High yields of small and flat adenomas with high-definition colonoscopes using either white light or narrow band imaging.

BACKGROUND & AIMS Detection of adenomas is an important goal of colonoscopy. Narrow band imaging (NBI) might highlight adenomas and lead to higher rates of adenoma detection. METHODS This was a randomized controlled trial of colonoscopy withdrawal in white light versus NBI in 434 patients aged 50 years or older with intact colons. All examinations were performed by a single experienced endoscopist with a known high detection rate of adenomas using high-definition, wide-angle (170 degrees field of view) colonoscopes. RESULTS There was no difference in the percent of patients with >or=1 adenoma for the entire cohort in white light (67%) versus NBI (65%) (P = .61) or in the subset of 257 patients with indication screening (58% vs 57%; P = .91). Both the prevalences of adenomas and the numbers of adenomas per colonoscopy are the highest ever reported in colonoscopy studies. The high prevalence rates of adenomas were accounted for by detection of large numbers of adenomas, including flat adenomas, which were <or=5 mm. CONCLUSIONS NBI did not result in better detection of adenomas by an endoscopist with a known high detection rate using white light. This result does not exclude a possible benefit of NBI in reducing variation between endoscopists in detection of adenomas. The very high adenoma detection rate in this study suggests that high definition should be directly tested for its effect on detection of adenomas.

[1]  Douglas K Rex,et al.  Endoscopist Can Be More Powerful than Age and Male Gender in Predicting Adenoma Detection at Colonoscopy , 2007, The American Journal of Gastroenterology.

[2]  Jacques Van Dam,et al.  A novel retrograde-viewing auxiliary imaging device (Third Eye Retroscope) improves the detection of simulated polyps in anatomic models of the colon. , 2006, Gastrointestinal endoscopy.

[3]  J. Reguła,et al.  Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. , 2006, The New England journal of medicine.

[4]  J. Bond,et al.  Colorectal cancers found after a complete colonoscopy. , 2006, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[5]  B. Petersen,et al.  Impact of endoscopist withdrawal speed on polyp yield: implications for optimal colonoscopy withdrawal time , 2006 .

[6]  Harminder Singh,et al.  Risk of developing colorectal cancer following a negative colonoscopy examination: evidence for a 10-year interval between colonoscopies. , 2006, JAMA.

[7]  Y. Yamaji,et al.  Usefulness of Hood Attached to the Tip of Colonoscope for Detection of Colorectal Polyps , 2006 .

[8]  V. Wong,et al.  A Randomized Controlled Study Comparing Cap-Assisted Colonoscopy Versus Conventional Colonoscopy: A Preliminary Result , 2006 .

[9]  H. Pohl,et al.  A Prospective Randomized Study Between Narrow Band Imaging and Conventional Wide-Angle Colonoscopy in the Detection of Colorectal Adenomas , 2006 .

[10]  Hisao Tajiri,et al.  Magnified Observation of Microvascular Architecture Using Narrow Band Imaging (NBI) for the Differential Diagnosis Between Non-Neoplastic and Neoplastic Colorectal Lesion. A Prospective Study , 2006 .

[11]  T. Ohkusa,et al.  Detectability of Colorectal Neoplasms By Newly Developed Auto-Fluorescence Imaging Video Colonoscopy , 2006 .

[12]  Amitabh Chak,et al.  Quality indicators for colonoscopy. , 2006, Gastrointestinal endoscopy.

[13]  D. Sautereau,et al.  High resolution colonoscopy with chromoscopy versus standard colonoscopy for the detection of colonic neoplasia: a randomized study. , 2006, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[14]  Claire D. Helbig.  Chromoendoscopy and its alternatives for colonoscopy: useful in the United States? , 2006, Reviews in gastroenterological disorders.

[15]  T. Byers,et al.  Colorectal cancer in patients under close colonoscopic surveillance. , 2005, Gastroenterology.

[16]  A. Schatzkin,et al.  Colonoscopic screening of average-risk women for colorectal neoplasia. , 2005, The New England journal of medicine.

[17]  John F. Johanson,et al.  Variation in Adenoma Detection Rates and Colonoscopic Withdrawal Times During Screening Colonoscopy , 2005 .

[18]  L. Rabeneck,et al.  Predictors of Missed Colorectal Cancer During Colonoscopy: A Population-Based Analysis , 2005 .

[19]  Bernard Burnand,et al.  Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study. , 2005, Gastrointestinal endoscopy.

[20]  Peter Lance,et al.  Analysis of colorectal cancer occurrence during surveillance colonoscopy in the dietary Polyp Prevention Trial. , 2004, Gastrointestinal endoscopy.

[21]  H. Tajiri,et al.  Narrow-band imaging in the diagnosis of colorectal mucosal lesions: a pilot study. , 2004, Endoscopy.

[22]  Douglas K Rex,et al.  170° Wide-Angle Colonoscope: Effect on Efficiency and Miss Rates , 2004, The American Journal of Gastroenterology.

[23]  B. Petersen,et al.  Evaluation of Polyp Detection in Relation to Procedure Time of Screening or Surveillance Colonoscopy , 2004, American Journal of Gastroenterology.

[24]  Perry Pickhardt,et al.  Location of Adenomas Missed by Optical Colonoscopy , 2004, Annals of Internal Medicine.

[25]  Jane Wardle,et al.  Wide variation in adenoma detection rates at screening flexible sigmoidoscopy. , 2004, Gastroenterology.

[26]  D. Rex,et al.  Impact of Proximal Colon Retroflexion on Adenoma Miss Rates , 2004, American Journal of Gastroenterology.

[27]  S S Cross,et al.  Detecting diminutive colorectal lesions at colonoscopy: a randomised controlled trial of pan-colonic versus targeted chromoscopy , 2004, Gut.

[28]  D. Rex,et al.  Wide angle colonoscopy with a prototype instrument: impact on miss rates and efficiency as determined by back-to-back colonoscopies , 2003, American Journal of Gastroenterology.

[29]  V. Sharma,et al.  Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia. , 2003, Gastrointestinal endoscopy.

[30]  Charles J. Lightdale,et al.  The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. , 2003, Gastrointestinal endoscopy.

[31]  Syed G. Shah,et al.  Total colonic dye-spray increases the detection of diminutive adenomas during routine colonoscopy: a randomized controlled trial. , 2002, Gastrointestinal endoscopy.

[32]  J. Church,et al.  Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: recommendations of the U.S. Multi-Society Task Force on Colorectal Cancer , 2002, American Journal of Gastroenterology.

[33]  Ralph Weissleder,et al.  Detection of dysplastic intestinal adenomas using enzyme-sensing molecular beacons in mice. , 2002, Gastroenterology.

[34]  R. Kiesslich,et al.  Chromoendoscopy with Indigocarmine Improves the Detection of Adenomatous and Nonadenomatous Lesions in the Colon , 2001, Endoscopy.

[35]  R. Capocaccia,et al.  Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence , 2001, Gut.

[36]  D. Ransohoff,et al.  Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. , 2000, The New England journal of medicine.

[37]  D. Lieberman,et al.  Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. , 2000, The New England journal of medicine.

[38]  D. Alberts,et al.  Lack of effect of a high-fiber cereal supplement on the recurrence of colorectal adenomas. Phoenix Colon Cancer Prevention Physicians' Network. , 2000, The New England journal of medicine.

[39]  J. Weissfeld,et al.  Lack of effect of a low-fat, high-fiber diet on the recurrence of colorectal adenomas. Polyp Prevention Trial Study Group. , 2000, The New England journal of medicine.

[40]  D. Rex,et al.  Colonoscopic withdrawal technique is associated with adenoma miss rates. , 2000, Gastrointestinal endoscopy.

[41]  M. Vatn,et al.  Population-based surveillance by colonoscopy: effect on the incidence of colorectal cancer. Telemark Polyp Study I. , 1999, Scandinavian journal of gastroenterology.

[42]  K. Okazaki,et al.  Efficacy of Total Colonoscopy with a Transparent Cap in Comparison with Colonoscopy without the Cap , 1998, Endoscopy.

[43]  D. Rex,et al.  Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice. , 1997, Gastroenterology.

[44]  S. Kudo,et al.  Colorectal tumours and pit pattern. , 1994, Journal of clinical pathology.

[45]  A. Zauber,et al.  Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. , 1993 .

[46]  C D Langefeld,et al.  Colonic neoplasia in asymptomatic persons with negative fecal occult blood tests: influence of age, gender, and family history. , 1993, The American journal of gastroenterology.