Download PDF
Digestive Disease Interventions 2022; 06(03): 237-248
DOI: 10.1055/s-0041-1740275
Review Article

Advanced Endoscopic Technologies to Improve the Diagnosis of Colorectal Polyps

Maria Daca Alvarez 
1   Department of Gastroenterology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Center for Biomedical Research in the Hepatic and Digestive Diseases Network (CIBERehd), Barcelona, Spain
,
Liseth Rivero-Sanchez 
,
Maria Pellisé 
1   Department of Gastroenterology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Center for Biomedical Research in the Hepatic and Digestive Diseases Network (CIBERehd), Barcelona, Spain
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Colonoscopy is the gold standard for colorectal cancer (CRC) prevention. The main quality indicator of colonoscopy is the adenoma detection rate, which is inversely associated with the risk of interval CRC and the risk of death from this neoplasia. In the setting of CRC prevention, diagnostic colonoscopy has undergone a remarkable evolution in the past 20 years. Hand in hand with the implementation of CRC prevention programs and technological advances, we are now able to identify tiny and subtle neoplastic lesions and predict their histology with great efficiency. In this article, we briefly review the endoscopy technologies that can be used to improve the detection and characterization of colorectal polyps.

Keywords

colonoscopy - colorectal cancer - prevention - chromoendoscopy - virtual chromoendoscopy - artificial intelligence - polyps - detection - characterization


Publication History

Received: 26 February 2021

Accepted: 18 October 2021

Article published online:
03 January 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Rutter MD, Beintaris I, Valori R. et al. World Endoscopy Organization consensus statements on post-colonoscopy and post-imaging colorectal cancer. Gastroenterology 2018; 155 (03) 909-925.e3
    CrossrefPubMedGoogle Scholar
  • 2 Zauber AG, Winawer SJ, O'Brien MJ. et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012; 366 (08) 687-696
    Google Scholar
  • 3 Rex DK, Boland CR, Dominitz JA. et al. Colorectal cancer screening: recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2017; 153 (01) 307-323
    CrossrefPubMedGoogle Scholar
  • 4 Kaminski MF, Regula J, Kraszewska E. et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 2010; 362 (19) 1795-1803
    Google Scholar
  • 5 Corley DA, Jensen CD, Marks AR. et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med 2014; 370 (14) 1298-1306
    Google Scholar
  • 6 Hassan C, Spadaccini M, Iannone A. et al. Performance of artificial intelligence in colonoscopy for adenoma and polyp detection: a systematic review and meta-analysis. Gastrointest Endosc 2021; 93 (01) 77-85.e6
    Google Scholar
  • 7 Barclay RL, Vicari JJ, Doughty AS, Johanson JF, Greenlaw RL. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med 2006; 355 (24) 2533-2541
    CrossrefPubMedGoogle Scholar
  • 8 ASGE Technology Committee. High-definition and high-magnification endoscopes. Gastrointest Endosc 2014; 80 (06) 919-927
    CrossrefPubMedGoogle Scholar
  • 9 Tziatzios G, Gkolfakis P, Lazaridis LD. et al. High-definition colonoscopy for improving adenoma detection: a systematic review and meta-analysis of randomized controlled studies. Gastrointest Endosc 2020; 91 (05) 1027-1036.e9
    CrossrefPubMedGoogle Scholar
  • 10 Subramanian V, Mannath J, Hawkey CJ, Ragunath K. High definition colonoscopy vs. standard video endoscopy for the detection of colonic polyps: a meta-analysis. Endoscopy 2011; 43 (06) 499-505
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Trivedi PJ, Braden B. Indications, stains and techniques in chromoendoscopy. QJM 2013; 106 (02) 117-131
    CrossrefPubMedGoogle Scholar
  • 12 Pohl J, Schneider A, Vogell H, Mayer G, Kaiser G, Ell C. Pancolonic chromoendoscopy with indigo carmine versus standard colonoscopy for detection of neoplastic lesions: a randomised two-centre trial. Gut 2011; 60 (04) 485-490
    CrossrefPubMedGoogle Scholar
  • 13 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
    PubMedGoogle Scholar
  • 14 Repici A, Wallace MB, East JE. et al. Efficacy of per-oral methylene blue formulation for screening colonoscopy. Gastroenterology 2019; 156 (08) 2198-2207.e1
    CrossrefPubMedGoogle Scholar
  • 15 Bisschops R, East JE, Hassan C. et al. Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) guideline - update 2019. Endoscopy 2019; 51 (12) 1155-1179
    Google Scholar
  • 16 van Leerdam ME, Roos VH, van Hooft JE. et al. Endoscopic management of Lynch syndrome and of familial risk of colorectal cancer: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2019; 51 (11) 1082-1093
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Rivero-Sánchez L, Arnau-Collell C, Herrero J. et al; EndoCAR Group from Spanish Gastroenterology Association (AEG) and Spanish Society of Digestive Endoscopy (SEED). White-light endoscopy is adequate for Lynch syndrome surveillance in a randomized and noninferiority study. Gastroenterology 2020; 158 (04) 895-904.e1
    CrossrefPubMedGoogle Scholar
  • 18 Houwen BBSL, Mostafavi N, Vleugels JLA. et al. Dye-based chromoendoscopy in patients with Lynch syndrome: an individual patient data meta-analysis of randomized trials. Am J Gastroenterol 2021; 116 (04) 825-828
    CrossrefPubMedGoogle Scholar
  • 19 López-Vicente J, Rodríguez-Alcalde D, Hernández L. et al; Endoscopy for High Risk Cancer Conditions group of the Spanish Gastroenterological Association and Spanish Digestive Endoscopy Society. Panchromoendoscopy increases detection of polyps in patients with serrated polyposis syndrome. Clin Gastroenterol Hepatol 2019; 17 (10) 2016-2023.e6
    CrossrefPubMedGoogle Scholar
  • 20 Chan JL, Lin L, Feiler M, Wolf AI, Cardona DM, Gellad ZF. Comparative effectiveness of i-SCAN™ and high-definition white light characterizing small colonic polyps. World J Gastroenterol 2012; 18 (41) 5905-5911
    CrossrefPubMedGoogle Scholar
  • 21 Kodashima S, Fujishiro M. Novel image-enhanced endoscopy with i-scan technology. World J Gastroenterol 2010; 16 (09) 1043-1049
    CrossrefPubMedGoogle Scholar
  • 22 Atkinson NSS, Ket S, Bassett P. et al. Narrow-band imaging for detection of neoplasia at colonoscopy: a meta-analysis of data from individual patients in randomized controlled trials. Gastroenterology 2019; 157 (02) 462-471
    Google Scholar
  • 23 Shinozaki S, Kobayashi Y, Hayashi Y. et al. Colon polyp detection using linked color imaging compared to white light imaging: systematic review and meta-analysis. Dig Endosc 2020; 32 (06) 874-881
    CrossrefPubMedGoogle Scholar
  • 24 Ikematsu H, Sakamoto T, Togashi K. et al. Detectability of colorectal neoplastic lesions using a novel endoscopic system with blue laser imaging: a multicenter randomized controlled trial. Gastrointest Endosc 2017; 86 (02) 386-394
    CrossrefPubMedGoogle Scholar
  • 25 Kidambi TD, Terdiman JP, El-Nachef N, Singh A, Kattah MG, Lee JK. Effect of I-scan electronic chromoendoscopy on detection of adenomas during colonoscopy. Clin Gastroenterol Hepatol 2019; 17 (04) 701-708.e1
    CrossrefPubMedGoogle Scholar
  • 26 Gkolfakis P, Tziatzios G, Dimitriadis GD, Triantafyllou K. New endoscopes and add-on devices to improve colonoscopy performance. World J Gastroenterol 2017; 23 (21) 3784-3796
    CrossrefPubMedGoogle Scholar
  • 27 Uraoka T, Tanaka S, Matsumoto T. et al. A novel extra-wide-angle-view colonoscope: a simulated pilot study using anatomic colorectal models. Gastrointest Endosc 2013; 77 (03) 480-483
    CrossrefPubMedGoogle Scholar
  • 28 Gluck N, Melhem A, Halpern Z, Mergener K, Santo E. A novel self-propelled disposable colonoscope is effective for colonoscopy in humans (with video). Gastrointest Endosc 2016; 83 (05) 998-1004.e1
    CrossrefPubMedGoogle Scholar
  • 29 Rubin M, Lurie L, Bose K, Kim SH. Expanding the view of a standard colonoscope with the Third Eye Panoramic cap. World J Gastroenterol 2015; 21 (37) 10683-10687
    CrossrefPubMedGoogle Scholar
  • 30 Gralnek IM, Suissa A, Domanov S. Safety and efficacy of a novel balloon colonoscope: a prospective cohort study. Endoscopy 2014; 46 (10) 883-887
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Hasan N, Gross SA, Gralnek IM, Pochapin M, Kiesslich R, Halpern Z. A novel balloon colonoscope detects significantly more simulated polyps than a standard colonoscope in a colon model. Gastrointest Endosc 2014; 80 (06) 1135-1140
    CrossrefPubMedGoogle Scholar
  • 32 Shirin H, Shpak B, Epshtein J. et al. G-EYE colonoscopy is superior to standard colonoscopy for increasing adenoma detection rate: an international randomized controlled trial (with videos). Gastrointest Endosc 2019; 89 (03) 545-553
    CrossrefPubMedGoogle Scholar
  • 33 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
    PubMedGoogle Scholar
  • 34 Kondo S, Yamaji Y, Watabe H. et al. A randomized controlled trial evaluating the usefulness of a transparent hood attached to the tip of the colonoscope. Am J Gastroenterol 2007; 102 (01) 75-81
    CrossrefPubMedGoogle Scholar
  • 35 Rastogi A, Bansal A, Rao DS. et al. Higher adenoma detection rates with cap-assisted colonoscopy: a randomised controlled trial. Gut 2012; 61 (03) 402-408
    CrossrefPubMedGoogle Scholar
  • 36 Horiuchi A, Nakayama Y, Kajiyama M, Kato N, Ichise Y, Tanaka N. Benefits and limitations of cap-fitted colonoscopy in screening colonoscopy. Dig Dis Sci 2013; 58 (02) 534-539
    CrossrefPubMedGoogle Scholar
  • 37 Kim DJ, Kim HW, Park SB. et al. Efficacy of cap-assisted colonoscopy according to lesion location and endoscopist training level. World J Gastroenterol 2015; 21 (20) 6261-6270
    CrossrefPubMedGoogle Scholar
  • 38 Triantafyllou K, Gkolfakis P, Tziatzios G, Papanikolaou IS, Fuccio L, Hassan C. Effect of Endocuff use on colonoscopy outcomes: a systematic review and meta-analysis. World J Gastroenterol 2019; 25 (09) 1158-1170
    CrossrefPubMedGoogle Scholar
  • 39 Patel HK, Chandrasekar VT, Srinivasan S. et al. Second-generation distal attachment cuff improves adenoma detection rate: meta-analysis of randomized controlled trials. Gastrointest Endosc 2021; 93 (03) 544-553.e7
    CrossrefPubMedGoogle Scholar
  • 40 Facciorusso A, Del Prete V, Buccino RV. et al. Comparative efficacy of colonoscope distal attachment devices in increasing rates of adenoma detection: a network meta-analysis. Clin Gastroenterol Hepatol 2018; 16 (08) 1209-1219.e9
    CrossrefPubMedGoogle Scholar
  • 41 Gkolfakis P, Tziatzios G, Facciorusso A, Muscatiello N, Triantafyllou K. Meta-analysis indicates that add-on devices and new endoscopes reduce colonoscopy adenoma miss rate. Eur J Gastroenterol Hepatol 2018; 30 (12) 1482-1490
    CrossrefPubMedGoogle Scholar
  • 42 Facciorusso A, Mohan BP, Crinò SF, Muscatiello N. Impact of EndoRings on colon adenoma detection rate: a meta-analysis of randomized trials. J Gastroenterol Hepatol 2021; 36 (02) 337-343
    CrossrefPubMedGoogle Scholar
  • 43 Wang P, Berzin TM, Glissen Brown JR. et al. Real-time automatic detection system increases colonoscopic polyp and adenoma detection rates: a prospective randomised controlled study. Gut 2019; 68 (10) 1813-1819
    CrossrefPubMedGoogle Scholar
  • 44 Repici A, Badalamenti M, Maselli R. et al. Efficacy of real-time computer-aided detection of colorectal neoplasia in a randomized trial. Gastroenterology 2020; 159 (02) 512-520.e7
    Google Scholar
  • 45 Barua I, Vinsard DG, Jodal HC. et al. Artificial intelligence for polyp detection during colonoscopy: a systematic review and meta-analysis. Endoscopy 2021; 53 (03) 277-284
    Google Scholar
  • 46 Ashat M, Klair JS, Singh D, Murali AR, Krishnamoorthi R. Impact of real-time use of artificial intelligence in improving adenoma detection during colonoscopy: a systematic review and meta-analysis. Endosc Int Open 2021; 9 (04) E513-E521
    Google Scholar
  • 47 Kudo S, Tamura S, Nakajima T, Yamano H, Kusaka H, Watanabe H. Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointest Endosc 1996; 44 (01) 8-14
    CrossrefPubMedGoogle Scholar
  • 48 Li M, Ali SM, Umm-a-OmarahGilani S, Liu J, Li YQ, Zuo XL. Kudo's pit pattern classification for colorectal neoplasms: a meta-analysis. World J Gastroenterol 2014; 20 (35) 12649-12656
    CrossrefPubMedGoogle Scholar
  • 49 Sano Y, Ikematsu H, Fu KI. et al. Meshed capillary vessels by use of narrow-band imaging for differential diagnosis of small colorectal polyps. Gastrointest Endosc 2009; 69 (02) 278-283
    CrossrefPubMedGoogle Scholar
  • 50 Hayashi N, Tanaka S, Hewett DG. et al. Endoscopic prediction of deep submucosal invasive carcinoma: validation of the narrow-band imaging international colorectal endoscopic (NICE) classification. Gastrointest Endosc 2013; 78 (04) 625-632
    CrossrefPubMedGoogle Scholar
  • 51 Misawa M, Kudo SE, Mori Y. et al. Characterization of colorectal lesions using a computer-aided diagnostic system for narrow-band imaging endocytoscopy. Gastroenterology 2016; 150 (07) 1531-1532.e3
    CrossrefPubMedGoogle Scholar
  • 52 Gupta N, Bansal A, Rao D. et al. Prevalence of advanced histological features in diminutive and small colon polyps. Gastrointest Endosc 2012; 75 (05) 1022-1030
    CrossrefPubMedGoogle Scholar
  • 53 Rex DK, Kahi C, O'Brien M. et al. The American Society for Gastrointestinal Endoscopy PIVI (Preservation and Incorporation of Valuable Endoscopic Innovations) on real-time endoscopic assessment of the histology of diminutive colorectal polyps. Gastrointest Endosc 2011; 73 (03) 419-422
    CrossrefPubMedGoogle Scholar
  • 54 Abu Dayyeh BK, Thosani N, Konda V. et al; ASGE Technology Committee. ASGE Technology Committee systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting real-time endoscopic assessment of the histology of diminutive colorectal polyps. Gastrointest Endosc 2015; 81 (03) 502.e1-502.e16
    CrossrefPubMedGoogle Scholar
  • 55 Klenske E, Zopf S, Neufert C. et al. I-scan optical enhancement for the in vivo prediction of diminutive colorectal polyp histology: results from a prospective three-phased multicentre trial. PLoS One 2018; 13 (05) e0197520
    CrossrefPubMedGoogle Scholar
  • 56 Bisschops R, Hassan C, Bhandari P. et al. BASIC (BLI Adenoma Serrated International Classification) classification for colorectal polyp characterization with blue light imaging. Endoscopy 2018; 50 (03) 211-220
    Article in Thieme ConnectPubMedGoogle Scholar
  • 57 Pohl H, Srivastava A, Bensen SP. et al. Incomplete polyp resection during colonoscopy-results of the complete adenoma resection (CARE) study. Gastroenterology 2013; 144 (01) 74-80.e1
    CrossrefPubMedGoogle Scholar
  • 58 Ferlitsch M, Moss A, Hassan C. et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2017; 49 (03) 270-297
    Google Scholar
  • 59 Backes Y, Moss A, Reitsma JB, Siersema PD, Moons LM. Narrow band imaging, magnifying chromoendoscopy, and gross morphological features for the optical diagnosis of T1 colorectal cancer and deep submucosal invasion: a systematic review and meta-analysis. Am J Gastroenterol 2017; 112 (01) 54-64
    CrossrefPubMedGoogle Scholar
  • 60 Kobayashi S, Yamada M, Takamaru H. et al. Diagnostic yield of the Japan NBI Expert Team (JNET) classification for endoscopic diagnosis of superficial colorectal neoplasms in a large-scale clinical practice database. United European Gastroenterol J 2019; 7 (07) 914-923
    CrossrefPubMedGoogle Scholar
  • 61 Jideh B, Bourke MJ. How to perform wide-field endoscopic mucosal resection and follow-up examinations. Gastrointest Endosc Clin N Am 2019; 29 (04) 629-646
    Google Scholar
  • 62 Moss A, Williams SJ, Hourigan LF. et al. Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study. Gut 2015; 64 (01) 57-65
    Google Scholar
  • 63 Kandel P, Brand EC, Pelt J. et al; EMR SCAR Group. Endoscopic scar assessment after colorectal endoscopic mucosal resection scars: when is biopsy necessary (EMR Scar Assessment Project for Endoscope (ESCAPE) trial). Gut 2019; 68 (09) 1633-1641
    CrossrefPubMedGoogle Scholar
  • 64 Pellisé M, Desomer L, Burgess NG. et al. The influence of clips on scars after EMR: clip artifact. Gastrointest Endosc 2016; 83 (03) 608-616
    CrossrefPubMedGoogle Scholar
  • 65 Sasajima K, Kudo SE, Inoue H. et al. Real-time in vivo virtual histology of colorectal lesions when using the endocytoscopy system. Gastrointest Endosc 2006; 63 (07) 1010-1017
    CrossrefPubMedGoogle Scholar
  • 66 Singh R, Chen Yi Mei SL, Tam W, Raju D, Ruszkiewicz A. Real-time histology with the endocytoscope. World J Gastroenterol 2010; 16 (40) 5016-5019
    CrossrefPubMedGoogle Scholar
  • 67 Mori Y, Kudo S, Ikehara N. et al. Comprehensive diagnostic ability of endocytoscopy compared with biopsy for colorectal neoplasms: a prospective randomized noninferiority trial. Endoscopy 2013; 45 (02) 98-105
    Article in Thieme ConnectPubMedGoogle Scholar
  • 68 Mori Y, Kudo SE, Wakamura K. et al. Novel computer-aided diagnostic system for colorectal lesions by using endocytoscopy (with videos). Gastrointest Endosc 2015; 81 (03) 621-629
    CrossrefPubMedGoogle Scholar
  • 69 Mori Y, Kudo SE, Chiu PW. et al. Impact of an automated system for endocytoscopic diagnosis of small colorectal lesions: an international web-based study. Endoscopy 2016; 48 (12) 1110-1118
    Article in Thieme ConnectPubMedGoogle Scholar
  • 70 Mori Y, Kudo SE, Misawa M. et al. Real-time use of artificial intelligence in identification of diminutive polyps during colonoscopy: a prospective study. Ann Intern Med 2018; 169 (06) 357-366
    CrossrefPubMedGoogle Scholar
  • 71 Misawa M, Kudo SE, Mori Y. et al. Accuracy of computer-aided diagnosis based on narrow-band imaging endocytoscopy for diagnosing colorectal lesions: comparison with experts. Int J CARS 2017; 12 (05) 757-766
    CrossrefPubMedGoogle Scholar
  • 72 Shahid MW, Buchner AM, Heckman MG. et al. Diagnostic accuracy of probe-based confocal laser endomicroscopy and narrow band imaging for small colorectal polyps: a feasibility study. Am J Gastroenterol 2012; 107 (02) 231-239
    CrossrefPubMedGoogle Scholar
  • 73 Su P, Liu Y, Lin S. et al. Efficacy of confocal laser endomicroscopy for discriminating colorectal neoplasms from non-neoplasms: a systematic review and meta-analysis. Colorectal Dis 2013; 15 (01) e1-e12
    CrossrefPubMedGoogle Scholar
  • 74 Byrne MF, Chapados N, Soudan F. et al. Real-time differentiation of adenomatous and hyperplastic diminutive colorectal polyps during analysis of unaltered videos of standard colonoscopy using a deep learning model. Gut 2019; 68 (01) 94-100
    CrossrefPubMedGoogle Scholar
  • 75 Lui TKL, Guo CG, Leung WK. Accuracy of artificial intelligence on histology prediction and detection of colorectal polyps: a systematic review and meta-analysis. Gastrointest Endosc 2020; 92 (01) 11-22.e6
    CrossrefPubMedGoogle Scholar