Endoscopy 2010; 42(10): 827-833
DOI: 10.1055/s-0030-1255713
Original article

© Georg Thieme Verlag KG Stuttgart · New York

High definition colonoscopy combined with i-Scan is superior in the detection of colorectal neoplasias compared with standard video colonoscopy: a prospective randomized controlled trial

A.  Hoffman1 , F.  Sar1 , M.  Goetz1 , A.  Tresch2 , J.  Mudter4 , S.  Biesterfeld3 , P.  R.  Galle1 , M.  F.  Neurath4 , R.  Kiesslich1
  • 1I Med Clinic, Johannes Gutenberg University of Mainz, Mainz, Germany
  • 2Gene Center, Department of Biochemistry, Ludwig-Maximilians-University Munich, Munich, Germany
  • 3Institute of Pathology, Johannes Gutenberg University Mainz, Mainz, Germany
  • 4I Med Clinic, Friedrich Alexander University Erlangen–Nürnberg, Erlangen, Germany
Further Information

Publication History

submitted 13 October 2009

accepted after revision 18 June 2010

Publication Date:
27 August 2010 (online)

Also available at
    Permissions and Reprints

See also:

Commentaire de travail de A. Hoffman et al., pp. 827Endoscopy 2010; 42(10): 883-883
DOI: 10.1055/s-0031-1291882

Introduction: Colonoscopy is the accepted gold standard for the detection of colorectal cancer. The aim of the current study was to prospectively compare high definition plus (HD+) colonoscopy with i-Scan functionality (electronic staining) vs. standard video colonoscopy. The primary endpoint was the detection of patients having colon cancer or at least one adenoma.

Methods: A total of 220 patients due to undergo screening colonoscopy, postpolypectomy surveillance or with a positive occult blood test were randomized in a 1 : 1 ratio to undergo HD+ colonoscopy in conjunction with i-Scan surface enhancement (90i series, Pentax, Tokyo, Japan) or standard video colonoscopy (EC-3870FZK, Pentax). Detected colorectal lesions were judged according to type, location, and size. Lesions were characterized in the HD+ group by using further i-Scan functionality (p- and v-modes) to analyze pattern and vessel architecture. Histology was predicted and biopsies or resections were performed on all identified lesions.

Results: HD+ colonoscopy with i-Scan functionality detected significantly more patients with colorectal neoplasia (38 %) compared with standard resolution endoscopy (13 %) (200 patients finally analyzed; 100 per arm). Significantly more neoplastic (adenomatous and cancerous) lesions and more flat adenomas could be detected using high definition endoscopy with surface enhancement. Final histology could be predicted with high accuracy (98.6 %) within the HD+ group.

Conclusions: HD+ colonoscopy with i-Scan is superior to standard video colonoscopy in detecting patients with colorectal neoplasia based on this prospective, randomized, controlled trial.

References

  • 1 Kahi C J, Rex D K, Imperiale T F. Screening, surveillance, and primary prevention for colorectal cancer: a review of the recent literature.  Gastroenterology. 2008;  135 380-399
    CrossrefPubMedSearch in Google Scholar
  • 2 Winawer S J, Zauber A G, Ho M N. et al . Prevention of colorectal cancer by colonoscopic polypectomy.  N Engl J Med. 1993;  329 1977-1981
    CrossrefPubMedSearch in Google Scholar
  • 3 McLoughlin R M, O’Morain C A. Colorectal cancer screening.  World J Gastroenterol. 2006;  12 6747-6750
    PubMedSearch in Google Scholar
  • 4 Rembacken B J, Fujii T, Cairns A. et al . Flat and depressed colonic neoplasms: a prospective study of 1000 colonoscopies in the UK.  Lancet. 2000;  8 1211-1214
    PubMedSearch in Google Scholar
  • 5 Saitoh Y, Waxmann I, West A B. et al . Prevalence and distinctive biological features of flat colorectal adenomas in a North American population.  Gastroenterology. 2001;  120 1657-1665
    CrossrefPubMedSearch in Google Scholar
  • 6 Soetikno R M, Kaltenbach T, Robert V. et al . Prevalence of nonpolypoid (flat and depressed) colorectal neoplasms in asymptomatic and symptomatic adults.  JAMA. 2008;  299 1027-1035
    CrossrefPubMedSearch in Google Scholar
  • 7 Kudo S, Kashida H, Tamura T. et al . Colonoscopic diagnosis and management of nonpolypoid early colorectal cancer.  Word J Surg. 2000;  24 1081-1090
    CrossrefPubMedSearch in Google Scholar
  • 8 Rex D K, Cutler C S, Lemmel G T. et al . Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies.  Gastroenterology. 1997;  112 24-28
    CrossrefPubMedSearch in Google Scholar
  • 9 Rex D K. Third Eye Retroscope: rationale, efficacy, challenges.  Rev Gastroenterol Disord. 2009;  9 1-6
    PubMedSearch in Google Scholar
  • 10 Rex D K, Helbig C C. High yield of small and flat adenomas with high definition colonoscopes using either white light or narrow band imaging.  Gastroenterology. 2007;  133 42-47
    CrossrefPubMedSearch in Google Scholar
  • 11 Goetz M, Kiesslich R. Advanced imaging of the gastrointestinal tract: research vs. clinical tools?.  Curr Opin Gastroenterol. 2009;  25 412-421
    CrossrefPubMedSearch in Google Scholar
  • 12 Hoffman A, Kagel C, Goetz M. et al . Recognition and characterization of small colonic neoplasia with high-definition colonoscopy using i-Scan is as precise as chromoendoscopy.  Dig Liver Dis. 2010;  42 45-50
    Search in Google Scholar
  • 13 Hoffman A, Basting N, Goetz M. et al . High-definition endoscopy with i-Scan and Lugol’s solution for more precise detection of mucosal breaks in patients with reflux symptoms.  Endoscopy. 2009;  41 107-112
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Burke C A, Choure A G, Sanaka M R. et al . A Comparison of high-definition versus conventional colonoscopes for polyp detection.  Dig Dis Sci. 2010;  55 1716-1720
    CrossrefPubMedSearch in Google Scholar
  • 15 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
    CrossrefPubMedSearch in Google Scholar
  • 16 Pellisé M, Fernández-Esparrach G, Cárdenas 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
    CrossrefPubMedSearch in Google Scholar
  • 17 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
    CrossrefPubMedSearch in Google Scholar
  • 18 Kudo S, Tamura S, Nakajima T. et al . Diagnosis of colorectal tumorous lesions by magnifying endoscopy.  Gastrointest Endosc. 1996;  44 8-14
    CrossrefPubMedSearch in Google Scholar
  • 19 Schlemper R J, Riddell R H, Kato Y. et al . The Vienna classification of gastrointestinal epithelial neoplasia.  Gut. 2000;  47 251-255
    CrossrefPubMedSearch in Google Scholar
  • 20 Levin W B, Lieberman D A, McFarland B. et al. American Cancer Society Colorectal Cancer Advisory Group, the US Multi-Society Task Force, and the American College of Radiology Colon Cancer Committee . Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology.  Gastroenterology. 2008;  134 1570-1595
    CrossrefPubMedSearch in Google Scholar
  • 21 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
    CrossrefPubMedSearch in Google Scholar
  • 22 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
    CrossrefPubMedSearch in Google Scholar
  • 23 Kaltenbach T, Friedland S, Soetikno R. A randomised tandem colonoscopy trial of narrow band imaging versus white light examination to compare neoplasia miss rates.  Gut. 2008;  57 1406-1412
    CrossrefPubMedSearch in Google Scholar
  • 24 Inoue T, Murano M, Murano N. et al . Comparative study of conventional colonoscopy and pan-colonic narrow-band imaging system in the detection of neoplastic colonic polyps: a randomized, controlled trial.  J Gastroenterol. 2008;  43 45-50
    CrossrefPubMedSearch in Google Scholar
  • 25 Adler A, Roll S, Marowski B. et al . Berlin Private-Practice Gastroenterology Working Group. Appropriateness of colonoscopy in the era of colorectal cancer screening: a prospective multicenter study in a private-practice setting (Berlin Colonoscopy Project 1, BECOP 1).  Dis Colon Rectum. 2007;  50 1628-1638
    CrossrefPubMedSearch in Google Scholar
  • 26 Chang C C, Hsieh C R, Lou H Y. et al . Comparative study of conventional colonoscopy, magnifying chromoendoscopy, and magnifying narrow-band imaging systems in the differential diagnosis of small colonic polyps between trainee and experienced endoscopist.  Int J Colorectal Dis. 2009;  24 1413-1419
    CrossrefPubMedSearch in Google Scholar
  • 27 Moher D, Schulz K F, Altmann D G. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials.  Lancet. 2001;  14 1191-1194
    PubMedSearch in Google Scholar
  • 28 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
    CrossrefPubMedSearch in Google Scholar
  • 29 Kanna B, Schori M, Azeez S. et al . Colorectal tumors within an urban minority population in New York City.  J Gen Intern Med. 2007;  22 835-840
    CrossrefPubMedSearch in Google Scholar
  • 30 Regula J, Rupinski M, Kraszewska E. et al . Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia.  N Engl J Med. 2006;  355 1863-1872
    CrossrefPubMedSearch in Google Scholar
  • 31 Huh K C, Rex D K. Advances in colonoscope technique and technology.  Rev Gastroenterol Disord. 2008;  8 223-232
    PubMedSearch in Google Scholar
  • 32 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
    CrossrefPubMedSearch in Google Scholar
  • 33 Sikka S, Ringold D A, Jonnalagadda S. et al . Comparison of white light and narrow band high definition images in predicting colon polyp histology, using standard colonoscopes without optical magnification.  Endoscopy. 2008;  40 818-822
    Thieme ConnectPubMedSearch in Google Scholar
  • 34 Rastogi A, Keighley J, Singh V. et al . High accuracy of narrow band imaging without magnification for the real-time characterization of polyp histology and its comparison with high-definition white light colonoscopy: a prospective study.  Am J Gastroenterol. 2009;  104 2422-2430
    CrossrefPubMedSearch in Google Scholar
  • 35 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
    CrossrefPubMedSearch in Google Scholar
  • 36 Hüneburg R, Lammert F, Rabe C. et al . Chromocolonoscopy detects more adenomas than white light colonoscopy or narrow band imaging colonoscopy in hereditary nonpolyposis colorectal cancer screening.  Endoscopy. 2009;  41 316-322
    Thieme ConnectPubMedSearch in Google Scholar
  • 37 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 38 Pohl J, Nguyen-Tat M, Pech O. et al . Computed virtual chromoendoscopy for classification of small colorectal lesions: a prospective comparative study.  Am J Gastroenterol. 2008;  103 562-569
    CrossrefPubMedSearch in Google Scholar
  • 39 Santos C E, Pereira-Lima J C, Lopes C V. et al . Comparative study between MBI (FICE) and magnification chromoendoscopy with indigo carmine in the differential diagnosis of neoplastic and non-neoplastic lesions of the colorectum.  Arq Gastroenterol. 2009;  46 111-115
    CrossrefPubMedSearch in Google Scholar

A. HoffmanMD 

I. Med. Clinic
Johannes Gutenberg University of Mainz

Langenbeckstr. 1
55101 Mainz
Germany

Fax: +49-6131-175552

Email: AHoff66286@aol.com