neoplastic and non-neoplastic lesions without chromoendoscopy, and should be very useful in detecting small or flat lesions missed by standard endoscopy. A study recently examined 148 colorectal lesions, 16 hyperplastic polyps, 84 tubular adenomas, and 48 early carcinomas [1]. Lesions were observed first under NBI magnification and then under standard magnification with chromoendoscopy. Correspondence between the two diagnostic methods was 88 % for type II, 100 % for type IIIs, 98 % for type IIIl, 88 % for type IV, 78 % for type Vi, and 100 % (3/3) for type Vn pit patterns. NBI depicted a brownish change on the basis of surface capillaries in 6 % of hyperplasia and 99 % of tubular adenomas (P < 0.005) [1] . In a second, prospective study, 180 colorectal lesions were observed with conventional colonoscopy, under low- and high-magnification NBI, and chromoendoscopy [2]. The diagnostic accuracy of NBI with low or high magnification was significantly higher than that of conventional colonoscopy (P = 0.0434 and P < 0.001), and was comparable to that of chromoendoscopy. Both low- and high-magnification NBI were capable of distinguishing neoplastic from non-neoplastic colorectal lesions [2].
A randomized controlled trial [3] of colonoscopy withdrawal in white light versus NBI in 434 patients aged 50 years was performed using high-definition, wide-angle (170° field of view) colonoscopes. There was no difference between groups in the percentage of patients with ≥ 1 adenoma for the entire cohort (white light 67 % vs. NBI 65 %; P = 0.61). The high prevalence rates of adenomas were accounted for by detection of large numbers of adenomas, including flat adenomas, which were ≤ 5 mm. For differential diagnosis of neoplastic (adenoma and adenocarcinoma) and hyperplastic polyps, the sensitivity of the conventional colonoscope for diagnosis of neoplastic polyps was 82.9 %, specificity was 80.0 %, and diagnostic accuracy was 81.8 % [4], significantly lower than those achieved with the NBI system (sensitivity 95.7 %, specificity 87.5 %, accuracy 92.7 %), and chromoendoscopy (sensitivity 95.7 %, specificity 87.5 %, accuracy 92.7 %). Therefore, no significant difference existed between the NBI system and chromoendoscopy during differential diagnosis of neoplastic and non-neoplastic polyps [4]. Moreover, pit patterns were not always identical with NBI and chromoendoscopy, so, the Kudo classification may need to be modified and revalidated before it can be used with confidence with NBI [5].
Another study compared the accuracy of NBI with standard colonoscopy in a prospective, randomized, crossover study of 42 patients with longstanding ulcerative colitis [6]. With NBI, 52 suspicious lesions were detected in 17 patients, compared with 28 suspicious lesions in 13 patients detected during conventional colonoscopy. In four patients the neoplasia was detected by both techniques, in four patients neoplasia was detected only by NBI, and in three patients neoplasia was detected only by conventional colonoscopy (P = 0.7). The sensitivity of the NBI system for the detection of patients with neoplasia seems to be comparable to conventional colonoscopy, although more suspicious lesions were found during NBI [6].
The value of combined chromoscopy and endomicroscopy was assessed for the diagnosis of intraepithelial neoplasias in a randomized controlled trial of ulcerative colitis in clinical remission [7]. In the conventional colonoscopic group (n = 73), random biopsy examinations and targeted biopsy examinations were performed. In the endomicroscopy group (n = 80), circumscribed mucosal lesions were identified by chromoscopy and evaluated for targeted biopsy examination by endomicroscopy. By using chromoscopy with endomicroscopy, 4.75-fold more neoplasias could be detected (P ≤ 0.005) than with conventional colonoscopy, although 50 % fewer biopsy specimens (P ≤ 0.008) were required. The presence of neoplastic changes could be predicted by endomicroscopy with high accuracy (sensitivity 94.7 %, specificity 98.3 %, accuracy 97.8 %). Thus, chromoscopy-guided endomicroscopy may lead to significant improvements in the clinical management of ulcerative colitis [7]. In a retrospective surveillance examination in 622 patients with ulcerative colitis, 46 patients were found to have dysplasia or colorectal cancer (CRC): 75 separate dysplastic or cancerous lesions were identified (mean 1.6 lesions per patient) [8]. In all, 38 of the 65 dysplastic lesions (58.5 %) and eight of the 10 cancers were visible to the endoscopist as 23 polyps and masses, one stricture, and 22 irregular mucosa. The per-patient sensitivities for dysplasia and for cancer were 71.8 % and 100 %, respectively. Dysplasia and cancer in ulcerative colitis are endoscopically visible in most patients and may be reliably identified during scheduled examinations in patients with chronic ulcerative colitis (CUC) undergoing surveillance with video endoscopy [8].
References
- 1 Hirata M, Oka S, Kaneko I. et al . Magnifying endoscopy with narrow band imaging for diagnosis of colorectal tumors. Gastrointest Endosc. 2007; 65 988-995
- 2 Chiu H M, Chang C Y, Chen C C. et al . A prospective comparative study of narrow-band imaging, chromoendoscopy, and conventional colonoscopy in the diagnosis of colorectal neoplasia. Gut. 2007; 56 373-379
- 3 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
- 4 Su M Y, Hsu C M, Ho Y P. et al . Comparative study of conventional colonoscopy, chromoendoscopy, and narrow-band imaging systems in differential diagnosis of neoplastic and nonneoplastic colonic polyps. Am J Gastroenterol. 2006; 101 2711-2716
- 5 East J E, Suzuki N, Saunders B P. Comparison of magnified pit pattern interpretation with narrow band imaging versus chromoendoscopy for diminutive colonic polyps: a pilot study. Gastrointest Endosc. 2007; 66 310-316
- 6 Dekker E, van den Broek F J, Reitsma J B. et al . Narrow-band imaging compared with conventional colonoscopy for the detection of dysplasia in patients with longstanding ulcerative colitis. Endoscopy. 2007; 39 216-221
- 7 Kiesslich R, Goetz M, Lammersdorf K. et al . Chromoscopy-guided endomicroscopy increases the diagnostic yield of intraepithelial neoplasia in ulcerative colitis. Gastroenterology. 2007; 132 874-882
- 8 Rubin D T, Rothe J A, Hetzel J T. et al . Are dysplasia and colorectal cancer endoscopically visible in patients with ulcerative colitis?. Gastrointest Endosc. 2007; 65 998-1004
- 9 Fujishiro M, Yahagi N, Kakushima N. et al . Outcomes of Endoscopic Submucosal Dissection for Colorectal Epithelial Neoplasms in 200 Consecutive Cases. Clin Gastroenterol Hepatol. 2007; 5 678-683
- 10 Saito Y, Uraoka T, Matsuda T. et al . Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections (with video). Gastrointest Endosc. 2007; [Epub ahead of print]
- 11 Hurlstone D P, Sanders D S, Thomson M, Cross S S. ”Salvage“ endoscopic mucosal resection in the colon using a retroflexion gastroscope dissection technique: a prospective analysis. Endoscopy. 2006; 38 902-906
- 12 Uraoka T, Saito Y, Matsuda T. et al . Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum. Gut. 2006; 55 1592-1597
- 13 Tanaka S, Oka S, Kaneko I. et al . Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization. Gastrointest Endosc. 2007; 66 100-107
- 14 Vieth M, Behrens H, Stolte M. Sporadic adenoma in ulcerative colitis: endoscopic resection is an adequate treatment. Gut. 2006; 55 1151-1155
- 15 Hurlstone D P, Sanders D S, Atkinson R. et al . Endoscopic mucosal resection for flat neoplasia in chronic ulcerative colitis: can we change the endoscopic management paradigm?. Gut. 2007; 56 838-846
- 16 Shah H A, Paszat L F, Saskin R. et al . Factors associated with incomplete colonoscopy: a population-based study. Gastroenterology. 2007; 132 2297-2203
- 17 Pasha S F, Harrison M E, Das A. et al . Utility of double-balloon colonoscopy for completion of colon examination after incomplete colonoscopy with conventional colonoscope. Gastrointest Endosc. 2007; 65 848-853
- 18 Anderson J C, Walker G, Birk J W. et al . Tapered colonoscope performs better than the pediatric colonoscope in female patients: a direct comparison through tandem colonoscopy. Gastrointest Endosc. 2007; 65 1042-1047
- 19 Lee D W, Li A C, Ko C W. et al . Use of a variable-stiffness colonoscope decreases the dose of patient-controlled sedation during colonoscopy: a randomized comparison of 3 colonoscopes. Gastrointest Endosc. 2007; 65 424-429
- 20 Eickhoff A, Jakobs R, Kamal A. et al . In vitro evaluation of forces exerted by a new computer-assisted colonoscope (the NeoGuide Endoscopy System). Endoscopy. 2006; 38 1224-1229
- 21 Sanaka M R, Shah N, Mullen K D. et al . Afternoon colonoscopies have higher failure rates than morning colonoscopies. Am J Gastroenterol. 2006; 101 2726-2730
- 22 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
- 23 Barclay R L, Vicari J J, Doughty A S. et al . Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med. 2006; 355 2533-2541
- 24 Simmons D T, Harewood G C, Baron T H. et al . Impact of endoscopist withdrawal speed on polyp yield: implications for optimal colonoscopy withdrawal time. Aliment Pharmacol Ther. 2006; 24 965-971
- 25 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
- 26 Kondo S, Yamaji Y, Watabe H. et al . A randomized controlled trial evaluating the usefulness of a transparent hood attached to the tip of the colonoscope. Am J Gastroenterol. 2007; 102 75-81
- 27 Ko C W, Riffle S, Shapiro J A. et al . Incidence of minor complications and time lost from normal activities after screening or surveillance colonoscopy. Gastrointest Endosc. 2007; 65 648-656
- 28 Brenner H, Chang-Claude J, Seiler C M. et al . Does a negative screening colonoscopy ever need to be repeated?. Gut. 2006; 55 1145-1150
- 29 Farrar W D, Sawhney M S, Nelson D B. et al . Colorectal cancers found after a complete colonoscopy. Clin Gastroenterol Hepatol. 2006; 4 1259-1264
- 30 Bressler B, Paszat L F, 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
- 31 Rulyak S J, Lieberman D A, Wagner E H, Mandelson M T. Outcome of follow-up colon examination among a population-based cohort of colorectal cancer patients. Clin Gastroenterol Hepatol. 2007; 5 470-476
- 32 Shapero T F, Hoover J, Paszat L F. et al . Colorectal cancer screening with nurse-performed flexible sigmoidoscopy: results from a Canadian community-based program. Gastrointest Endosc. 2007; 65 640-645
- 33 Schoen R E, Weissfeld J L, Pinsky P F, Riley T. Yield of advanced adenoma and cancer based on polyp size detected at screening flexible sigmoidoscopy. Gastroenterology. 2006; 131 1683-1689
- 34 Thiis-Evensen E, Seip B, Vatn M H, Hoff G S. Impact of a colonoscopic screening examination for colorectal cancer on later utilization of distal GI endoscopies. Gastrointest Endosc. 2006; 64 948-954
- 35 Eliakim R, Fireman Z, Gralnek I M. et al . Evaluation of the PillCam Colon capsule in the detection of colonic pathology: results of the first multicenter, prospective, comparative study. Endoscopy. 2006; 38 963-970
- 36 Schoofs N, Deviere J, Van Gossum A. PillCam colon capsule endoscopy compared with colonoscopy for colorectal tumor diagnosis: a prospective pilot study. Endoscopy. 2006; 38 971-977
D. Heresbach, MD
Department of Gastroenterology
Service des Maladies de l’Appareil Digestif
CHU Pontchaillou
35033 Rennes
France
Fax: +33-2-99284189
Email: denis.heresbach@chu-rennes.fr