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Turner MA, Cox KE, Liu S, Neel N, Amirfakhri S, Nishino H, Hosseini M, Alcantara JA, Abd El-Hafeez AA, Lwin TM, Mallya K, Pisegna JR, Singh SK, Ghosh P, Hoffman RM, Batra SK, Bouvet M. Specific Targeting and Labeling of Colonic Polyps in CPC-APC Mice with Mucin 5AC Fluorescent Antibodies: A Model for Detection of Early Colon Cancer. Curr Issues Mol Biol 2023; 45:3347-3358. [PMID: 37185743 PMCID: PMC10136452 DOI: 10.3390/cimb45040219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 05/17/2023] Open
Abstract
Poor visualization of polyps can limit colorectal cancer screening. Fluorescent antibodies to mucin5AC (MUC5AC), a glycoprotein upregulated in adenomas and colorectal cancer, could improve screening colonoscopy polyp detection rate. Adenomatous polyposis coli flox mice with a Cdx2-Cre transgene (CPC-APC) develop colonic polyps that contain both dysplastic and malignant tissue. Mice received MUC5AC-IR800 or IRdye800 as a control IV and were sacrificed after 48 h for near-infrared imaging of their colons. A polyp-to-background ratio (PBR) was calculated for each polyp by dividing the mean fluorescence intensity of the polyp by the mean fluorescence intensity of the background tissue. The mean 25 μg PBR was 1.70 (±0.56); the mean 50 μg PBR was 2.64 (±0.97); the mean 100 μg PBR was 3.32 (±1.33); and the mean 150 μg PBR was 3.38 (±0.87). The mean PBR of the dye-only control was 2.22 (±1.02), significantly less than the 150 μg arm (p-value 0.008). The present study demonstrates the ability of fluorescent anti-MUC5AC antibodies to specifically target and label colonic polyps containing high-grade dysplasia and intramucosal adenocarcinoma in CPC-APC mice. This technology can potentially improve the detection rate and decrease the miss rate of advanced colonic neoplasia and early cancer at colonoscopy.
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Affiliation(s)
- Michael A. Turner
- Division of Surgical Oncology, Department of Surgery, University of California San Diego, La Jolla, CA 92037, USA
- Department of Surgery, VA San Diego Healthcare System, La Jolla, CA 92161, USA
| | - Kristin E. Cox
- Division of Surgical Oncology, Department of Surgery, University of California San Diego, La Jolla, CA 92037, USA
- Department of Surgery, VA San Diego Healthcare System, La Jolla, CA 92161, USA
| | - Shanglei Liu
- Division of Surgical Oncology, Department of Surgery, University of California San Diego, La Jolla, CA 92037, USA
| | - Nicholas Neel
- Division of Surgical Oncology, Department of Surgery, University of California San Diego, La Jolla, CA 92037, USA
- Department of Surgery, VA San Diego Healthcare System, La Jolla, CA 92161, USA
| | - Siamak Amirfakhri
- Division of Surgical Oncology, Department of Surgery, University of California San Diego, La Jolla, CA 92037, USA
- Department of Surgery, VA San Diego Healthcare System, La Jolla, CA 92161, USA
| | - Hiroto Nishino
- Division of Surgical Oncology, Department of Surgery, University of California San Diego, La Jolla, CA 92037, USA
- Department of Surgery, VA San Diego Healthcare System, La Jolla, CA 92161, USA
| | - Mojgan Hosseini
- Department of Pathology, University of California San Diego, La Jolla, CA 92037, USA
| | - Joshua A. Alcantara
- Department of Cellular and Molecular Medicine, University of California San Diego, La Jolla, CA 92037, USA
| | - Amer Ali Abd El-Hafeez
- Department of Cellular and Molecular Medicine, University of California San Diego, La Jolla, CA 92037, USA
| | - Thinzar M. Lwin
- Department of Surgical Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Kavita Mallya
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Joseph R. Pisegna
- Department of Gastroenterology, VA Los Angeles Healthcare System, Los Angeles, CA 90073, USA
| | - Satish K. Singh
- Medical Service, Section of Gastroenterology, VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Medicine, Section of Gastroenterology, Boston University School of Medicine, Boston, MA 02118, USA
| | - Pradipta Ghosh
- Department of Cellular and Molecular Medicine, University of California San Diego, La Jolla, CA 92037, USA
- Department of Medicine, University of California San Diego, La Jolla, CA 92037, USA
| | - Robert M. Hoffman
- Division of Surgical Oncology, Department of Surgery, University of California San Diego, La Jolla, CA 92037, USA
- Department of Surgery, VA San Diego Healthcare System, La Jolla, CA 92161, USA
- AntiCancer, Inc., San Diego, CA 92111, USA
| | - Surinder K. Batra
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Michael Bouvet
- Division of Surgical Oncology, Department of Surgery, University of California San Diego, La Jolla, CA 92037, USA
- Department of Surgery, VA San Diego Healthcare System, La Jolla, CA 92161, USA
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Wang Y, Li L, Niu X, Gao F, Chai N, Linghu E. Melanosis coli: a contrast effect or an oncogenic effect? A large-scale retrospective cohort study. Int J Colorectal Dis 2023; 38:63. [PMID: 36884096 DOI: 10.1007/s00384-023-04357-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Melanosis coli is characterized by brown mucosa with pigmentation. Studies have showed an increased adenoma detection rate in melanosis patients, whether it is caused by a contrast effect or an oncogenic effect is still controversial. The detection of serrated polys in melanosis patients remains unknown. AIMS The study aimed to clarify the correlation of adenoma detection rate with melanosis coli and discuss outcomes in less-experienced endoscopists. Serrated polyp detection rate was also been investigated. METHODS A total of 2150 patients and 39,630 controls were enrolled. A propensity score matching method was used to balance covariates between the two groups. The detection of polyps, adenomas, serrated polyps, and their features was analyzed. RESULTS The polyp detection rate (44.65% vs 41.01%, P = 0.005) and adenoma detection rate (30.34% vs 23.92%, P < 0.001) were significantly higher, and the serrated polyp detection rate (0.93% vs 1.58%, P = 0.033) was significantly lower in melanosis coli. The percentage of low-risk adenomas (44.60% vs 39.16%, P < 0.001) and polyps with 6 to 10 mm in size (20.16% vs 16.21%, P < 0.001) were higher in melanosis coli. The detection of large serrated polyps was lower (0.11% vs 0.41%, P = 0.026) in melanosis coli. CONCLUSION Melanosis coli correlates with an increased adenoma detection rate. The detection of large serrated polyps was lower in melanosis patients. Melanosis coli may not be considered a precancerous lesion.
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Affiliation(s)
- Yan Wang
- Nankai University School of Medicine, Nankai University, Tianjin, 300071, China
- Department of Gastroenterology, the First Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Longsong Li
- Department of Gastroenterology, the First Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Xiaotong Niu
- Department of Gastroenterology, the First Medical Center of PLA General Hospital, Beijing, 100853, China
- Medical School of Chinese PLA, Beijing, 100853, China
| | - Fei Gao
- Department of Gastroenterology, the First Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Ningli Chai
- Department of Gastroenterology, the First Medical Center of PLA General Hospital, Beijing, 100853, China.
| | - Enqiang Linghu
- Nankai University School of Medicine, Nankai University, Tianjin, 300071, China.
- Department of Gastroenterology, the First Medical Center of PLA General Hospital, Beijing, 100853, China.
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Antonelli G, Correale L, Spadaccini M, Maselli R, Bhandari P, Bisschops R, Cereatti F, Dekker E, East JE, Iacopini F, Jover R, Kiesslich R, Pellise M, Sharma P, Rex DK, Repici A, Hassan C. Dye-based chromoendoscopy for the detection of colorectal neoplasia: meta-analysis of randomized controlled trials. Gastrointest Endosc 2022; 96:411-422. [PMID: 35588768 DOI: 10.1016/j.gie.2022.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/10/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Dye-based chromoendoscopy (DBC) could be effective in increasing the adenoma detection rate (ADR) in patients undergoing colonoscopy, but the technique is time-consuming and its uptake is limited. We aimed to assess the effect of DBC on ADR based on available randomized controlled trials (RCTs). METHODS Four databases were searched up to April 2022 for RCTs comparing DBC with conventional colonoscopy (CC) in terms of ADR, advanced ADR, and sessile serrated adenoma detection rate as well as the mean adenomas per patient and non-neoplastic lesions. Relative risk (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes were calculated using random-effect models. The I2 test was used for quantifying heterogeneity. Risk of bias was evaluated with the Cochrane tool. RESULTS Overall, 10 RCTs (5334 patients) were included. Indication for colonoscopy was screening or surveillance (3 studies) and mixed (7 studies). Pooled ADR was higher in the DBC group versus the CC group (95% CI, 48.1% [41.4%-54.8%] vs 39.3% [33.5%-46.4%]; RR, 1.20 [1.11-1.29]), with low heterogeneity (I2 = 29%). This effect was consistent for advanced ADR (RR, 1.21 [1.03-1.42]; I2 = .0%), sessile serrated adenomas (6.1% vs 3.5%; RR, 1.68 [1.15-2.47]; I2 = 9.8%), and mean adenomas per patient (MD, .24 [.17-.31]) overall and in the right-sided colon (MD, .28 [.14-.43]). A subgroup analysis considering only trials using high-definition white-light endoscopy reduced the heterogeneity while still showing a significant increase in adenoma detection with DBC: 51.6% (95% confidence interval [CI], 47.1%-56.1%) and 59.1% (95% CI, 54.7-63.3%), RR = 1.14 (95% CI, 1.06-1.23), P = .0004, I2 = .0%, P = .50. CONCLUSIONS Meta-analysis of RCTs showed that DBC increases key quality parameters in colonoscopy, supporting its use in everyday clinical practice.
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Affiliation(s)
- Giulio Antonelli
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy; Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Loredana Correale
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Marco Spadaccini
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Roberta Maselli
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Pradeep Bhandari
- Department of Gastroenterology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, Catholic University of Leuven, (KUL), TARGID, University Hospital Leuven, Leuven, Belgium
| | - Fabrizio Cereatti
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - James E East
- Translational Gastroenterology Unit, Nuffield Department of Medicine, Experimental Medicine Division, John Radcliffe Hospital, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK; Division of Gastroenterology and Hepatology, Mayo Clinic Healthcare, London, UK
| | - Federico Iacopini
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
| | - Rodrigo Jover
- Servicio de Gastroenterología, Hospital Universitario de Canarias, Instituto Universitario de Tecnologías Biomédicas (ITB) & Centro de Investigación Biomédica de Canarias (CIBICAN), Santa Cruz de Tenerife, Spain
| | - Ralph Kiesslich
- Department of Internal Medicine II Gastroenterology, Hepatology and Endocrinology, Helios Dr Horst Schmidt Kliniken Wiesbaden, Wiesbaden, Germany
| | - Maria Pellise
- Gastroenterology Department, Endoscopy Unit, ICMDiM, Hospital Clinic, CIBEREHD, IDIBAPS, University of Barcelona, Catalonia, Spain
| | - Prateek Sharma
- Department of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Douglas K Rex
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
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Iwatate M, Hirata D, Francisco CPD, Co JT, Byeon J, Joshi N, Banerjee R, Quach DT, Aye TT, Chiu H, Lau LHS, Ng SC, Ang TL, Khomvilai S, Li X, Ho S, Sano W, Hattori S, Fujita M, Murakami Y, Shimatani M, Kodama Y, Sano Y. Efficacy of international web-based educational intervention in the detection of high-risk flat and depressed colorectal lesions higher (CATCH project) with a video: Randomized trial. Dig Endosc 2022; 34:1166-1175. [PMID: 35122323 PMCID: PMC9540870 DOI: 10.1111/den.14244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/14/2022] [Accepted: 01/23/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Three subcategories of high-risk flat and depressed lesions (FDLs), laterally spreading tumors non-granular type (LST-NG), depressed lesions, and large sessile serrated lesions (SSLs), are highly attributable to post-colonoscopy colorectal cancer (CRC). Efficient and organized educational programs on detecting high-risk FDLs are lacking. We aimed to explore whether a web-based educational intervention with training on FIND clues (fold deformation, intensive stool/mucus attachment, no vessel visibility, and demarcated reddish area) may improve the ability to detect high-risk FDLs. METHODS This was an international web-based randomized control trial that enrolled non-expert endoscopists in 13 Asian countries. The participants were randomized into either education or non-education group. All participants took the pre-test and post-test to read 60 endoscopic images (40 high-risk FDLs, five polypoid, 15 no lesions) and answered whether there was a lesion. Only the education group received a self-education program (video and training questions and answers) between the tests. The primary outcome was a detection rate of high-risk FDLs. RESULTS In total, 284 participants were randomized. After excluding non-responders, the final data analyses were based on 139 participants in the education group and 130 in the non-education group. The detection rate of high-risk FDLs in the education group significantly improved by 14.7% (66.6-81.3%) compared with -0.8% (70.8-70.0%) in the non-education group. Similarly, the detection rate of LST-NG, depressed lesions, and large SSLs significantly increased only in the education group by 12.7%, 12.0%, and 21.6%, respectively. CONCLUSION Short self-education focusing on detecting high-risk FDLs was effective for Asian non-expert endoscopists. (UMIN000042348).
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Affiliation(s)
- Mineo Iwatate
- Gastrointestinal Center and Institute of Minimally‐invasive Endoscopic Care (iMEC)Sano HospitalHyogoJapan
| | - Daizen Hirata
- Gastrointestinal Center and Institute of Minimally‐invasive Endoscopic Care (iMEC)Sano HospitalHyogoJapan
- Department of Gastroenterology and HepatologyKindai UniversityOsakaJapan
| | | | - Jonard Tan Co
- Institute of Digestive and Liver DiseasesSt. Luke’s Medical CenterTaguig CityPhilippines
| | - Jeong‐Sik Byeon
- Department of GastroenterologyAsan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - Neeraj Joshi
- Gastro Enterology UnitNepal Cancer Hospital and Research CentreLalitpurNepal
| | - Rupa Banerjee
- Medical GastroenterologyAsian Institute of GastroenterologyNew DelhiIndia
| | - Duc Trong Quach
- University of Medicine and Pharmacy at Ho Chi Minh CityHo Chi MinhVietnam
| | | | - Han‐Mo Chiu
- Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Louis H. S. Lau
- Department of Medicine and TherapeuticsFaculty of MedicineInstitute of Digestive DiseaseThe Chinese University of Hong KongHong KongChina
| | - Siew C. Ng
- Department of Medicine and TherapeuticsFaculty of MedicineInstitute of Digestive DiseaseThe Chinese University of Hong KongHong KongChina
| | - Tiing Leong Ang
- Department of Gastroenterology and HepatologyChangi General HospitalSingHealthSingapore
| | - Supakij Khomvilai
- Surgical EndoscopyColorectal DivisionDepartment of SurgeryFaculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Xiao‐Bo Li
- Division of Gastroenterology and HepatologyKey Laboratory of Gastroenterology and HepatologyMinistry of Health, Renji HospitalSchool of MedicineShanghai Institute of Digestive DiseaseShanghai Jiao Tong UniversityShanghaiChina
| | - Shiaw‐Hooi Ho
- Department of MedicineFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Wataru Sano
- Gastrointestinal Center and Institute of Minimally‐invasive Endoscopic Care (iMEC)Sano HospitalHyogoJapan
| | - Santa Hattori
- Gastrointestinal Center and Institute of Minimally‐invasive Endoscopic Care (iMEC)Sano HospitalHyogoJapan
| | - Mikio Fujita
- Gastrointestinal Center and Institute of Minimally‐invasive Endoscopic Care (iMEC)Sano HospitalHyogoJapan
| | | | - Masaaki Shimatani
- The Third Department of Internal MedicineDivision of Gastroenterology and HepatologyKansai Medical University Medical CenterOsakaJapan
| | - Yuzo Kodama
- Division of GastroenterologyDepartment of Internal MedicineKobe University Graduate School of MedicineHyogoJapan
| | - Yasushi Sano
- Gastrointestinal Center and Institute of Minimally‐invasive Endoscopic Care (iMEC)Sano HospitalHyogoJapan
- Kansai Medical UniversityOsakaJapan
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Sha J, Wang P, Sang N, Zhang H, Yang A, Chen L, Gong Z, Li C, Qin Y, Li X, Ji Y, Gao F. The value of three narrow-band imaging model in the diagnosis of small colorectal polyps. Sci Rep 2020; 10:22032. [PMID: 33328496 PMCID: PMC7744507 DOI: 10.1038/s41598-020-78708-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 11/23/2020] [Indexed: 01/07/2023] Open
Abstract
This prospective study was aimed to evaluate the clinical value of narrow-band imaging (NBI), magnification endoscopy with narrow-band imaging (NBIME) and magnification endoscopy with acetic acid enhancement and narrow-band imaging (AA-NBIME) in the diagnosis of small colorectal polyps. We studied 261 small colorectal polyps from 122 patients with the use of above three techniques. Lesions were resected for histopathological analysis. The endoscopic images were independently reviewed by three experts and three non-experts and the diagnostic accuracy and image definition were compared among the modalities. The “experts-agreed” diagnostic accuracy was 87.7% for NBI versus 91.6% for NBIME versus 94.6% for AA-NBIME. The “non-experts-agreed” diagnostic accuracy was 80.1% for NBI versus 84.3% for NBIME versus 89.3% for AA-NBIME. All experts and non-experts diagnosed the small colorectal polyps statistically more accurately with AA-NBIME than NBI (P < 0.05). In all three modalities, the expert group’s diagnostic accuracies were statistically significantly higher compared with the non-expert group. For experts, the Kappa values for AA-NBIME, NBIME and NBI diagnosis were 0.962 (0.892–1.032), 0.577 (0.507–0.647) and 0.567 (0.497–0.637), respectively; while for nonexperts, 0.818 (0.748–0.888), 0.532 (0.462–0.602) and 0.530 (0.460–0.600). This demonstrated a good reproducibility of AA-NBIME diagnosis. The average scores (experts and non-experts) of images acquired using AA-NBIME were significantly higher than those acquired using NBIME and ME (P < 0.05). AA-NBIME is a promising tool to clearly visualize the mucosal pit pattern (PP) of colorectal polyps for better differentiating neoplastic polyps from non-neoplastic ones.
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Affiliation(s)
- Jie Sha
- Department of Gastroenterology, Jingjiang People's Hospital, Jingjiang, 214500, Jiangsu, China
| | - Pin Wang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China
| | - Nan Sang
- Department of Gastroenterology, The Geriatric Hospital of Nanjing Medical University, Nanjing, 210024, Jiangsu, China
| | - Huiai Zhang
- Department of Gastroenterology, Taixing People's Hospital, Taizhou, 225400, Jiangsu, China
| | - Aiping Yang
- Department of Gastroenterology, Jingjiang People's Hospital, Jingjiang, 214500, Jiangsu, China
| | - Lei Chen
- Department of Gastroenterology, Jingjiang People's Hospital, Jingjiang, 214500, Jiangsu, China
| | - Zewei Gong
- Department of Gastroenterology, Jingjiang People's Hospital, Jingjiang, 214500, Jiangsu, China
| | - Chao Li
- Department of Gastroenterology, Jingjiang People's Hospital, Jingjiang, 214500, Jiangsu, China
| | - Yumeng Qin
- Department of Gastroenterology, Jingjiang People's Hospital, Jingjiang, 214500, Jiangsu, China
| | - Xueliang Li
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Yong Ji
- Department of Gastroenterology, Jingjiang People's Hospital, Jingjiang, 214500, Jiangsu, China.
| | - Feng Gao
- Department of Gastroenterology, Jingjiang People's Hospital, Jingjiang, 214500, Jiangsu, China.
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Cap-Assisted Chromoendoscopy Using a Mounted Cap Versus Standard Colonoscopy for Adenoma Detection. Am J Gastroenterol 2020; 115:465-472. [PMID: 31972618 DOI: 10.14309/ajg.0000000000000510] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Some neoplastic lesions remain undetected on colonoscopy. To date, no studies have investigated whether combining cap-assisted colonoscopy with chromoendoscopy increases the adenoma detection rate (ADR). This study aimed to compare cap-assisted chromoendoscopy (CAP/CHROMO) with standard colonoscopy (SC) with respect to their efficacy in detecting adenomas. METHODS This prospective, multicenter, randomized controlled trial included asymptomatic subjects aged 45-75 years who underwent colonoscopy for the first time at 14 university hospitals. Subjects were randomized to either the CAP/CHROMO group (with 0.09% indigo carmine spraying using a cap-mounted catheter at the tip of the colonoscope) or the SC group. All polyps were resected, but only histologically confirmed neoplastic lesions were considered for analysis. The primary outcome was ADR, defined as the proportion of subjects with at least 1 adenoma. RESULTS A total of 1,905 subjects were randomized to the CAP/CHROMO (n = 948) or SC (n = 957) group at 14 centers. Subjects' demographic characteristics were similar between both groups. The CAP/CHROMO group had significantly higher ADR than the SC group (54.4% vs 44.9%, P < 0.001). Significantly, more subjects with at least 1 proximal colon adenoma were identified by CAP/CHROMO (38.6%) than by SC (31.2%) (P = 0.001). The proximal serrated polyp detection rate by CAP/CHROMO was significantly higher in the female subgroup vs SC. However, advanced ADR was not different between the CAP/CHROMO and SC groups (9.3% vs 7.6%, P = 0.180). DISCUSSION CAP/CHROMO markedly improved the ADR and enhanced the detection of proximal adenoma. CAP/CHROMO is feasible for routine application and will allow for a more effective surveillance program.
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O’Morain NR, Syafiq MI, Shahin A, Ryan B, Crowther S, McNamara D. Dye-based chromoendoscopy following polypectomy reduces incomplete polyp resection. Endosc Int Open 2020; 8:E13-E19. [PMID: 31921979 PMCID: PMC6949170 DOI: 10.1055/a-1024-3759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 07/29/2019] [Indexed: 02/07/2023] Open
Abstract
Background and study aims The completeness of a polyp resection is an important determinant of quality in colonoscopy, and may reduce incidence of interval cancers. Incomplete resection rates (IRR) vary widely and range from 6.5 % to 22.7 %. Residual disease is more likely with larger polyps, for sessile serrated adenomas, and with more proximal lesions. Chromoendoscopy is increasingly employed in lesion detection. The aims of this study were to assess local IRR, and to determine whether chromoendoscopy could correctly identify residual disease post polypectomy. Patients and methods This was a prospective study examining post polypectomy sites. Chromoendoscopy (0.13 % indigo carmine) was applied to resection bases to identify residual disease. Targeted base biopsies were taken from identified residual disease (positive group) or random base biopsies were taken when a clear base was visualised (negative group). Overall rates of incomplete resection were documented. Reported rates post chromoendoscopy and actual histological rates were documented and compared. Results A total of 102 polyps were identified for inclusion, of which 15 % (n = 16) were excluded. Resection quality was evaluated in 86 polyps of 61 patients (female n = 33 54 %; mean Age 62.3 years). Polyps were mainly removed by cold snare (n = 71, 82.5 %). Most polyps (n = 58, 67 %) measured between 5 to 10 mm. Polyps were largely located in the right colon (n = 57, 66 %). Overall histological residual disease occurred in 17 /86 (19.6 %). Chromoendoscopy correctly identified residual disease in 13 of 17 bases (76.5 %). Only four of /86 (4.6 %) of polyp bases were missclassified post-chromoendoscopy (odds ratio 0.284 (95 % CI 0.0857-0.9409), P = 0.03). Conclusion Indigo carmine chromoendoscopy improves early detection of residual disease post polypectomy, reducing incomplete resection rates.
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Affiliation(s)
- Neil R. O’Morain
- Department of Gastroenterology and Clinical Medicine, Tallaght University Hospital, Trinity College Dublin,Trinity Academic Gastroenterology Group, Tallaght University Hospital, Trinity College Dublin
| | - Mohd I. Syafiq
- Department of Gastroenterology and Clinical Medicine, Tallaght University Hospital, Trinity College Dublin,Trinity Academic Gastroenterology Group, Tallaght University Hospital, Trinity College Dublin
| | - Ammar Shahin
- Department of Gastroenterology and Clinical Medicine, Tallaght University Hospital, Trinity College Dublin
| | - Barbara Ryan
- Department of Gastroenterology and Clinical Medicine, Tallaght University Hospital, Trinity College Dublin,Trinity Academic Gastroenterology Group, Tallaght University Hospital, Trinity College Dublin
| | - Stephen Crowther
- Department of Histopathology, Tallaght University Hospital, Trinity College Dublin, Ireland
| | - Deirdre McNamara
- Department of Gastroenterology and Clinical Medicine, Tallaght University Hospital, Trinity College Dublin,Trinity Academic Gastroenterology Group, Tallaght University Hospital, Trinity College Dublin
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Crockett SD, Nagtegaal ID. Terminology, Molecular Features, Epidemiology, and Management of Serrated Colorectal Neoplasia. Gastroenterology 2019; 157:949-966.e4. [PMID: 31323292 DOI: 10.1053/j.gastro.2019.06.041] [Citation(s) in RCA: 213] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 06/07/2019] [Accepted: 06/15/2019] [Indexed: 12/11/2022]
Abstract
In addition to the adenoma to carcinoma sequence, colorectal carcinogenesis can occur via the serrated pathway. Studies have focused on clarification of categories and molecular features of serrated polyps, as well as endoscopic detection and risk assessment. Guidelines from the World Health Organization propose assigning serrated polyps to categories of hyperplastic polyps, traditional serrated adenomas, and sessile serrated lesions (SSLs). Traditional serrated adenomas and SSLs are precursors to colorectal cancer. The serrated pathway is characterized by mutations in RAS and RAF, disruptions to the Wnt signaling pathway, and widespread methylation of CpG islands. Epidemiology studies of serrated polyps have been hampered by inconsistencies in terminology and reporting, but the prevalence of serrated class polyps is 20%-40% in average-risk individuals; most serrated polyps detected are hyperplastic. SSLs, the most common premalignant serrated subtype, and are found in up to 15% of average-risk patients by high-detecting endoscopists. Variations in rate of endoscopic detection of serrated polyps indicate the need for careful examination, with adequate bowel preparation and sufficient withdrawal times. Risk factors for SSLs include white race, family history of colorectal cancer, smoking, and alcohol intake. Patients with serrated polyps, particularly SSLs and traditional serrated adenomas, have an increased risk of synchronous and metachronous advanced neoplasia. Surveillance guidelines vary among countries, but SSLs and proximal hyperplastic polyps require special attention in assignment of surveillance interval-especially in light of concerns regarding incomplete detection and resection.
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Affiliation(s)
- Seth D Crockett
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
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9
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Tanaka Y, Inoue T, Kakimoto K, Nakazawa K, Tawa H, Hirata Y, Okada T, Nouda S, Kawakami K, Takeuchi T, Egashira Y, Higuchi K. Evaluation of the impact of linked color imaging for improving the visibility of colonic polyp. Oncol Lett 2019; 18:5555-5560. [PMID: 31620200 DOI: 10.3892/ol.2019.10917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 05/02/2019] [Indexed: 12/19/2022] Open
Abstract
Linked color imaging (LCI) is a novel endoscopic system used to increase color contrast. As LCI does not decrease luminal brightness, it may improve the detection of colonic neoplasms. However, the extent to which LCI improves the visibility of colonic polyps has not yet been determined. Between December 2016 and May 2017, patients who received total colonoscopy were consecutively recruited into this retrospective, single-center study. For each polyp identified, images obtained from white light (WL) imaging, blue laser imaging (BLI), and LCI of the same lesion and its surrounding mucosa were evaluated. The color differences (ΔE) between each lesion and its surrounding mucosa in non-magnified images were computed quantitatively using the CIELAB color space, which defines color perception according to colorimetric values, and compared among WL, BLI, LCI, and chromoendoscopy. The ΔE between the vessel and non-vessel areas in magnified images was also assessed. Of the 64 patients who were incorporated into this study, non-magnified and magnified (×80) images from 113 and 95 polyps, respectively, were assessed. The ΔE was intensified by LCI and chromoendoscopy compared with WL and BLI. The ΔE of neoplastic lesions was also intensified by LCI. In magnified images, BLI and LCI significantly increased the ΔE between the vessel and non-vessel areas compared with WL. Luminal brightness, indicated by L*, was not impaired by LCI; however, was reduced by BLI compared with WL and LCI. These results suggest that LCI enhanced the detection of colonic neoplasms without impairing luminal brightness. We propose the routine use of LCI for colonic polyp detection and BLI for magnifying observations of colonic polyps detected by LCI.
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Affiliation(s)
- Yasuyoshi Tanaka
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan
| | - Takuya Inoue
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan.,Department of Gastroenterology, Inoue Gastroenterology and Endoscopy Clinic, Osaka 595-0072, Japan
| | - Kazuki Kakimoto
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan
| | - Kei Nakazawa
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan
| | - Hideki Tawa
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan
| | - Yuki Hirata
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan
| | - Toshihiko Okada
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan
| | - Sadaharu Nouda
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan
| | - Ken Kawakami
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan
| | - Toshihisa Takeuchi
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan
| | - Yutaro Egashira
- Department of Pathology, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan
| | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan
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Li L, Ou Y, Yue H, Sun H, Chen P, Liu S, He F, Peng Q, Deng S. Comparison of the detection of colorectal lesions in different endoscopic modalities: A network meta-analysis and systematic review. Exp Ther Med 2019; 18:154-162. [PMID: 31258649 DOI: 10.3892/etm.2019.7535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 10/19/2018] [Indexed: 12/11/2022] Open
Abstract
A colonoscopy is considered to be the standard diagnostic test used to detect early colorectal lesions. Detection rates are expected to improve with optimised visualisation. A systematic review and network meta-analysis was conducted to evaluate detection efficiency in several colonoscopic modalities. Relevant articles were identified in searches of the PubMed, EMBASE and Cochrane Library databases. The modalities, comprising of standard-definition white light (SDWL), high-definition white light (HDWL), narrow-band imaging (NBI), autofluorescence imaging (AFI), PENTAX image enhanced technology (i-SCAN), Fuji Intelligent Color Enhancement (FICE), dye-based chromoendoscopy and novel image enhanced systems, including blue laser imaging (BLI) and linked color imaging (LCI), were compared to identify the most efficient modalities that could be used to detect colorectal lesions. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated. As a result, 40 studies fulfilled the inclusion criteria. Overall, in the network meta-analyses, NBI (OR, 1.29; 95% CI, 1.04-1.58), FICE (OR, 1.39; 95% CI, 1.11-1.77), chromoendoscopy (OR, 1.53; 95% CI, 1.22-1.93) and AFI (OR, 1.81; 95% CI, 1.07-2.87) were significantly better compared with SDWL at identifying adenoma in patients, and chromoendoscopy also proved significantly superior to HDWL (OR, 1.30; 95% CI, 1.06-1.60). In pairwise analyses, it was demonstrated that chromoendoscopy was significantly superior to HDWL at detecting the number of polyps (MD, -1.11; 95% CI, -1.46, -0.76) and flat lesions (MD, -0.30; 95% CI, -0.49, -0.10) per subject. Additionally, FICE detected a significantly greater number of subjects with polyps (OR, 0.78; 95% CI, 0.64-0.96) and NBI was significantly better at detecting the number of subjects with flat lesions (OR, 0.77; 95% CI, 0.60-0.99) compared with HDWL. Based on the meta-analysis, NBI, FICE and AFI were significantly better compared with SDWL at detecting patients with adenoma. Additionally, chromoendoscopy was significantly better than SDWL and HDWL at detecting the number of colorectal adenoma, however additional studies are needed to confirm these findings.
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Affiliation(s)
- Lifu Li
- Department of Gastroenterology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Yinghua Ou
- Department of Gastroenterology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Hui Yue
- Department of Gastroenterology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Hong Sun
- Department of Gastroenterology, Nanfang Hospital, Guangzhou, Guangdong 510000, P.R. China
| | - Peisheng Chen
- Department of Gastroenterology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Suying Liu
- Department of Gastroenterology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Fengjian He
- Department of Gastroenterology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Qianqian Peng
- Department of Gastroenterology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Sanhua Deng
- Department of Gastroenterology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
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11
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Ahmed S, Strand S, Weinmann-Menke J, Urbansky L, Galle PR, Neumann H. Molecular endoscopic imaging in cancer. Dig Endosc 2018; 30:719-729. [PMID: 29846982 DOI: 10.1111/den.13199] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/21/2018] [Indexed: 12/14/2022]
Abstract
Cancer is one of the major causes of death in both the USA and Europe. Molecular imaging is a novel field that is revolutionizing cancer management. It is based on the molecular signature of cells in order to study the human body both in normal and diseased conditions. The emergence of molecular imaging has been driven by the difficulties associated with cancer detection, particularly early-stage premalignant lesions which are often unnoticed as a result of minimal or no structural changes. Endoscopic surveillance is the standard method for early-stage cancer detection. In addition to recent major advancements in endoscopic instruments, significant progress has been achieved in the exploration of highly specific molecular probes and the combination of both will permit significant improvement of patient care. In this review, we provide an outline of the current status of endoscopic imaging and focus on recent applications of molecular imaging in gastrointestinal, hepatic and other cancers in the context of detection, targeted therapy and personalized medicine. As new imaging agents have the potential to broadly expand our cancer diagnostic capability, we will also present an overview of the main types of optical molecular probes with their pros and cons. We conclude by discussing the challenges and future prospects of the field.
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Affiliation(s)
- Shakil Ahmed
- Department of Interdisciplinary Endoscopy, I. Medical Clinic and Polyclinic, University Hospital Mainz, Mainz, Germany
| | - Susanne Strand
- Department of Interdisciplinary Endoscopy, I. Medical Clinic and Polyclinic, University Hospital Mainz, Mainz, Germany
| | - Julia Weinmann-Menke
- Department of Interdisciplinary Endoscopy, I. Medical Clinic and Polyclinic, University Hospital Mainz, Mainz, Germany
| | - Lana Urbansky
- Department of Interdisciplinary Endoscopy, I. Medical Clinic and Polyclinic, University Hospital Mainz, Mainz, Germany
| | - Peter R Galle
- Department of Interdisciplinary Endoscopy, I. Medical Clinic and Polyclinic, University Hospital Mainz, Mainz, Germany
| | - Helmut Neumann
- Department of Interdisciplinary Endoscopy, I. Medical Clinic and Polyclinic, University Hospital Mainz, Mainz, Germany
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12
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Abstract
GOALS To compare the adenoma detection rate (ADR) during colonoscopy in patients with melanosis coli against matched controls without melanosis. BACKGROUND Melanosis coli is a colonoscopic finding in which the colon wall appears darkly pigmented, most often due to extended laxative use, and is considered benign. The pigmentation spares adenomas, which should therefore be more readily detectable in melanosis coli. STUDY We identified all patients with melanosis on colonoscopy at our institution over a 5-year period. We matched each patient with 2 controls by age, gender, and endoscopist. We compared the prevalence of adenomas between groups, and used multivariable analysis, adjusting for procedure indication and bowel preparation quality, to determine the independent association of melanosis with adenoma detection. RESULTS At least 1 adenoma was detected in 34.7% of melanosis patients and 26.5% of controls [odds ratio (OR)=1.52; 95% confidence interval (CI), 1.04-2.24; P=0.03]. On multivariable analysis, the presence of melanosis remained associated with increased adenoma detection (OR=1.56; 95% CI, 1.05-2.33; P=0.03). Melanosis patients were more likely to have an adenoma ≤5 mm (OR=1.62; 95% CI, 1.04-2.51; P=0.03), but not adenomas 6 to 9 mm or ≥10 mm. CONCLUSIONS Melanosis coli is associated with a significant increase in ADR during colonoscopy compared with controls. The increased visibility of adenomas given their contrast with the pigmented background is a likely explanation. Future efforts to identify bowel preparation agents that can induce a similar effect could improve ADRs during colonoscopy.
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13
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Bhandari P, Thayalasekaran S, Keisslich R, Bisschops R, Hoffmann A, Haidry R, Esteban J, López Viedma B, Godzhello E, Almadi M, Neumann H, Sanduleanu S. Detection and characterization of colorectal polyps using high-definition white light and i-Scan: Evidence-based consensus recommendations using a modified Delphi process. United European Gastroenterol J 2018; 6:748-754. [PMID: 30083337 DOI: 10.1177/2050640618764531] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/30/2017] [Indexed: 12/12/2022] Open
Abstract
Background i-Scan is an image enhancement modality, which provides enhanced views of mucosal structures and vascular patterns. Methods A modified Delphi process was used to develop a series of evidence-based statements on the role of high-definition white light (HDWL) and i-Scan for the detection and diagnosis of colorectal neoplasms. Each statement was voted to achieve consensus (i.e. >80% agreement). Results Seven proposed statements achieved consensus: (1) HDWL is recommended rather than standard definition (SD) for detection and diagnosis of colorectal neoplasms; (2) HDWL colonoscopy with i-Scan improves polyp and adenoma detection rates when compared with SD colonoscopy; (3) HDWL + i-Scan is superior to HDWL alone for the optical diagnosis of colorectal neoplasms; (4) HDWL + i-Scan in expert hands meets American Society for Gastrointestinal Endoscopy (ASGE) in the Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) standards for optical diagnosis of diminutive neoplasms; (5) HDWL + i-Scan in non-expert hands does not meet ASGE PIVI standards for optical diagnosis of diminutive neoplasms; (6) optical diagnosis of polyps with i-Scan has a learning curve and needs systematic training; and (7) the performance of i-Scan for the in vivo diagnosis of colorectal neoplasms is similar to Narrow Band Imaging (NBI) and Fuji Intelligent Chromo Endoscopy (FICE). Conclusions Seven proposed statements on the use of HDWL and i-Scan for the detection and diagnosis of colorectal neoplasms achieved consensus.
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Affiliation(s)
| | | | | | - Raf Bisschops
- Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | | | | | | | | | | | - Majid Almadi
- King Khalid University Hospital, Medicine, King Saud University
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14
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Oka S, Tanaka S, Sano Y, Saitoh Y, Shimoda R, Tajiri H. Advanced diagnostic endoscopy in the lower gastrointestinal tract: A review of JGES core sessions. Dig Endosc 2018; 30:192-197. [PMID: 29055071 DOI: 10.1111/den.12977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 10/16/2017] [Indexed: 12/20/2022]
Abstract
At each of the 89th to the 92nd congresses of the Japan Gastroenterological Endoscopy Society, a series of featured discussion sessions concerning advanced diagnostic endoscopy in the lower gastrointestinal tract were presented. In total, 45 lectures were presented in this subject area. It was shown that, in recent years, several convenient and less invasive colonoscopic modalities have been developed. This review article summarizes these core sessions and the efficacy of the techniques discussed.
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Affiliation(s)
- Shiro Oka
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Yasushi Sano
- Gastrointestinal Center & Institute of Minimally-invasive Endoscopic Care (iMEC), Sano Hospital, Hyogo, Japan
| | - Yusuke Saitoh
- Digestive Disease Center, Asahikawa City Hospital, Asahikawa, Japan
| | - Ryo Shimoda
- Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School, Saga, Japan
| | - Hisao Tajiri
- Department of Innovative Interventional Endoscopy Research, The Jikei University School of Medicine, Tokyo, Japan
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15
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Suzuki T, Hara T, Kitagawa Y, Takashiro H, Nankinzan R, Sugita O, Yamaguchi T. Linked-color imaging improves endoscopic visibility of colorectal nongranular flat lesions. Gastrointest Endosc 2017; 86:692-697. [PMID: 28193491 DOI: 10.1016/j.gie.2017.01.044] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 01/31/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS As a newly developed image-enhanced endoscopy (IEE) technique, linked-color imaging (LCI) provides very bright images with enhanced color tones. With the objective of improving the detection rate of colorectal flat tumor lesions, which are difficult to detect, we examined the usefulness of LCI from the viewpoint of visibility. METHODS Fifty-three consecutive nongranular flat tumors were used in this study. Endoscopic images were acquired by white-light imaging (WLI), blue-laser imaging (BLI)-bright, and LCI modes. For each lesion, we selected 1 image each acquired by WLI, BLI-bright, and LCI modes. Six endoscopists interpreted the images. By using a previously reported visibility scale, we scored the visibility level on a scale of 1 to 4. RESULTS The mean (± standard deviation) visibility scores were 2.74 ± 1.08 for WLI, 2.94 ± 0.97 for BLI-bright, and 3.36 ± 0.72 for LCI. The score was significantly higher for BLI-bright compared with WLI (P < .001) and again higher for LCI compared with BLI-bright (P < .001). When we compared between experts and trainees, the corresponding scores of experts were 2.83 ± 1.06, 3.17 ± 0.88, and 3.40 ± 0.74, with a tendency similar to the scores of all endoscopists. For the trainees, there was no difference between the scores for WLI (2.65 ± 1.10) and BLI-bright (2.71 ± 1.00), but the score for LCI (3.31 ± 0.69) was significantly higher than that for WLI or BLI-bright (P < .001). When only sessile serrated adenoma/polyp lesions were analyzed, LCI remained significantly higher than the other 2. CONCLUSIONS The present findings suggest that LCI increases the visibility of colorectal flat lesions and contributes to improvement of the detection rate for these lesions.
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Affiliation(s)
- Takuto Suzuki
- Department of Endoscopy, Chiba Cancer Center, Chuoku, Chiba, Japan
| | | | | | - Hideyuki Takashiro
- Department of Gastroenterology, Chiba Cancer Center, Chuoku, Chiba, Japan
| | - Rino Nankinzan
- Department of Gastroenterology, Chiba Cancer Center, Chuoku, Chiba, Japan
| | - Osamu Sugita
- Department of Gastroenterology, Chiba Cancer Center, Chuoku, Chiba, Japan
| | - Taketo Yamaguchi
- Department of Gastroenterology, Chiba Cancer Center, Chuoku, Chiba, Japan
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16
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Buchner AM. The Role of Chromoendoscopy in Evaluating Colorectal Dysplasia. Gastroenterol Hepatol (N Y) 2017; 13:336-347. [PMID: 28690450 PMCID: PMC5495038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Chromoendoscopy pertains to image-enhanced endoscopic techniques such as dye-based chromoendoscopy and electronic chromoendoscopy using narrow-band imaging, flexible spectral imaging color enhancement, and i-scan. Dye-based chromoendoscopy has been demonstrated to improve colorectal dysplasia detection in high-risk patients with long-term inflammatory bowel disease, and electronic chromoendoscopy techniques have been shown to improve characterization of diminutive colorectal lesions, allowing for optical diagnosis during a colonoscopy examination. This article reviews endoscopic imaging using chromoendoscopy techniques for colorectal dysplasia evaluation.
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Affiliation(s)
- Anna M Buchner
- Dr Buchner is an assistant professor of medicine in the Division of Gastroenterology at the University of Pennsylvania in Philadelphia, Pennsylvania
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17
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Herreros de Tejada A, González-Lois C, Santiago J. Serrated lesions and serrated polyposis syndrome. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 109:516-526. [PMID: 28530106 DOI: 10.17235/reed.2017.4065/2015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The serrated pathway has been shown to be an alternative colorectal carcinogenetic route potentially accounting for up to one third of all CRCs. Serrated lesions, particularly SSPs, have been a focus of research during the past few years. They have well-established histological and molecular characteristics that account for their potential carcinogenetic risk through the accumulation BRAF, KRAS and methylator profile (CpG) mutations. Their endoscopic identification and resection represent a challenge because of their specific characteristics, and the need for an adequate specimen for histological diagnosis. Knowledge of these lesions is key, as is the adoption of established criteria for their endoscopic description and histological diagnosis. SPS is the maximum expression of involvement by serrated lesions, is associated with increased risk for CRC, and requires attentive endoscopic follow-up, as well as family screening. While the exact etiopathogenic mechanism remains unknown, current research will likely provide us with appropriate answers in the not too distant future.
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Affiliation(s)
| | - Carmen González-Lois
- Anatomía Patológica, Hospital Universitario Puerta de Hierro Majadahonda, España
| | - José Santiago
- Digestivo, Hospital Universitario Puerta de Hierro Majadahonda, España
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18
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Matsuda T, Ono A, Sekiguchi M, Fujii T, Saito Y. Advances in image enhancement in colonoscopy for detection of adenomas. Nat Rev Gastroenterol Hepatol 2017; 14:305-314. [PMID: 28293023 DOI: 10.1038/nrgastro.2017.18] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
High-quality colonoscopy is mandatory to prevent adenoma recurrence and colorectal cancer. In the past few years, technical advances have been developed with the purpose of improving adenoma detection rate (ADR), one of the most important validated colonoscopy quality benchmarks. Several techniques or devices are used to optimize visualization: observation techniques; add-on devices; auxiliary imaging devices; colonoscopes with increased field of view; and colonoscopes with an integrated inflatable reusable balloon. Image-enhanced endoscopy (IEE) facilitates the detection and characterization of polyps and especially nonpolypoid colorectal neoplasms. Indigo carmine is the most frequently used dye in colonoscopy as it deposits in depressed areas, improving detection of flat and depressed lesions. Virtual chromoendoscopy has emerged as an effective contrast enhancement technology without the limitation of preparing dyes and applying them through the colonoscope working channel. Narrow-band imaging (NBI) enhances the capillary pattern and surface of the mucosa using optical filters, and second-generation NBI provides a twofold brighter image than the previous system, yielding promising ADR results. Moreover, a second-generation blue laser imaging system, LASEREO, has been reported to improve not only polyp detection rate but also ADR, becoming a promising IEE modality. Herein, we describe technical advances in colonoscopy imaging and their effect on ADR.
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Affiliation(s)
- Takahisa Matsuda
- Cancer Screening Center, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.,Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.,Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Akiko Ono
- Department of Gastroenterology, Hospital Clínico Universitario Virgen de la Arrixaca, Ctra. Madrid-Cartagena s/n, El Palmar, 30128, Murcia, Spain
| | - Masau Sekiguchi
- Cancer Screening Center, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.,Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.,Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Takahiro Fujii
- TF Clinic, 4-13-11 Ginza, Chuo-ku, Tokyo 104-0061, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
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19
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Okamoto K, Kitamura S, Kimura T, Nakagawa T, Sogabe M, Miyamoto H, Muguruma N, Takayama T. Clinicopathological characteristics of serrated polyps as precursors to colorectal cancer: Current status and management. J Gastroenterol Hepatol 2017; 32:358-367. [PMID: 27376251 DOI: 10.1111/jgh.13482] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2016] [Indexed: 12/13/2022]
Abstract
Serrated polyps have long been thought to lack malignant potential in the human colorectum. However, identification of the serrated pathway to colorectal cancer based on molecular biology has improved our understanding of the pathogenesis of colorectal cancers. Accordingly, serrated polyps such as traditional serrated adenoma and sessile serrated adenoma/polyps (SSA/P) are now considered to be precursor lesions of the serrated pathway. Recently, serrated polyps were classified into three subtypes, consisting of hyperplastic polyp, SSA/P, and traditional serrated adenoma, according to the World Health Organization classification. It has been suggested that SSA/P in the proximal colon are a precursor lesion of pathogenesis of colorectal cancer and are characterized by BRAF mutation and a CpG island methylator phenotype with or without microsatellite instability. However, SSA/P is more challenging to detect by colonoscopy and is likely to account for some interval cancers, particularly in the proximal colon because it presents flat or sessile, isochroous appearance, and occasionally has a mucous cap. Furthermore, the possibility has been raised that pathologists misclassify SSA/P as hyperplastic polyp. It is important for gastroenterologists to recognize the endoscopic features of serrated polyps to facilitate their detection and removal and also to establish postpolypectomy surveillance guidelines. In this review, we discuss the recent classification of serrated polyps; the molecular characteristics of the serrated pathway; appropriate diagnostic methods using endoscopy, including a new image-enhanced endoscopic technique; and management of these lesions.
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Affiliation(s)
- Koichi Okamoto
- Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Shinji Kitamura
- Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Tetsuo Kimura
- Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Tadahiko Nakagawa
- Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Masahiro Sogabe
- Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Hiroshi Miyamoto
- Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Naoki Muguruma
- Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Tetsuji Takayama
- Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
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Dolz-Abadía C, Vilella-Martorell A. [Submucosal chromoendoscopy. A technique that highlights epithelia and differentiates histological components, and renders colon polypectomy easier and safer]. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2016; 107:430-5. [PMID: 26140636 DOI: 10.17235/reed.2015.3550/2014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Submucosal chromoendoscopy involves the injection of a solution containing a vital stain, usually indigo carmine, into the intestinal wall submucosal layer. This allows to: Better delimit and characterize the various epithelia present (colonic mucosa, adenoma, hyperplastic polyp, serrated polyp, small bowel mucosa); expose and delimit lesion implantation areas; cooperate in the lifting of resectable lesions; ensure section across the submucosal plane; identify intestinal wall structures; render complex polypectomy feasible; and facilitate the identification of perforations.The present paper offers information on the endoscopic technique for submucosal injection, solution preparation and concentration, and on the potential benefits it may provide for polypectomy or endocopic mucosal resection whether en block or piecemeal. This endoscopic technique simultaneously combines a diagnostic and a therapeutic aspect, since lesion lifting in association with better delimited contours may improve not only accuracy but also endoscopic resection safety and feasibility.
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Brown SR, Baraza W, Din S, Riley S. Chromoscopy versus conventional endoscopy for the detection of polyps in the colon and rectum. Cochrane Database Syst Rev 2016; 4:CD006439. [PMID: 27056645 PMCID: PMC8749964 DOI: 10.1002/14651858.cd006439.pub4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although conventional colonoscopy is the most accurate test available for the investigation of the colorectum for polyps, data exist that raise concerns about its sensitivity. Chromoscopy (spraying dye onto the surface of the colon to make polyps more visible) may be one way of enhancing the ability of colonoscopy to detect polyps, particularly diminutive flat lesions, which otherwise may be difficult to detect. OBJECTIVES To determine whether the use of chromoscopy enhances the detection of polyps and neoplasia during endoscopic examination of the colon and rectum. SEARCH METHODS We searched the following databases: Cochrane Colorectal Cancer Group Specialised Register (October 2015), Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library; Issue 10, 2015), MEDLINE (January 1950 to October 2015), EMBASE (January 1974 to October 2015), and ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform (both November 2015). We also handsearched abstracts from relevant meetings from 1980 to 2015. Search terms included 'randomised trials' containing combinations of the following: 'chromoscopy' 'colonoscopy' 'dye-spray' 'chromo-endoscopy' 'indigo-carmine' 'magnifying endoscopy'. SELECTION CRITERIA We included all prospective randomised trials comparing chromoscopic with conventional endoscopic examination of the whole of the colon and rectum. We excluded studies of people with inflammatory bowel disease or polyposis syndromes and any studies that combined chromoscopy with additional interventions (cap assistance, water-perfused, etc.). DATA COLLECTION AND ANALYSIS Two review authors independently assessed the methodological quality of potentially eligible trials, and two review authors independently extracted data from the included trials. Outcome measures included the detection of polyps (neoplastic and non-neoplastic), the detection of diminutive lesions, the number of participants with multiple neoplastic lesions, and the extubation time. MAIN RESULTS We included seven trials (2727 participants) in this update. Five trials were of sufficiently similar design to allow for pooled results. Two trials differed substantially in design and were included in a subgroup analysis. All the trials had some methodological drawbacks. However, combining the results showed a significant difference in favour of chromoscopy for all detection outcomes. In particular, chromoscopy was likely to yield significantly more people with at least one neoplastic lesion (odds ratio (OR) 1.53, 95% confidence interval (CI) 1.31 to 1.79; 7 trials; 2727 participants), and at least one diminutive neoplastic lesion (OR 1.51, 95% CI 1.19 to 1.92; 4 trials; 1757 participants). Significantly more people with three or more neoplastic lesions were also detected, but only when studies that used high-definition colonoscopy in the control group were excluded (OR 4.63, 95% CI 1.99 to 10.80; 2 trials; 519 participants). None of the included studies reported any adverse events related to the use of the contrast dye. AUTHORS' CONCLUSIONS There is strong evidence that chromoscopy enhances the detection of neoplasia in the colon and rectum. People with neoplastic polyps, particularly those with multiple polyps, are at increased risk of developing colorectal cancer. Such lesions, which presumably would be missed with conventional colonoscopy, could contribute to the interval cancer numbers on any surveillance programme.
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Affiliation(s)
- Steven R Brown
- Sheffield Teaching HospitalsSurgeryDept Surgery, Northern General HospitalHerried RoadSheffield S7South YorkshireUKS5 7AU
| | - Wal Baraza
- NHSColorectal Surgery59 Ryegate Road SheffieldSheffieldYorkshireUKS10 5FB
| | - Said Din
- Sheffield Teaching HospitalsDepartment of GastroenterologySheffieldUK
| | - Stuart Riley
- Sheffield Teaching HospitalsDepartment of GastroenterologySheffieldUK
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Lee HS, Jeon SW. Is Retroflexion Helpful in Detecting Adenomas in the Right Colon?: A Single Center Interim Analysis. Intest Res 2015; 13:326-31. [PMID: 26576138 PMCID: PMC4641859 DOI: 10.5217/ir.2015.13.4.326] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 11/15/2014] [Accepted: 12/30/2014] [Indexed: 12/14/2022] Open
Abstract
Background/Aims Colonoscopy is less effective at screening for colorectal cancer in the right side of the colon. Retroflexion during colonoscopy is expected to improve the detection rate of colorectal adenomas. The aim of the present study was to evaluate the usefulness of retroflexion in the right-sided colon. Methods From April to November 2013, a total of 398 patients were enrolled in this study. For each patient, a cap-assisted colonoscopic examination was performed. After cecal intubation, a forward view examination from the cecum up to the hepatic flexure was performed and all identified polyps were removed. The colonoscope was reinserted to the cecum, and a careful second forward view examination of the cecum to the hepatic flexure was performed, with removal of additionally identified polyps. The colonoscope was then reinserted to the cecum and retroflexed; a third colonoscopic examination was then performed to the hepatic flexure in retroflexion with removal of additional polyps. Total polyp numbers and characteristics were compared between the two forward view examinations and the retroflexion examination. Results A successful retroflexion was performed in 90.2% of patients. A total of 213 polyps and 143 adenomas were detected in the right-sided colon using the routine method of examining the right colon twice in forward view. An additional 35 polyps and 24 adenomas were detected on retroflexion. Of these 35 polyps, 27 (77.1%) were small-sized polyps (≤5 mm) and 24 (71.4%) were adenomas. Finding additional adenomas using the retroflexion technique was associated with older age. Conclusions Colonoscopic retroflexion is helpful in the detection of cecum and ascending colon adenomas, especially small-sized adenomas (≤5 mm). It is particularly useful in older patients.
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Affiliation(s)
- Hyun Seok Lee
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seong Woo Jeon
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
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Abstract
Chromoendoscopy techniques improve the visualization of mucosal structures. This article reviews and summarizes key studies addressing the impact of chromoendoscopy on colonic neoplasia detection and differentiation of neoplastic from non-neoplastic polyps in average and high-risk populations, including patients with colonic inflammatory bowel disease (IBD). In this context, there are convincing data that chromoendoscopy differentiates neoplastic from non-neoplastic polyps in average-risk populations with high accuracy. Moreover, dye-based chromoendoscopy improves neoplasia detection in colonic IBD surveillance.
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Affiliation(s)
- Michael J Bartel
- Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Michael F Picco
- Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Michael B Wallace
- Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
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24
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Magnification endoscopy with acetic acid enhancement and a narrow-band imaging system for pit pattern diagnosis of colorectal neoplasms. J Clin Gastroenterol 2015; 49:306-12. [PMID: 24804989 DOI: 10.1097/mcg.0000000000000148] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND GOALS Pit pattern (PP) analysis of colorectal neoplasms using magnification chromoendoscopy with crystal violet (CV-MCE) is useful for predicting histologic features, but it is time consuming. Capillary pattern analysis by magnification endoscopy with narrow-band imaging (NBIME) is a useful and simpler procedure, but its diagnostic accuracy may be inferior to CV-MCE. NBIME with acetic acid enhancement (A-NBIME) is effective for rapid visualization of gastric mucosal microstructures. We performed a prospective study to compare the diagnostic reliability and feasibility of A-NBIME and CV-MCE in PP diagnosis of colorectal neoplasms. STUDY The present study consisted of 3 protocols: Study-1 assessed 56 colorectal lesions photographed with A-NBIME and CV-MCE, and the endoscopic images were reviewed by 3 experts to compare the diagnostic concordance; study-2 assessed 202 colorectal lesions photographed with A-NBIME in 116 consecutive patients and the correlation between PP and histologic findings; study-3 randomly allocated 100 patients with colorectal lesions equally to A-NBIME and CV-MCE, and compared the procedure time and visible ratio of PP. RESULTS The κ value for interobserver agreement for A-NBIME and CV-MCE was 0.71 (0.66 to 0.75) and 0.80 (0.75 to 0.85), respectively. Intraobserver agreement between modalities for each reviewer was 0.79 (0.70 to 0.88), 0.80 (0.71 to 0.90), and 0.74 (0.67 to 0.82). Non-neoplastic polyps and massively invasive submucosal adenocarcinomas were statistically related to type II and type VI-H/VN. The procedure time was statistically shorter with A-NBIME than with CV-MCE (31 vs. 81 s), and the visible ratio of PP was equivalent (98.9% vs. 98.3%). CONCLUSIONS A-NBIME is comparable with CV-MCE in PP diagnosis of colorectal neoplasms and is a simpler technique.
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Matsuda T, Kawano H, Chiu HM. Screening colonoscopy: what is the most reliable modality for the detection and characterization of colorectal lesions? Dig Endosc 2015; 27 Suppl 1:25-9. [PMID: 25630990 DOI: 10.1111/den.12451] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 01/26/2015] [Indexed: 01/27/2023]
Abstract
Colonoscopy is considered the best modality for the detection and treatment of colorectal polyps. However, some polyps still may not be detected. Although conventional white-light endoscopy is the gold standard for the detection of colorectal polyps, up to a fifth of lesions may be missed on screening colonoscopy, especially non-polypoid colorectal neoplasms. Recently, many studies have reported on various endoscopic modalities that improve the detection and characterization of colorectal lesions. Newly developed modalities might be helpful to recognize colorectal lesions; however, careful observation is required to identify flat/depressed lesions as well as hidden polyps during screening and surveillance colonoscopy.
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Affiliation(s)
- Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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26
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Oka S, Tamai N, Ikematsu H, Kawamura T, Sawaya M, Takeuchi Y, Uraoka T, Moriyama T, Kawano H, Matsuda T. Improved visibility of colorectal flat tumors using image-enhanced endoscopy. Dig Endosc 2015; 27 Suppl 1:35-9. [PMID: 25612053 DOI: 10.1111/den.12445] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 01/18/2015] [Indexed: 02/08/2023]
Abstract
Colonoscopy is considered the gold standard for detecting colorectal tumors; however, conventional colonoscopy can miss flat tumors. We aimed to determine whether visualization of colorectal flat lesions was improved by autofluorescence imaging and narrow-band imaging image analysis in conjunction with a new endoscopy system. Eight physicians compared autofluorescent, narrow-band, and chromoendoscopy images to 30 corresponding white-light images of flat tumors. Physicians rated tumor visibility from each image set as follows: +2 (improved), +1 (somewhat improved), 0 (equivalent to white light), -1 (somewhat decreased), and -2 (decreased). The eight scores for each image were totalled and evaluated. Interobserver agreement was also examined. Autofluorescent, narrow-band, and chromoendoscopy images showed improvements of 63.3% (19/30), 6.7% (2/30), and 73.3% (22/30), respectively, with no instances of decreased visibility. Autofluorescence scores were generally greater than narrow-band scores. Interobserver agreement was 0.65 for autofluorescence, 0.80 for narrow-band imaging, and 0.70 for chromoendoscopy. In conclusion, using a new endoscopy system in conjunction with autofluorescent imaging improved visibility of colorectal flat tumors, equivalent to the visibility achieved using chromoendoscopy.
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Affiliation(s)
- Shiro Oka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
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Rai T, Navaneethan U, Gohel T, Podugu A, Thota PN, Kiran RP, Lopez R, Sanaka MR. Effect of quality of bowel preparation on quality indicators of adenoma detection rates and colonoscopy completion rates. Gastroenterol Rep (Oxf) 2015; 4:148-53. [PMID: 25680361 PMCID: PMC4863185 DOI: 10.1093/gastro/gov002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 01/09/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND AIM Adequate bowel preparation is important for safe and effective colonoscopy. Quality indicators (QI) for colonoscopy include achieving at least 95% completion rate and an adenoma detection rate (ADR) of at least 25% in average-risk men and 15% in average-risk women aged over 50. Our aim was to investigate the impact of bowel preparation on ADR and colonoscopy completion rates. METHODS This retrospective cohort study included patients who underwent colonoscopy between January 2008 and December 2009. The main outcome measurements were ADR and colonoscopy completion rates to the cecum. RESULTS A total of 2519 patients was included; 1030 (41.0%) had excellent preparation, 1145 (45.5%) good-, 240 (9.5%) fair-, and 104 (4.1%) poor preparation. Colonoscopy completion rates were significantly lower in patients with poor or fair preparation (72.1% and 75.4%, respectively) than in those with good and excellent preparation (99.7% and 99.9%, respectively; P < 0.001), and significantly lower than the QI of 95% (P < 0.001). ADR in men and women combined was similar in all four grades of preparation (excellent, good, fair and poor) at 24.2% vs. 26.8% vs. 32.1% vs. 22.1%, respectively; P = 0.06. All the groups had ADR above the QI (25% for men and 15% for women) with evidence of significantly higher ADR in the women with excellent or good preparation and in men with excellent, good or fair preparation. On multivariate analysis, male gender was significantly associated with increased ADR (P < 0.001), while the quality of bowel preparation did not influence ADR. CONCLUSIONS Patients with fair and poor standards of preparation have significantly lower colonoscopy completion rates than those with excellent and good preparation. However, there was no difference in ADR between the different grades of preparation.
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Affiliation(s)
- Tarun Rai
- Digestive Disease Institute, The Cleveland Clinic, Cleveland, OH, USA
| | | | - Tushar Gohel
- Digestive Disease Institute, The Cleveland Clinic, Cleveland, OH, USA
| | - Amareshwar Podugu
- Digestive Disease Institute, The Cleveland Clinic, Cleveland, OH, USA
| | | | - Ravi P Kiran
- Digestive Disease Institute, The Cleveland Clinic, Cleveland, OH, USA
| | - Rocio Lopez
- Digestive Disease Institute, The Cleveland Clinic, Cleveland, OH, USA
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Rahmi G, Lecomte T, Malka D, Maniere T, Le Rhun M, Guimbaud R, Lapalus MG, Le Sidaner A, Moussata D, Caron O, Barbieux JP, Gaudric M, Coron E, Barange K, Ponchon T, Sautereau D, Samaha E, Saurin JC, Chaussade S, Laurent-Puig P, Chatellier G, Cellier C. Impact of chromoscopy on adenoma detection in patients with Lynch syndrome: a prospective, multicenter, blinded, tandem colonoscopy study. Am J Gastroenterol 2015; 110:288-98. [PMID: 25601014 DOI: 10.1038/ajg.2014.423] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 12/02/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVES In Lynch syndrome, flat and diminutive adenomas are particularly prone to malignant transformation, but they can be missed by standard colonoscopy. It is not known whether chromocolonoscopy is able to detect more adenomas than standard colonoscopy in patients with Lynch syndrome. METHODS We conducted a prospective, multicenter, randomized trial to compare standard colonoscopy with standard colonoscopy followed by pancolonic chromoscopy with indigo carmine in patients with a proven germline mutation in a mismatch-repair gene related to Lynch syndrome and who were undergoing screening or surveillance colonoscopy. Standard colonoscopy was used first to detect visible lesions. Colonoscopy with chromoscopy was then performed by a second gastroenterologist (blinded to the findings of the first colonoscopy) to detect additional lesions. The primary end point was the number of patients in whom at least one adenoma was detected. RESULTS A total of 78 eligible patients (median age, 45 years) were enrolled at 10 centers from July 2008 to August 2009. Significantly more patients with at least one adenoma were identified by chromocolonoscopy (32/78 (41%)) than by standard colonoscopy (18/78 (23%); P<0.001). The percentage of patients in whom at least one additional adenoma was detected during the chromoscopy was 31% (24/78). Overall, chromocolonoscopy plus colonoscopy detected a total of 55 adenomas in 32 patients (mean number of adenomas detected per patient: 0.7 vs. standard colonoscopy alone: 0.3; P<0.001). CONCLUSION The results support the proposition that chromocolonoscopy may significantly improve the detection rate of colorectal adenomas in patients undergoing screening or surveillance colonoscopy for Lynch syndrome.
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Affiliation(s)
- Gabriel Rahmi
- 1] Université Paris Descartes, Paris, France; Paris Sorbonne Cité, Paris, France [2] Assistance Publique des Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Thierry Lecomte
- 1] Université François-Rabelais, Paris, France [2] Service d'Hépato-gastroentérologie et de Cancérologie digestive, CHRU de Tours, Paris, France
| | - David Malka
- Département de Médecine Oncologique, Unité d'oncologie digestive, Institut Gustave Roussy, Villejuif, France
| | - Thibault Maniere
- 1] Université Paris Descartes, Paris, France; Paris Sorbonne Cité, Paris, France [2] Assistance Publique des Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Marc Le Rhun
- Service d'Hépato-gastroentérologie, CHU de Nantes, Nantes, France
| | - Rosine Guimbaud
- 1] Service d'oncologie, Hôpital Purpan, Toulouse, France [2] Université de Toulouse 3 University, Toulouse, France
| | | | - Anne Le Sidaner
- Service d'Hépato-gastroentérologie, CHU Dupuytren, Limoges, France
| | - Driffa Moussata
- Service de Gastroentérologie, Hôpital Lyon Sud, Lyon, France
| | - Olivier Caron
- Service d'oncogénétique, Institut Gustave Roussy, Villejuif, France
| | - Jean-Pierre Barbieux
- Service d'Hépato-gastroentérologie et de Cancérologie digestive, CHRU de Tours, Paris, France
| | - Marianne Gaudric
- Assistance Publique des Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Cochin, Paris, France
| | - Emmanuel Coron
- Service d'Hépato-gastroentérologie, CHU de Nantes, Nantes, France
| | - Karl Barange
- Service d'Hépato-gastroentérologie, Hôpital Purpan, Toulouse, France
| | - Thierry Ponchon
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Lyon, France
| | - Denis Sautereau
- Service d'Hépato-gastroentérologie, CHU Dupuytren, Limoges, France
| | - Elia Samaha
- Assistance Publique des Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Stanislas Chaussade
- 1] Université Paris Descartes, Paris, France; Paris Sorbonne Cité, Paris, France [2] Assistance Publique des Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Cochin, Paris, France
| | - Pierre Laurent-Puig
- 1] Université Paris Descartes, Paris, France; Paris Sorbonne Cité, Paris, France [2] Assistance Publique des Hôpitaux de Paris, Unité d'oncogénétique, Hôpital Européen Georges Pompidou, Paris, France
| | - Gilles Chatellier
- 1] Université Paris Descartes, Paris, France; Paris Sorbonne Cité, Paris, France [2] Assistance Publique des Hôpitaux de Paris, Unité d'épidémiologie et de recherche clinique, Hôpital européen Georges Pompidou, Paris, France
| | - Christophe Cellier
- 1] Université Paris Descartes, Paris, France; Paris Sorbonne Cité, Paris, France [2] Assistance Publique des Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Européen Georges Pompidou, Paris, France
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Toyoshima N, Sakamoto T, Makazu M, Nakajima T, Matsuda T, Kushima R, Shimoda T, Fujii T, Inoue H, Kudo SE, Saito Y. Prevalence of serrated polyposis syndrome and its association with synchronous advanced adenoma and lifestyle. Mol Clin Oncol 2014; 3:69-72. [PMID: 25469272 DOI: 10.3892/mco.2014.423] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 09/12/2014] [Indexed: 12/30/2022] Open
Abstract
We assessed the clinicopathological characteristics of patients with serrated polyposis syndrome (SPS) and the incidence of advanced adenoma/colorectal cancer (CRC). We prospectively enrolled 249 consecutive patients who underwent colonoscopy at the National Cancer Center Hospital over a 6-month period. All the polyps were diagnosed using magnification colonoscopy and resection/biopsy. The enrolled patients were divided into two groups, i) those with ≥5 histologically diagnosed hyperplastic polyps (HPs) proximal to the sigmoid colon, with at least 2 polyps >10 mm in diameter and ii) those with ≥20 HPs distributed throughout the colon. The clinical characteristics of the two groups were compared, including lifestyle, family history of CRC and colonoscopic findings. HPs were identified in 228 patients, of whom 21 (8.4%) had SPS. All 21 patients had ≥20 HPs distributed throughout the colon, with none having >2 HPs ≥1 cm in diameter in the right colon. Synchronous advanced adenoma/CRC was diagnosed in 76/249 (30.5%) patients. The prevalence of advanced adenoma/CRC was higher among patients with compared to those without SPS (P=0.075). SPS was also associated with older age and higher body mass index (BMI). Our results suggested that older age and higher BMI are independent risk factors for SPS. Advanced adenoma/CRC tended to occur more frequently among patients with compared to those without SPS, although the difference was not statistically significant.
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Affiliation(s)
- Naoya Toyoshima
- Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan ; Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa 224-8503, Japan
| | - Taku Sakamoto
- Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Makomo Makazu
- Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Takeshi Nakajima
- Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Ryoji Kushima
- Division of Molecular Pathology, National Cancer Center Research Institute, Tokyo 104-0045, Japan
| | - Tadakazu Shimoda
- Division of Molecular Pathology, National Cancer Center Research Institute, Tokyo 104-0061, Japan
| | | | - Haruhiro Inoue
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa 224-8503, Japan
| | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa 224-8503, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan
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30
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Senore C, Reggio D, Musso A, Bruno M, De Angelis C, Giordanino C, Coppo C, Tari R, Pagliarulo M, Carmagnola S, Montino F, Silvani M, Segnan N, Rizzetto M, Saracco GM. Narrow band imaging vs. high definition colonoscopy for detection of colorectal adenomas in patients with positive faecal occult blood test: a randomised trial. Dig Liver Dis 2014; 46:803-7. [PMID: 24908572 DOI: 10.1016/j.dld.2014.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 03/25/2014] [Accepted: 05/08/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND The impact of narrow band imaging in improving the adenoma detection rate in a screening scenario is still unclear. AIM To evaluate whether narrow band imaging compared with high definition white light colonoscopy can enhance the adenoma detection rate during screening colonoscopy. METHODS Consecutive patients presenting for screening colonoscopy were included into this study and were randomly assigned to the narrow band imaging group (Group 1) or standard colonoscopy group (Group 2). Primary end point was the adenoma detection rate and secondary aim was the detection rate of advanced adenomas. RESULTS Overall, 117 patients were allocated to Group 1 and 120 to Group 2. Both the adenoma detection rate and the detection rate of advanced adenomas were not significantly different between the two groups (respectively, 52.1% vs. 55%, RR=0.95, 95% CI 0.75-1.20; 32.5% vs. 44.2%, RR=0.74, 95% CI 0.53-1.02). No significant difference between the proportions of polypoid and flat adenomas was found. Male gender, no prior history of screening, and endoscopist's adenoma detection rate were independent predictive factors of higher advanced adenoma detection rate. CONCLUSIONS In a screening scenario, narrow band imaging did not improve the adenoma nor advanced adenoma detection rates compared to high definition white light colonoscopy.
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Affiliation(s)
- Carlo Senore
- Cancer Epidemiology Unit, CPO Piemonte, AOU Città della Salute e della Scienza, Turin, Italy
| | - Dario Reggio
- Liver Transplant Unit, Molinette Hospital, University of Turin, Italy
| | - Alessandro Musso
- Division of Gastrohepatology, Molinette Hospital, University of Turin, Italy
| | - Mauro Bruno
- Division of Gastrohepatology, Molinette Hospital, University of Turin, Italy
| | - Claudio De Angelis
- Division of Gastrohepatology, Molinette Hospital, University of Turin, Italy
| | - Chiara Giordanino
- Department of Oncology, A.O.U. S. Luigi Gonzaga, University of Turin, Italy
| | - Claudia Coppo
- Department of Oncology, A.O.U. S. Luigi Gonzaga, University of Turin, Italy
| | - Roberto Tari
- Division of Gastroenterology, A.O.U. Maggiore della Carità, Novara, Italy
| | - Michela Pagliarulo
- Division of Gastroenterology, A.O.U. Maggiore della Carità, Novara, Italy
| | | | - Franco Montino
- Division of Gastroenterology, A.O.U. Maggiore della Carità, Novara, Italy
| | - Marco Silvani
- Cancer Epidemiology Unit, CPO Piemonte, AOU Città della Salute e della Scienza, Turin, Italy
| | - Nereo Segnan
- Cancer Epidemiology Unit, CPO Piemonte, AOU Città della Salute e della Scienza, Turin, Italy
| | - Mario Rizzetto
- Division of Gastrohepatology, Molinette Hospital, University of Turin, Italy
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Tutticci N, Bourke MJ. Advances in colonoscopy. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2014; 12:119-139. [PMID: 24615389 DOI: 10.1007/s11938-014-0009-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Colonoscopy with polypectomy has been established as the major prevention and detection strategy for colorectal cancer for over a decade. Over this period advances in colonoscopic imaging, polyp detection, prediction of histopathology and polypectomy techniques have all been seen; however, the true magnitude of the limitations of colonoscopy has only recently been widely recognized. The rate and location of missed or interval cancers after complete colonoscopy appears to be influenced by the operator-dependency of colonoscopy and failure of conventional practices to detect and treat adenomatous, and possibly more importantly, non-adenomatous colorectal cancer precursors. Consequently, studies that expand our understanding of these factors and advances that aim to improve colonoscopy, polypectomy, and cancer protection are of critical importance.
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Affiliation(s)
- Nicholas Tutticci
- Department of Gastroenterology and Hepatology, Westmead Hospital, 106A/151 Hawkesbury Road, Westmead, NSW, 2145, Australia,
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Coda S, Thillainayagam AV. State of the art in advanced endoscopic imaging for the detection and evaluation of dysplasia and early cancer of the gastrointestinal tract. Clin Exp Gastroenterol 2014; 7:133-50. [PMID: 24868168 PMCID: PMC4028486 DOI: 10.2147/ceg.s58157] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Ideally, endoscopists should be able to detect, characterize, and confirm the nature of a lesion at the bedside, minimizing uncertainties and targeting biopsies and resections only where necessary. However, under conventional white-light inspection – at present, the sole established technique available to most of humanity – premalignant conditions and early cancers can frequently escape detection. In recent years, a range of innovative techniques have entered the endoscopic arena due to their ability to enhance the contrast of diseased tissue regions beyond what is inherently possible with standard white-light endoscopy equipment. The aim of this review is to provide an overview of the state-of-the-art advanced endoscopic imaging techniques available for clinical use that are impacting the way precancerous and neoplastic lesions of the gastrointestinal tract are currently detected and characterized at endoscopy. The basic instrumentation and the physics behind each method, followed by the most influential clinical experience, are described. High-definition endoscopy, with or without optical magnification, has contributed to higher detection rates compared with white-light endoscopy alone and has now replaced ordinary equipment in daily practice. Contrast-enhancement techniques, whether dye-based or computed, have been combined with white-light endoscopy to further improve its accuracy, but histology is still required to clarify the diagnosis. Optical microscopy techniques such as confocal laser endomicroscopy and endocytoscopy enable in vivo histology during endoscopy; however, although of invaluable assistance for tissue characterization, they have not yet made transition between research and clinical use. It is still unknown which approach or combination of techniques offers the best potential. The optimal method will entail the ability to survey wide areas of tissue in concert with the ability to obtain the degree of detailed information provided by microscopic techniques. In this respect, the challenging combination of autofluorescence imaging and confocal endomicroscopy seems promising, and further research is awaited.
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Affiliation(s)
- Sergio Coda
- Section of Gastroenterology and Hepatology, Department of Medicine and Photonics Group, Department of Physics, Imperial College London, London, UK ; Endoscopy Unit, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Andrew V Thillainayagam
- Section of Gastroenterology and Hepatology, Department of Medicine and Photonics Group, Department of Physics, Imperial College London, London, UK ; Endoscopy Unit, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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Longcroft-Wheaton G, Bhandari P. A review of image-enhanced endoscopy in the evaluation of colonic polyps. Expert Rev Gastroenterol Hepatol 2014; 8:267-81. [PMID: 24491220 DOI: 10.1586/17474124.2014.881714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The practice of colonoscopy has changed considerably over the last decade. The growth of image-enhanced endoscopy have altered our concepts of how we perform colonoscopy. This article examines the evidence base behind these techniques and looks at where future research needs to be directed.
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Saito Y, Gimeno-García A, Matsuda T, Nicolás-Pérez D, Uraoka T, Quintero E. New Imaging Modalities for Identification of Hidden Polyps. CURRENT COLORECTAL CANCER REPORTS 2014. [DOI: 10.1007/s11888-013-0206-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Omata F, Ohde S, Deshpande GA, Kobayashi D, Masuda K, Fukui T. Image-enhanced, chromo, and cap-assisted colonoscopy for improving adenoma/neoplasia detection rate: a systematic review and meta-analysis. Scand J Gastroenterol 2014; 49:222-37. [PMID: 24328858 DOI: 10.3109/00365521.2013.863964] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The effectiveness of narrow band imaging (NBI), chromoendoscopy (CE), and cap-assisted colonoscopy (CAC) on adenoma detection rate (ADR) has been investigated in previous meta-analyses; however, there have been no meta-analyses of autofluorescence imaging (AFI) or flexible spectral imaging color enhancement (FICE) or i-scan. The aim of this study was to determine whether AFI and FICE/i-scan was more effective than standard/high-definition white light endoscopy to improve ADR and to update previous meta-analyses of NBI, CE, and CAC. DESIGN A systematic review and meta-analysis was conducted. Four investigators selected appropriate randomized controlled trials (RCT) using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. All RCTs in which colonoscopy were performed with AFI, FICE, i-scan, NBI, CE, and CAC were included. The risk ratios (RRs) calculated from adenoma/neoplasia detection rate were used as the main outcome measurement. RESULTS A total of 42 studies were included in the analysis. Pooled estimates of RR (95%confidence interval [CI]) using AFI, FICE/i-scan, NBI, CE, and CAC were 1.04 (95% CI: 0.87-1.24) (I² = 0%) (fixed effects model [FEM]); 1.09 (95% CI: 0.97-1.23) (I² = 5%) (FEM); 1.03 (95% CI: 0.96-1.11) (I² = 0%) (FEM); 1.36 (95% CI: 1.23-1.51) (I² = 16%) (FEM); and 1.03 (95% CI: 0.93-1.14) (I² = 48%) (random effects model [REM]), respectively. The pooled estimate of RR (95%CI) using indigo carmine in non-ulcerative colitis (UC) patients and methylene blue in UC patients was 1.33 (95% CI: 1.20-1.48) (I² = 14%) (FEM) and 2.39 (95% CI: 1.18-4.84) (I² = 0%) (FEM), respectively. CONCLUSION In contrast to AFI, FICE/i-scan, NBI, and CAC, only CE improves ADR. CE with methylene blue, though not NBI, is effective for surveillance of neoplasia in chronic UC patients.
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Affiliation(s)
- Fumio Omata
- Department of Internal Medicine, St. Luke's International Hospital , Chuo-Ku , Japan
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Kwon SC, Choi SW, Choi SH, Park HS, Lee SH, Kim BG, Seo EH, Jang M, Ryu SM, Kim DH, Kim YH, Ha JO, Lee JS. The Effect of Indigocarmine on Improvement of the Polyp Detection Rate during Colonoscopic Examination with Hood Cap. Intest Res 2014; 12:60-5. [PMID: 25349565 PMCID: PMC4204691 DOI: 10.5217/ir.2014.12.1.60] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 09/29/2013] [Accepted: 10/28/2013] [Indexed: 02/07/2023] Open
Abstract
Background/Aims Hood cap-assisted chromocolonoscopy using indigocarmine is expected to improve the detection rate of colorectal polyps, especially adenomatous polyps. Therefore, aim of the present study was to evaluate the usefulness of hood cap-assisted chromocolonoscopy in routine colonoscopic examinations. Methods From January, 2013 through March, 2013, a total of 86 patients were enrolled (M:F=33:53, mean age=60 years). For each patient, hood cap-assisted colonoscopic examination was performed, followed by hood cap-assisted chromocolonoscopy using 0.2% indigocarmine from the cecum to the hepatic flexure. Total numbers and characteristics of polyps were compared before and after indigo carmine dye spraying. Results Prior to dye spraying, 48 polyps were found in 37 patients, and after dye spraying, 53 additional polyps were found in 34 patients. Of these undetected polyps, 45 (85%) were small sized polyps (≤0.5 cm). Histologically, 19 (36%) were adenomatous polyps, and of these, 15 (28%) were tubular adenomas and 4 (8%) were serrated adenomas. As for the polyp detection rate, there was no difference between the expert and the non-expert groups. Conclusion Hood cap-assisted chromocolonoscopic examination using indigocarmine was helpful in detecting cecum and ascending colon polyps, especially small sized polyps (<0.5 cm) and neoplastic polyps.
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Affiliation(s)
- Sang Chang Kwon
- Division of Gastroenterology, Department of Internal Medicine, Busan Saint Mary's Hospital, Busan, Korea
| | - Sung Won Choi
- Department of Internal Medicine, Guposungsim Hospital, Busan, Korea
| | - Seong Ho Choi
- Division of Gastroenterology, Department of Internal Medicine, Busan Saint Mary's Hospital, Busan, Korea
| | - Hee Seung Park
- Division of Gastroenterology, Department of Internal Medicine, Busan Saint Mary's Hospital, Busan, Korea
| | - Seung Heon Lee
- Division of Gastroenterology, Department of Internal Medicine, Busan Saint Mary's Hospital, Busan, Korea
| | - Bong Gun Kim
- Division of Gastroenterology, Department of Internal Medicine, Busan Saint Mary's Hospital, Busan, Korea
| | - Eun Hee Seo
- Division of Gastroenterology, Department of Internal Medicine, Busan Saint Mary's Hospital, Busan, Korea
| | - Mun Jang
- Division of Gastroenterology, Department of Internal Medicine, Busan Saint Mary's Hospital, Busan, Korea
| | - Seung Min Ryu
- Division of Gastroenterology, Department of Internal Medicine, Busan Saint Mary's Hospital, Busan, Korea
| | - Dong Hyun Kim
- Division of Gastroenterology, Department of Internal Medicine, Busan Saint Mary's Hospital, Busan, Korea
| | - Young Hoon Kim
- Division of Gastroenterology, Department of Internal Medicine, Busan Saint Mary's Hospital, Busan, Korea
| | - Jun Ouk Ha
- Division of Gastroenterology, Department of Internal Medicine, Busan Saint Mary's Hospital, Busan, Korea
| | - Jae Seung Lee
- Division of Gastroenterology, Department of Internal Medicine, Busan Saint Mary's Hospital, Busan, Korea
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Feature space optimization for virtual chromoendoscopy augmented by topography. MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION : MICCAI ... INTERNATIONAL CONFERENCE ON MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION 2014; 17:642-9. [PMID: 25333173 DOI: 10.1007/978-3-319-10404-1_80] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Optical colonoscopy is the preferred modality for the screening and prevention of colorectal cancer. Chromoendoscopy can increase lesion detection rate by highlighting tissue topography with a colored dye, but is too time-consuming to be adopted in routine colonoscopy screening. We developed a fast and dye-free technique that generates virtual chromoendoscopy images that incorporate topography features acquired from photometric stereo endoscopy. We demonstrate that virtual chromoendoscopy augmented by topography achieves similar image quality to conventional chromoendoscopy in ex-vivo swine colon.
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Lasisi F, Mouchli A, Riddell R, Goldblum JR, Cummings OW, Ulbright TM, Rex DK. Agreement in interpreting villous elements and dysplasia in adenomas less than one centimetre in size. Dig Liver Dis 2013; 45:1049-55. [PMID: 23871251 DOI: 10.1016/j.dld.2013.05.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 05/08/2013] [Accepted: 05/27/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Villous elements and dysplasia grade in small adenomas are used in many countries to guide post-polypectomy colonoscopy intervals. AIMS Measure agreement in interpretation of villous elements and dysplasia in small adenomas. METHODS Consecutive endoscopically resected adenomas <10mm in size (203 adenomas less than 6mm and 149 adenomas 6-9 mm in size) were reviewed by 3 expert gastrointestinal pathologists. Interpretations were compared to routine clinical pathology readings at our institution and to each other. RESULTS All pathologists used the same definitions for villous and tubular histology. The overall kappas for villous elements in <6mm and 6-9 mm adenomas were 0.29 and 0.26, respectively. Interpretation of dysplasia grade had kappas of 0.02 and 0.09 for adenomas <6mm and 6-9 mm, respectively. Two expert pathologists who used cytologic criteria had much higher fractions of high grade dysplasia compared to the third expert and the pathologists at our centre, who relied on architectural criteria. CONCLUSIONS Villous elements and dysplasia grade in small adenomas are problematic as determinants of post-polypectomy surveillance intervals. Uniform pathologic criteria for dysplasia grade are needed.
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Affiliation(s)
- Femi Lasisi
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
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Ide D, Tamai N, Inomata H, Ohya TR, Aihara H, Saito S, Kato T, Tajiri H. Visualization of colorectal neoplasia by a second-generation autofluorescence imaging system. Scand J Gastroenterol 2013; 48:1302-7. [PMID: 24011375 DOI: 10.3109/00365521.2013.834073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Autofluorescence imaging (AFI) systems may allow better visualization of colorectal neoplasia than conventional methods. However, this is difficult to demonstrate objectively. Recently, a second-generation AFI system with a noise-reduction algorithm was developed. We aimed to objectively evaluate the visualization of colorectal neoplasia by using a second-generation AFI system and software to calculate the color-contrast index. MATERIAL AND METHODS We retrospectively reviewed 53 consecutive colorectal neoplasias examined using the second-generation AFI system. Color-contrast indices between the colorectal lesions and the surrounding normal mucosa in the WLI, AFI and NBI images were calculated. The WLI, AFI, NBI and CE images were also evaluated by endoscopists using questionnaire-based visualization scores. RESULTS The color-contrast index seen in the AFI images (33.74 ± 9.20) was significantly higher than that in either the WLI (11.14 ± 6.14) or NBI images (11.72 ± 7.12). There was no significant difference between the color-contrast indices of the WLI and NBI images. The mean AFI image visualization score (6.7 ± 1.8) was significantly higher than that of WLI (6.0 ± 1.7), and tended to be higher than that of the NBI images (6.1 ± 1.6) when assessed by less-experienced endoscopists. CONCLUSIONS This study objectively demonstrates that compared to WLI and NBI, the second-generation AFI system enables superior visualization of colorectal neoplasms. The visualization scores were higher for the AFI images when evaluated by less-experienced endoscopists. These results indicate that the second-generation AFI system may aid less-experienced endoscopists in the detection of colorectal neoplasia.
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Affiliation(s)
- Daisuke Ide
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, The Jikei University School of Medicine , Tokyo , Japan
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Abstract
Chromocolonoscopy is the process of endoscopically examining the colon mucosa after it has been stained with dye. The goal is to allow the endoscopist to identify subtle features in the mucosa, such as morphologically flat polyps or crypt patterns. Studies examining the efficacy of chromocolonoscopy to identify adenomas missed by conventional colonoscopy have shown that although chromocolonoscopy increases polyp yield, most additional lesions are small in size. Staining can also help in differentiating neoplastic from non-neoplastic polyps. Perhaps the most useful aspect of chromocolonoscopy is increasing the yield for dysplasia in patients undergoing colonoscopy for inflammatory bowel disease surveillance.
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Affiliation(s)
- Deepika Devuni
- University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA
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Steele SR, Johnson EK, Champagne B, Davis B, Lee S, Rivadeneira D, Ross H, Hayden DA, Maykel JA. Endoscopy and polyps-diagnostic and therapeutic advances in management. World J Gastroenterol 2013; 19:4277-4288. [PMID: 23885138 PMCID: PMC3718895 DOI: 10.3748/wjg.v19.i27.4277] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 05/30/2013] [Accepted: 06/10/2013] [Indexed: 02/06/2023] Open
Abstract
Despite multiple efforts aimed at early detection through screening, colon cancer remains the third leading cause of cancer-related deaths in the United States, with an estimated 51000 deaths during 2013 alone. The goal remains to identify and remove benign neoplastic polyps prior to becoming invasive cancers. Polypoid lesions of the colon vary widely from hyperplastic, hamartomatous and inflammatory to neoplastic adenomatous growths. Although these lesions are all benign, they are common, with up to one-quarter of patients over 60 years old will develop pre-malignant adenomatous polyps. Colonoscopy is the most effective screening tool to detect polyps and colon cancer, although several studies have demonstrated missed polyp rates from 6%-29%, largely due to variations in polyp size. This number can be as high as 40%, even with advanced (> 1 cm) adenomas. Other factors including sub-optimal bowel preparation, experience of the endoscopist, and patient anatomical variations all affect the detection rate. Additional challenges in decision-making exist when dealing with more advanced, and typically larger, polyps that have traditionally required formal resection. In this brief review, we will explore the recent advances in polyp detection and therapeutic options.
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Parot V, Lim D, González G, Traverso G, Nishioka NS, Vakoc BJ, Durr NJ. Photometric stereo endoscopy. JOURNAL OF BIOMEDICAL OPTICS 2013; 18:076017. [PMID: 23864015 PMCID: PMC4407669 DOI: 10.1117/1.jbo.18.7.076017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 06/14/2013] [Accepted: 06/21/2013] [Indexed: 05/18/2023]
Abstract
While color video endoscopy has enabled wide-field examination of the gastrointestinal tract, it often misses or incorrectly classifies lesions. Many of these missed lesions exhibit characteristic three-dimensional surface topographies. An endoscopic system that adds topographical measurements to conventional color imagery could therefore increase lesion detection and improve classification accuracy. We introduce photometric stereo endoscopy (PSE), a technique which allows high spatial frequency components of surface topography to be acquired simultaneously with conventional two-dimensional color imagery. We implement this technique in an endoscopic form factor and demonstrate that it can acquire the topography of small features with complex geometries and heterogeneous optical properties. PSE imaging of ex vivo human gastrointestinal tissue shows that surface topography measurements enable differentiation of abnormal shapes from surrounding normal tissue. Together, these results confirm that the topographical measurements can be obtained with relatively simple hardware in an endoscopic form factor, and suggest the potential of PSE to improve lesion detection and classification in gastrointestinal imaging.
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Affiliation(s)
- Vicente Parot
- Madrid-MIT M+Visión Consortium, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts 02114
| | - Daryl Lim
- Madrid-MIT M+Visión Consortium, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts 02114
| | - Germán González
- Madrid-MIT M+Visión Consortium, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts 02114
| | - Giovanni Traverso
- Harvard Medical School, Massachusetts General Hospital, Division of Gastroenterology, Boston, Massachusetts 02114
- Massachusetts Institute of Technology, Koch Institute for Integrative Cancer Research, Department of Chemical Engineering, Cambridge, Massachusetts 02139
| | - Norman S. Nishioka
- Harvard Medical School, Massachusetts General Hospital, Division of Gastroenterology, Boston, Massachusetts 02114
| | - Benjamin J. Vakoc
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts 02114
| | - Nicholas J. Durr
- Madrid-MIT M+Visión Consortium, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts 02114
- Address all correspondence to: Nicholas J. Durr, Madrid-MIT M+Visión Consortium, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139. Tel: 617-324-4227; Fax: 617-643-9208; E-mail:
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Raju GS, Vadyala V, Slack R, Krishna SG, Ross WA, Lynch PM, Bresalier RS, Hawk E, Stroehlein JR. Adenoma detection in patients undergoing a comprehensive colonoscopy screening. Cancer Med 2013; 2:391-402. [PMID: 23930215 PMCID: PMC3699850 DOI: 10.1002/cam4.73] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 02/23/2013] [Accepted: 02/26/2013] [Indexed: 12/22/2022] Open
Abstract
Measures shown to improve the adenoma detection during colonoscopy (excellent bowel preparation, cecal intubation, cap fitted colonoscope to examine behind folds, patient position change to optimize colon distention, trained endoscopy team focusing on detection of subtle flat lesions, and incorporation of optimum endoscopic examination with adequate withdrawal time) are applicable to clinical practice and, if incorporated are projected to facilitate comprehensive colonoscopy screening program for colon cancer prevention. To determine adenoma and serrated polyp detection rate under conditions designed to optimize quality parameters for comprehensive screening colonoscopy. Retrospective analysis of data obtained from a comprehensive colon cancer screening program designed to optimize quality parameters. Academic medical center. Three hundred and forty-three patients between the ages of 50 years and 75 years who underwent first screening colonoscopy between 2009 and 2011 among 535 consecutive patients undergoing colonoscopy. Comprehensive colonoscopy screening program was utilized to screen all patients. Cecal intubation was successful in 98.8% of patients. The Boston Bowel Preparation Scale for quality of colonoscopy was 8.97 (95% confidence interval [CI]; 8.94, 9.00). The rate of adenoma detection was 60% and serrated lesion (defined as serrated adenomas or hyperplastic polyps proximal to the splenic flexure) detection was 23%. The rate of precancerous lesion detection (adenomas and serrated lesions) was 66%. The mean number of adenomas per screening procedure was 1.4 (1.2, 1.6) and the mean number of precancerous lesions (adenomas or serrated lesions) per screening procedure was 1.6 (1.4, 1.8). Retrospective study and single endoscopist experience. A comprehensive colonoscopy screening program results in high-quality screening with high detection of adenomas, advanced adenomas, serrated adenomas, and multiple adenomas.
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Affiliation(s)
- Gottumukkala S Raju
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Limketkai BN, Lam-Himlin D, Arnold MA, Arnold CA. The cutting edge of serrated polyps: a practical guide to approaching and managing serrated colon polyps. Gastrointest Endosc 2013; 77:360-75. [PMID: 23410696 DOI: 10.1016/j.gie.2012.11.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 11/06/2012] [Indexed: 12/13/2022]
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Dai J, Shen YF, Sano Y, Li XB, Xue HB, Zhao YJ, Gao YJ, Song Y, Ge ZZ. Evaluation of narrow-band imaging in the diagnosis of colorectal lesions: is a learning curve involved? Dig Endosc 2013; 25:180-8. [PMID: 23368810 DOI: 10.1111/j.1443-1661.2012.01367.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 07/12/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND The usefulness of endoscopy narrow-band imaging (NBI) in differentiating colorectal lesions has been demonstrated. However, the learning curve associated with this technique is a concern for endoscopists. METHODS Prior to carrying out these colonoscopies, four endoscopists attended a training course designed to teach the principles of NBI and application of the Sano Capillary Pattern (CP) classification criteria. Following a pre-test, endoscopists used NBI with magnification and CP analysis for real-time colonoscopy exams to predict lesion histology. Three sets of 15 lesions were imaged. These three sets included both lesions requiring endoscopic treatment (e.g. target lesions) and lesions that were not, or could not be, treated by endoscopy (e.g. non-target lesions). The diagnostic accuracy of each endoscopist for each set of lesions was evaluated to assess the learning curve associated with the application of NBI. RESULTS Overall accuracy, sensitivity, and specificity for differentiating neoplastic and non-neoplastic lesions were 95.4%, 98.0%, and 92.0%, respectively. For target lesions versus non-target lesions, the diagnostic accuracy associated with the second set of lesions was better than that achieved with the first set of lesions (78.3% vs 96.7% (P = 0.02) and 70.0% vs 96.7% ( P < 0.01), respectively in each case). In contrast, the difference in diagnostic accuracy between the second and third sets of lesions was not significant. CONCLUSION NBI with magnification is a useful tool for the diagnosis of colorectal lesions. Moreover, following a short training program and with minimal clinic practice, less experienced endoscopists were able to become competent in the method.
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Affiliation(s)
- Jun Dai
- Department of Gastroenterology, Key Laboratory of Gastroenterology & Hepatology, Ministry of Health at Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China
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Abstract
Early detection of malignancies within the gastrointestinal tract is essential to improve the prognosis and outcome of affected patients. However, conventional white light endoscopy has a miss rate of up to 25% for gastrointestinal pathology, specifically in the context of small and flat lesions within the colon. Chromoendoscopy and other advanced imaging techniques aim at facilitating the visualization and detection of neoplastic lesions and have been applied throughout the gastrointestinal tract. Chromoendoscopy, particularly in combination with magnifying endoscopy has significantly improved means to detect neoplastic lesions in the gastrointestinal mucosa, particularly in ulcerative colitis and Crohn's colitis. In addition, chromoendoscopy is beneficial in the upper gastrointestinal tract, especially when evaluating Barrett's oesophagus (BO) for the presence of dysplasia. Furthermore, it also improves characterization, differentiation and diagnosis of endoscopically detected suspicious lesions, and helps to delineate the extent of neoplastic lesions that may be amenable to endoscopic resection. This review discusses the dyes, indications and advanced endoscopic imaging methods used in various chromoendoscopic techniques, and presents a critical overview of the existing evidence supporting their use in current practice with a particular emphasis on the role in inflammatory bowel disease and BO.
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Affiliation(s)
- P J Trivedi
- Centre for Liver Research and NIHR Institute of Biomedical Research, 5th Floor IBR Building, University of Birmingham, Birmingham B15 2TT, UK
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Fujiya M, Kohgo Y. Image-enhanced endoscopy for the diagnosis of colon neoplasms. Gastrointest Endosc 2013; 77:111-118.e5. [PMID: 23148965 DOI: 10.1016/j.gie.2012.07.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 07/18/2012] [Indexed: 02/08/2023]
Affiliation(s)
- Mikihiro Fujiya
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Hokkaido, Japan
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Morgan J, Thomas K, Lee-Robichaud H, Nelson RL, Braungart S. Transparent cap colonoscopy versus standard colonoscopy to improve caecal intubation. Cochrane Database Syst Rev 2012; 12:CD008211. [PMID: 23235654 PMCID: PMC7105905 DOI: 10.1002/14651858.cd008211.pub3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Colonoscopy is considered the gold-standard investigation for screening and diagnosis of colorectal cancer. It is also becoming increasingly desirable for assessment, management, diagnosis and follow-up of other colorectal diseases, such as inflammatory bowel diseases and acute diverticulitis. Hence, due to the increasing demand for colonoscopy, devices to advance examination techniques are highly sought-after and the colonoscope with the transparent cap could be one of these. OBJECTIVES To identify and review all relevant data in order to determine whether colonoscopy with a transparent cap is a more effective diagnostic tool than colonoscopy. SEARCH METHODS We searched the MEDLINE, EMBASE and CINAHL databases, and the Cochrane Central Register of Controlled Trials for all randomised controlled trials (RCTs) comparing the use of colonoscopy with a transparent cap with standard colonoscopy. SELECTION CRITERIA Studies were included if they were randomised controlled trials which compared the use of colonoscopy with a transparent cap with standard colonoscopy. DATA COLLECTION AND ANALYSIS Data on study methods, participants, interventions used and outcomes measured was extracted from each study. Data was entered into the Cochrane Review Manager software (RevMan 5.0, 2008) and analysed using Cochrane MetaView. MAIN RESULTS In the present meta-analysis, we considered 14 randomised controlled trials so far published. The findings of our work indicate that colonoscopy with transparent cap has a faster caecal intubation time when compared with standard colonoscopy. Reviewing studies individually would also seem to favour colonoscopy with transparent cap for polyp detection rate and pain during procedure but due to lack of comparable data meta-analysis was not feasible. AUTHORS' CONCLUSIONS This review suggests that a transparent cap on the end of the colonoscope may give a marginally faster caecal intubation time compared with standard colonoscopy. It also suggests that there is a better polyp detection rate and less pain with the cap. However, the authors feel that further randomised controlled trials in this area would provide more clinically significant information on this adjunct to colonoscopy.
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Affiliation(s)
- Jenna Morgan
- Department of General Surgery, Northern General Hospital, Sheffield,
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East JE, Ignjatovic A, Suzuki N, Guenther T, Bassett P, Tekkis PP, Saunders BP. A randomized, controlled trial of narrow-band imaging vs high-definition white light for adenoma detection in patients at high risk of adenomas. Colorectal Dis 2012; 14:e771-8. [PMID: 22958651 DOI: 10.1111/codi.12014] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM The study aimed to investigate whether narrow-band imaging (NBI) can enhance adenoma detection in patients at high risk for adenomas compared with high-definition white-light endoscopy (WLE). High risk was defined as three or more adenomas at last colonoscopy, history of colorectal cancer and positive faecal occult blood test. METHOD Two hundred and fourteen patients were randomized 1:1 to examination with NBI or WLE. The primary outcome measure was the proportion of patients with at least one adenoma detected. Secondary outcomes included total adenomas and polyps, flat adenomas, nonadenomatous polyps, advanced adenomas and patients with three or five or more adenomas. A post hoc analysis to examine the effect of endoscopist and bowel preparation was performed. RESULTS There was no significant difference in the proportion of patients with at least one adenoma: NBI 73%vs WLE 66%, odds ratio 1.40 (95% CI 0.78-2.52), P = 0.26. There was no significant difference for any secondary outcome measure except for the number of flat adenomas which was significantly greater with NBI [comparison ratio 2.66 (95% CI 1.52-4.63), P = 0.001]. Post hoc analysis indicated that one of three endoscopists performed significantly better for adenoma detection with NBI than WLE [comparison ratio 1.92 (95% CI 1.07-3.44), P = 0.03]. Good bowel preparation was associated with significantly improved adenoma detection with NBI [comparison ratio 1.55 (95% CI 1.01-2.22), P = 0.04] but not with fair preparation. CONCLUSION Overall NBI did not improve detection compared with WLE in a group of patients at high risk for colorectal adenomas, but specific subgroups might benefit.
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Affiliation(s)
- J E East
- Wolfson Unit for Endoscopy, St Mark's Hospital, Imperial College London, London, UK
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Digital chromoendoscopy for diagnosis of diminutive colorectal lesions. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2012; 2012:279521. [PMID: 23082070 PMCID: PMC3469075 DOI: 10.1155/2012/279521] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 08/21/2012] [Indexed: 12/17/2022]
Abstract
Introduction. To compare the accuracy of digital and real-time chromoendoscopy for the differential diagnosis of diminutive (<5 mm) neoplastic and nonneoplastic colorectal lesions. Materials and Methods. This is a prospective randomized study comparing the Fujinon intelligent color enhancement (FICE) system (65 patients/95 lesions) and indigo carmine (69 patients/120 lesions) in the analysis of capillary meshwork and pit pattern, respectively. All lesions were less than 5 mm in diameter, and magnification was used in both groups. Histopathology was the gold standard examination. Results. Of 215 colorectal lesions, 153 (71.2%) were adenomas, and 62 were hyperplastic polyps (28.8%). Morphological analysis revealed 132 (61.4%) superficial lesions, with 7 (3.3%) depressed lesions, and 83 (38.6%) protruding lesions. Vascular meshwork analysis using FICE and magnification resulted in 91.7% sensitivity, 95.7% specificity, and 92.6% accuracy in differentiating neoplastic from nonneoplastic lesions. Pit pattern analysis with indigo carmine and magnification showed 96.5% sensitivity, 88.2% specificity, and 94.2% accuracy for the same purpose. Conclusion. Both magnifying virtual chromoendoscopy and indigo carmine chromoendoscopy showed high accuracy in the histopathological diagnosis of colorectal lesions less than 5 mm in diameter.
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