A comparison of high definition-image enhanced colonoscopy and standard white-light colonoscopy for colorectal polyp detection

Background and study aims: Colonoscopy is widely used to detect and remove precancerous polyps, but fails to detect some polyps. Recent studies evaluating different image-enhanced methods have revealed conflicting results. The efficacy of colonoscopy imaging with simultaneous use of commercially available improvements, including high definition narrow band imaging (HD-NBI), and monochromatic charge-coupled device (CCD) video, was compared with a widely used standard definition white light (SDWL) colonoscopy system for detecting colorectal polyps. The primary aim was to determine whether the combination of image-enhanced colonoscopy systems resulted in fewer missed polyps compared with conventional colonoscopy.

Patients and methods: In a randomized controlled trial (Clinicaltrials.gov. study number NCT00825292) patients having routine screening and surveillance underwent tandem colonoscopies with SDWL and image-enhanced (HD-NBI) colonoscopy. The main outcome measurement was the per-polyp false-negative (“miss”) rate. Secondary outcomes were adenoma miss rate, and per-patient polyp and adenoma miss rates.

Results: 100 patients were randomized and 96 were included in the analysis. In total, 177 polyps were detected; of these, 72 (41 %) were adenomatous. Polyp and adenoma miss rates for SDWL colonoscopy were 57 % (60 /105) and 49 % (19 /39); those for image-enhanced colonoscopy were 31 % (22 /72) and 27 % (9 /33) (P = 0.005 and P = 0.036 for polyps and adenomas, respectively). Image-enhanced and SDWL approaches had similar per-patient miss rates for polyps (6 /35 vs. 9 /32, P = 0.27) and adenomas (4 /22 vs. 8 /20, P = 0.11).

Conclusions: Utilization of multiple recent improvements in image-enhanced colonoscopy was associated with a reduced miss rate for all polyps and for adenomatous polyps. It is not known which individual feature or combination of image-enhancement features led to the improvement.

^* Dr. Gross and Dr. Buchner contributed equally to the study and share first authorship.

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