Published online Apr 16, 2022. doi: 10.4253/wjge.v14.i4.226
Peer-review started: July 14, 2021
First decision: September 5, 2021
Revised: September 13, 2021
Accepted: January 25, 2022
Article in press: January 25, 2022
Published online: April 16, 2022
Sessile serrated adenomas (SSAs) are important premalignant lesions that are difficult to detect during colonoscopy due to poor definition, concealment by mucous caps, and flat appearance. High definition (HD) colonoscopy may uniquely aid in the detection of these inconspicuous lesions compared to standard definition (SD) colonoscopes. In the absence of existing clinical guidelines to obligate the use of HD colonoscopy for colorectal cancer screening in average-risk patients, demonstrating the benefit of HD colonoscopy on SSA detection rate (SSADR) may help strengthen the evidence to recommend its use in all settings.
To evaluate the benefit of HD colonoscopy compared to SD colonoscopy on SSADR in average-risk patients undergoing screening colonoscopy.
Data from screening colonoscopies for patients aged 50-76 years two years before and two years after the transition from SD colonoscopy to HD colonoscopy at our large, academic teaching center were collected. Patients with symptoms of colorectal disease, positive occult blood test, history of colon polyps, cancer, polyposis syndrome, inflammatory bowel disease or family history of colon cancer or polyps were excluded. Patients whose endoscopists did not perform colonoscopies both before and after scope definition change were also excluded. Differences in individual endoscopist SSADR, average SSADR, and overall SSADR with SD colonoscopy vs HD colonoscopy were also evaluated for significance.
A total of 3657 colonoscopies met eligibility criteria with 2012 colonoscopies from the SD colonoscopy period and 1645 colonoscopies from the HD colonoscopy period from a pool of 11 endoscopists. Statistically significant improvements of 2.30% in mean SSADR and 2.53% in overall SSADR were noted with HD colonoscopy (P = 0.00028 and P = 0.00849, respectively). On the individual level, three endoscopists experienced statistically significant benefit with HD colonoscopy (+5.74%, P = 0.0056; +4.50%, P = 0.0278; +4.84%, P = 0.03486).
Our study suggests that HD colonoscopy statistically significantly improves sessile serrated adenoma detection rate in the screening of average risk patients during screening colonoscopy. By improving the detection and removal of these lesions, adoption of HD colonoscopy may reduce the significant premalignant burden of sessile serrated adenomas.
Core Tip: Sessile serrated adenomas (SSA) have become increasingly recognized as important premalignant lesions that are difficult to detect during colonoscopy due to similarity in appearance to surrounding colonic mucosa. We performed a retrospective study to evaluate the impact of high definition (HD) colonoscopy compared to standard definition colonoscopy on SSA detection rate (SSADR) during screening colonoscopy. Our study found a statistically significant benefit to SSADR with HD colonoscopy that also met benchmark detection rates. To our knowledge, this study is the first to show the utility of HD colonoscopy for SSADR in average-risk patients, thereby demonstrating it as an important tool for routine colorectal cancer screening. In the absence of a strong clinical guideline to obligate the use of HD colonoscopy, the benefit demonstrated to SSADR by HD colonoscopy in our study may help strengthen the evidence to recommend its use in all settings.