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Hasegawa I, Suzuki S, Yamamura T, Aniwan S, Chiu HM, Laohavichitra K, Chirapongsathorn S, Kuo CY, Yoshida N, Ang TL, Takezawa T, Rerknimitr R, Ishikawa H, Gotoda T. Linked color imaging improves colorectal lesion detection especially for low performance endoscopists: An international trial in Asia. J Gastroenterol Hepatol 2024; 39:1374-1381. [PMID: 38602345 DOI: 10.1111/jgh.16576] [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] [Received: 10/05/2023] [Revised: 12/21/2023] [Accepted: 03/30/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND AND AIM Linked color imaging (LCI) is an image-enhanced endoscopy technique that accentuates the color difference between red and white, potentially improving the adenoma detection rate (ADR). However, it remains unclear whether LCI performance in detecting colorectal lesions differs based on endoscopists' experience levels. We aimed to evaluate the differences in LCI efficacy based on the experience levels of endoscopists by conducting an exploratory analysis. METHODS In this post hoc analysis of an international randomized controlled trial comparing the detection of adenoma and other lesions using colonoscopy with LCI and high-definition white light imaging (WLI), we included patients from 11 institutions across four countries/regions: Japan, Thailand, Taiwan, and Singapore. We retrospectively reviewed differences in the lesion detection of LCI according to endoscopists' colonoscopy history or ADR. RESULTS We included 1692 and 1138 patients who underwent colonoscopies performed by 54 experts (experience of ≥ 5000 colonoscopies) and by 43 non-experts (experience of < 5000 colonoscopies), respectively. Both expert and non-expert groups showed a significant improvement in ADR with LCI compared to WLI (expert, 61.7% vs 46.4%; P < 0.001; non-expert, 56.6% vs 46.4%; P < 0.001). LCI had no effect on sessile serrated lesion detection rate in non-experts (3.1% vs 2.5%; P = 0.518). LCI significantly improved detection rates in endoscopists with relatively low detection performance, defined as an ADR < 50%. CONCLUSIONS This exploratory study analyzed data from a previous trial and revealed that LCI is useful for both experts and non-experts and is even more beneficial for endoscopists with relatively low detection performance using WLI.
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Affiliation(s)
- Issei Hasegawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sho Suzuki
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, School of Medicine, Chiba, Japan
| | - Takeshi Yamamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satmai Aniwan
- Center of Excellence in Endoscopy for Gastrointestinal Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Sakkarin Chirapongsathorn
- Department of Medicine, Division of Gastroenterology and Hepatology, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Chen-Ya Kuo
- Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, SingHealth, Singapore
| | - Takahito Takezawa
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan
| | - Rungsun Rerknimitr
- Center of Excellence in Endoscopy for Gastrointestinal Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Hideki Ishikawa
- Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takuji Gotoda
- Department of Medicine, Division of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
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Kang YW, Lee JH, Lee JY. The Utility of Narrow-Band Imaging International Colorectal Endoscopic Classification in Predicting the Histologies of Diminutive Colorectal Polyps Using I-Scan Optical Enhancement: A Prospective Study. Diagnostics (Basel) 2023; 13:2720. [PMID: 37627979 PMCID: PMC10453535 DOI: 10.3390/diagnostics13162720] [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: 07/08/2023] [Revised: 08/13/2023] [Accepted: 08/19/2023] [Indexed: 08/27/2023] Open
Abstract
(1) Background: This study aimed to evaluate the accuracy of predicting the histology of diminutive colonic polyps (DCPs) (≤5 mm) using i-scan optical enhancement (OE) based on the narrow-band imaging international colorectal endoscopic (NICE) classification. The study compared the diagnostic accuracy between experts who were already familiar with the NICE classification and trainees who were not, both before and after receiving brief training on the NICE classification. (2) Method: This prospective, single-center clinical trial was conducted at the Dong-A University Hospital from March 2020 to August 2020 and involved two groups of participants. The first group comprised two experienced endoscopists who were proficient in using i-scan OE and had received formal training in optical diagnosis and dye-less chromoendoscopy (DLC) techniques. The second group consisted of three endoscopists in the process of training in internal medicine at the Dong-A University Hospital. Each endoscopist examined the polyps and evaluated them using the NICE classification through i-scan OE. The results were not among the participants. Trained endoscopists were divided into pre- and post-training groups. (3) Results: During the study, a total of 259 DCPs were assessed using i-scan OE by the two expert endoscopists. They made real-time histological predictions according to the NICE classification criteria. For the trainee group, before training, the area under the receiver operating characteristic curves (AUROCs) for predicting histopathological results using i-scan OE were 0.791, 0.775, and 0.818. However, after receiving training, the AUROCs improved to 0.935, 0.949, and 0.963, which were not significantly different from the results achieved by the expert endoscopists. (4) Conclusions: This study highlights the potential of i-scan OE, along with the NICE classification, in predicting the histopathological results of DCPs during colonoscopy. In addition, this study suggests that even an endoscopist without experience in DLC can effectively use i-scan OE to improve diagnostic performance with only brief training.
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Affiliation(s)
| | | | - Jong Yoon Lee
- Division of Gastroenterology, Department of Internal Medicine, Dong-A University College of Medicine, Busan 49201, Republic of Korea; (Y.W.K.); (J.H.L.)
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Qi ZP, Xu EP, He DL, Wang Y, Chen BS, Dong XS, Shi Q, Cai SL, Guo Q, Li N, Li X, Huang HY, Li B, Sun D, Xu JG, Chen ZH, Yalikong A, Liu JY, Lv ZT, Xu JM, Zhou PH, Zhong YS. Efficacy of image-enhanced endoscopy for colorectal adenoma detection: A multicenter, randomized trial. World J Gastrointest Oncol 2023; 15:878-891. [PMID: 37275449 PMCID: PMC10237030 DOI: 10.4251/wjgo.v15.i5.878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/24/2023] [Accepted: 04/12/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Improved adenoma detection at colonoscopy has decreased the risk of developing colorectal cancer. However, whether image-enhanced endoscopy (IEE) further improves the adenoma detection rate (ADR) is controversial.
AIM To compare IEE with white-light imaging (WLI) endoscopy for the detection and identification of colorectal adenoma.
METHODS This was a multicenter, randomized, controlled trial. Participants were enrolled between September 2019 to April 2021 from 4 hospital in China. Patients were randomly assigned to an IEE group with WLI on entry and IEE on withdrawal (n = 2113) or a WLI group with WLI on both entry and withdrawal (n = 2098). The primary outcome was the ADR. The secondary endpoints were the polyp detection rate (PDR), adenomas per colonoscopy, adenomas per positive colonoscopy, and factors related to adenoma detection.
RESULTS A total of 4211 patients (966 adenomas) were included in the analysis (mean age, 56.7 years, 47.1% male). There were 2113 patients (508 adenomas) in the IEE group and 2098 patients (458 adenomas) in the WLI group. The ADR in two group were not significantly different [24.0% vs 21.8%, 1.10, 95% confidence interval (CI): 0.99-1.23, P = 0.09]. The PDR was higher with IEE group (41.7%) than with WLI group (36.1%, 1.16, 95%CI: 1.07-1.25, P = 0.01). Differences in mean withdrawal time (7.90 ± 3.42 min vs 7.85 ± 3.47 min, P = 0.30) and adenomas per colonoscopy (0.33 ± 0.68 vs 0.28 ± 0.62, P = 0.06) were not significant. Subgroup analysis found that with narrow-band imaging (NBI), between-group differences in the ADR, were not significant (23.7% vs 21.8%, 1.09, 95%CI: 0.97-1.22, P = 0.15), but were greater with linked color imaging (30.9% vs 21.8%, 1.42, 95%CI: 1.04-1.93, P = 0.04). the second-generation NBI (2G-NBI) had an advantage of ADR than both WLI and the first-generation NBI (27.0% vs 21.8%, P = 0.01; 27.0% vs 21.2.0%, P = 0.01).
CONCLUSION This prospective study confirmed that, among Chinese, IEE didn’t increase the ADR compared with WLI, but 2G-NBI increase the ADR.
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Affiliation(s)
- Zhi-Peng Qi
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200030, China
| | - En-Pan Xu
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200030, China
| | - Dong-Li He
- Endoscopy Center, Shanghai Xuhui Central Hospital, Shanghai 200030, China
| | - Yan Wang
- Endoscopy Center, Traditional Chinese Medical Hospital, Rongcheng 264300, Shandong Province, China
| | - Bai-Sheng Chen
- Department of Endoscopy Center, Xiamen Branch of Affiliated Zhongshan Hospital of Fudan University, Xiamen 361000, Fujian Province, China
| | - Xue-Si Dong
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100000, China
| | - Qiang Shi
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200030, China
| | - Shi-Lun Cai
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200030, China
| | - Qi Guo
- Endoscopy Center, Shanghai Xuhui Central Hospital, Shanghai 200030, China
| | - Ni Li
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100000, China
| | - Xing Li
- Department of Gastroenterology, Pingxiang People’s Hospital, Pingxiang 337000, Jiangxi Province, China
| | - Hai-Yan Huang
- Department of Clinical Medicine, Xiaogang Hospital, Ningbo 315000, Zhejiang Province, China
| | - Bing Li
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200030, China
| | - Di Sun
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200030, China
| | - Jian-Guang Xu
- Endoscopy Center, Quzhou People’s Hospital, Quzhou 324000, Zhejiang Province, China
| | - Zhang-Han Chen
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200030, China
| | - Ayimukedisi Yalikong
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200030, China
| | - Jin-Yi Liu
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200030, China
| | - Zhen-Tao Lv
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200030, China
| | - Jian-Min Xu
- Department of General Surgery, Zhongshan Hospital of Fudan University, Shanghai 200030, China
| | - Ping-Hong Zhou
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200030, China
| | - Yun-Shi Zhong
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200030, China
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Samnani S, Khan R, Heitman SJ, Hilsden RJ, Byrne MF, Grover SC, Forbes N. Optimizing adenoma detection in screening-related colonoscopy. Expert Rev Gastroenterol Hepatol 2023:1-14. [PMID: 37158052 DOI: 10.1080/17474124.2023.2212159] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
INTRODUCTION Screening-related colonoscopy is a vital component of screening initiatives to both diagnose and prevent colorectal cancer (CRC), with prevention being reliant upon early and accurate detection of pre-malignant lesions. Several strategies, techniques, and interventions exist to optimize endoscopists' adenoma detection rates (ADR). AREAS COVERED This narrative review provides an overview of the importance of ADR and other colonoscopy quality indicators. It then summarizes the available evidence regarding the effectiveness of the following domains in terms of improving ADR: endoscopist factors, pre-procedural parameters, peri-procedural parameters, intra-procedural strategies and techniques, antispasmodics, distal attachment devices, enhanced colonoscopy technologies, enhanced optics, and artificial intelligence. These summaries are based on an electronic search of the databases Embase, Pubmed, and Cochrane performed on December 12, 2022. EXPERT OPINION Given the prevalence and associated morbidity and mortality of CRC, the quality of screening-related colonoscopy quality is appropriately prioritized by patients, endoscopists, units, and payers alike. Endoscopists performing colonoscopy should be up to date regarding available strategies, techniques, and interventions to optimize their performance.
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Affiliation(s)
- Sunil Samnani
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rishad Khan
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Steven J Heitman
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Robert J Hilsden
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael F Byrne
- Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - Samir C Grover
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON, Canada
| | - Nauzer Forbes
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Teramoto A, Hamada S, Ogino B, Yasuda I, Sano Y. Updates in narrow-band imaging for colorectal polyps: Narrow-band imaging generations, detection, diagnosis, and artificial intelligence. Dig Endosc 2022; 35:453-470. [PMID: 36480465 DOI: 10.1111/den.14489] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/01/2022] [Indexed: 01/20/2023]
Abstract
Narrow-band imaging (NBI) is an optical digital enhancement method that allows the observation of vascular and surface structures of colorectal lesions. Its usefulness in the detection and diagnosis of colorectal polyps has been demonstrated in several clinical trials and the diagnostic algorithms have been simplified after the establishment of endoscopic classifications such as the Japan NBI Expert Team classification. However, there were issues including lack of brightness in the earlier models, poor visibility under insufficient bowel preparation, and the incompatibility of magnifying endoscopes in certain endoscopic platforms, which had impeded NBI from becoming standardized globally. Nonetheless, NBI continued its evolution and the newest endoscopic platform launched in 2020 offers significantly brighter and detailed images. Enhanced visualization is expected to improve the detection of polyps while universal compatibility across all scopes including magnifying endoscopy will promote the global standardization of magnifying diagnosis. Therefore, knowledge related to magnifying colonoscopy will become essential as magnification becomes standardly equipped in future models, although the advent of computer-aided diagnosis and detection may greatly assist endoscopists to ensure quality of practice. Given that most endoscopic departments will be using both old and new models, it is important to understand how each generation of endoscopic platforms differ from each other. We reviewed the advances in the endoscopic platforms, artificial intelligence, and evidence related to NBI essential for the next generation of endoscopic practice.
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Affiliation(s)
- Akira Teramoto
- Third Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
| | - Seiji Hamada
- Gastrointestinal Center, Urasoe General Hospital, Okinawa, Japan
| | - Banri Ogino
- Third Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
| | - Ichiro Yasuda
- Third Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
| | - Yasushi Sano
- Gastrointestinal Center, Sano Hospital, Hyogo, Japan
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Sakamoto T, Ikematsu H, Tamai N, Mizuguchi Y, Takamaru H, Murano T, Shinmura K, Sasabe M, Furuhashi H, Sumiyama K, Saito Y. Detection of colorectal adenomas with texture and color enhancement imaging: Multicenter observational study. Dig Endosc 2022; 35:529-537. [PMID: 36398944 DOI: 10.1111/den.14480] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/17/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We aimed to evaluate the efficacy of texture and color enhancement imaging (TXI), which allows the acquisition of brighter images with enhanced color and surface structure in colorectal polyp detection compared to white light imaging. METHODS Patients who underwent colonoscopy with repeated ascending colon observation using TXI and white light imaging between August 2020 and January 2021 were identified in three institutions. The outcomes included the mean number of adenomas detected per procedure (MAP), adenoma detection rate (ADR), and ascending colonic adenoma miss rate (Ac-AMR). Logistic regression was used to determine the effects of the variables on the outcomes. RESULTS We included 1043 lesions from 470 patients in the analysis. The MAP, ADR, flat polyp detection rate, and Ac-AMR in TXI and white light imaging were 1.5% (95% confidence interval 1.3-1.6%) vs. 1.0% (0.9-1.1%), 58.2% (51.7-64.6%) vs. 46.8% (40.2-53.4%), 66.2% (59.8-72.2%) vs. 49.8% (43.2-56.4%), and 17.9% (12.1-25.2%) vs. 28.2% (20.0-37.6%), respectively. TXI, age, withdrawal time, and endoscopy type were identified as significant factors affecting the MAP and the ADR using multivariate regression analysis. CONCLUSIONS Our study indicates that TXI improve the detection of colorectal neoplastic lesions. However, prospective randomized trials are required to confirm these findings.
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Affiliation(s)
- Taku Sakamoto
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroaki Ikematsu
- Division of Science and Technology for Endoscopy, National Cancer Center Hospital East, Chiba, Japan.,Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Naoto Tamai
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | | | | | - Tatsuro Murano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Kensuke Shinmura
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Maasa Sasabe
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Hiroto Furuhashi
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazuki Sumiyama
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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Miyakura Y, Chino A, Tanakaya K, Lefor AK, Akagi K, Takao A, Yamada M, Ishida H, Komori K, Sasaki K, Miguchi M, Hirata K, Sudo T, Ishikawa T, Yamaguchi T, Tomita N, Ajioka Y. Current practice of colonoscopy surveillance in patients with lynch syndrome: A multicenter retrospective cohort study in Japan. DEN OPEN 2022; 3:e179. [PMID: 36330234 PMCID: PMC9624071 DOI: 10.1002/deo2.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/21/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022]
Abstract
Objectives Colonoscopy surveillance reduces the incidence of colorectal cancer through the detection and endoscopic removal of adenomas. Current guidelines recommend that patients with Lynch syndrome should have colonoscopy surveillance every 1–2 years starting at the age of 20–25. However, insufficient data are available to evaluate the quality and safety of colonoscopy surveillance for patients with Lynch syndrome nationwide in Japan. Methods Patients with Lynch syndrome (n = 309) from 13 institutions who underwent one or more colonoscopy procedures were enrolled in this retrospective analysis. Colonoscopy completion rate, colonoscopy‐related complication rate, proportion with an adequate colonoscopy interval, and adenoma detection rate were reviewed. Results The colonoscopy completion rate was 98.8% and a history of previous colorectal cancer surgery was significantly associated with a higher completion rate. All complications were associated with endoscopic treatment and the rate of bleeding needing hemostasis and perforation needing surgical repair were both 0.16% after colonoscopy with polypectomy. The adenoma detection rate at the first colonoscopy was 25%. Although there was no difference in the completion and complication rates based on differences in the colonoscopy experience of the endoscopist, the detection rate of adenomas and intramucosal cancers was significantly higher with more experienced endoscopists. The proportion of patients developing cancer was significantly higher with a >24 months than a ≤24 months interval. Conclusion High‐volume experienced endoscopists and appropriate surveillance intervals may minimize the risk of developing colorectal cancers in patients with Lynch syndrome.
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Affiliation(s)
- Yasuyuki Miyakura
- Department of SurgerySaitama Medical Center Jichi Medical UniversitySaitamaJapan,Department of SurgeryJichi Medical UniversityTochigiJapan,The Committee of Hereditary Colorectal Cancer, Japanese Society for Cancer of the Colon and RectumTokyoJapan
| | - Akiko Chino
- The Committee of Hereditary Colorectal Cancer, Japanese Society for Cancer of the Colon and RectumTokyoJapan,Department of Gastroenterology, Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Kohji Tanakaya
- The Committee of Hereditary Colorectal Cancer, Japanese Society for Cancer of the Colon and RectumTokyoJapan,Department of SurgeryIwakuni Clinical CenterYamaguchiJapan
| | | | - Kiwamu Akagi
- The Committee of Hereditary Colorectal Cancer, Japanese Society for Cancer of the Colon and RectumTokyoJapan,Department of Molecular Diagnosis and Cancer PreventionSaitama Cancer CenterSaitamaJapan
| | - Akinari Takao
- The Committee of Hereditary Colorectal Cancer, Japanese Society for Cancer of the Colon and RectumTokyoJapan,Department of GastroenterologyTokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
| | - Masayoshi Yamada
- The Committee of Hereditary Colorectal Cancer, Japanese Society for Cancer of the Colon and RectumTokyoJapan,Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
| | - Hideyuki Ishida
- The Committee of Hereditary Colorectal Cancer, Japanese Society for Cancer of the Colon and RectumTokyoJapan,Department of Digestive Tract and General SurgerySaitama Medical Center, Saitama Medical UniversitySaitamaJapan
| | - Koji Komori
- The Committee of Hereditary Colorectal Cancer, Japanese Society for Cancer of the Colon and RectumTokyoJapan,Department of Gastroenterological SurgeryAichi Cancer Center HospitalAichiJapan
| | - Kazuhito Sasaki
- The Committee of Hereditary Colorectal Cancer, Japanese Society for Cancer of the Colon and RectumTokyoJapan,Department of Surgical Oncology, Faculty of MedicineThe University of TokyoTokyoJapan
| | - Masashi Miguchi
- The Committee of Hereditary Colorectal Cancer, Japanese Society for Cancer of the Colon and RectumTokyoJapan,Department of SurgeryHiroshima Prefectural HospitalHiroshimaJapan
| | - Keiji Hirata
- The Committee of Hereditary Colorectal Cancer, Japanese Society for Cancer of the Colon and RectumTokyoJapan,Department of Surgery I, School of MedicineUniversity of Occupational and Environmental HealthFukuokaJapan
| | - Tomoya Sudo
- The Committee of Hereditary Colorectal Cancer, Japanese Society for Cancer of the Colon and RectumTokyoJapan,Department of SurgeryKurume UniversityFukuokaJapan
| | - Toshiaki Ishikawa
- The Committee of Hereditary Colorectal Cancer, Japanese Society for Cancer of the Colon and RectumTokyoJapan,Department of Medical Oncology, Faculty of MedicineJuntendo UniversityTokyoJapan
| | - Tatsuro Yamaguchi
- The Committee of Hereditary Colorectal Cancer, Japanese Society for Cancer of the Colon and RectumTokyoJapan,Department of Clinical Genetics, Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
| | - Naohiro Tomita
- The Committee of Hereditary Colorectal Cancer, Japanese Society for Cancer of the Colon and RectumTokyoJapan,Cancer Treatment CenterToyonaka Municipal HospitalOsakaJapan
| | - Yoichi Ajioka
- Japanese Society for Cancer of Colon and RectumTokyoJapan,Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental SciencesNiigata UniversityNiigataJapan
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Gubbiotti A, Spadaccini M, Badalamenti M, Hassan C, Repici A. Key factors for improving adenoma detection rate. Expert Rev Gastroenterol Hepatol 2022; 16:819-833. [PMID: 36151898 DOI: 10.1080/17474124.2022.2128761] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Colonoscopy is a fundamental tool in colorectal cancer (CRC) prevention. Nevertheless, one-fourth of colorectal neoplasms are still missed during colonoscopy, potentially being the main reason for post-colonoscopy colorectal cancer (PCCRC). Adenoma detection rate (ADR) is currently known as the best quality indicator correlating with PCCRC incidence. AREAS COVERED We performed a literature review in order to summarize evidences investigating key factors affecting ADR: endoscopists education and training, patient management, endoscopic techniques, improved navigation (exposition defect), and enhanced lesions recognition (vision defect) were considered. EXPERT OPINION 'Traditional' factors, such as split dose bowel preparation, adequate withdrawal time, and right colon second view, held a significant impact on ADR. Several devices and technologies have been developed to promote high-quality colonoscopy, however artificial intelligence may be considered the most promising tool for ADR improvement, provided that endoscopists education and recording are guaranteed.
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Affiliation(s)
- Alessandro Gubbiotti
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Italy
| | - Marco Spadaccini
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Italy
| | - Matteo Badalamenti
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Italy
| | - Cesare Hassan
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Italy
| | - Alessandro Repici
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Italy
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Bürger M, Weber M, Petersen I, Stallmach A, Schmidt C. Adenoma detection rate using narrow-band imaging is inferior to high-definition white light colonoscopy in screening and surveillance colonoscopies in daily clinical care: A randomized controlled trial. Medicine (Baltimore) 2022; 101:e29858. [PMID: 35960070 PMCID: PMC9371537 DOI: 10.1097/md.0000000000029858] [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] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Despite recent advances in endoscopic technology adenoma miss rate still is up to 20% contributing to interval cancers. Improved imaging modalities have been introduced to increase adenoma detection rate (ADR). Recently, narrow-band imaging (NBI) (Exera II series, Olympus Corporation) was not significantly better than high-definition white light colonoscopy (HD-WLC). An improved second generation of NBI (190-NBI) is characterized by better illumination of the bowel lumen and may be associated with a higher ADR. METHODS We performed a prospective randomized study on patients referred to the Jena University Hospital for screening or surveillance colonoscopy between January 2015 and April 2017. Participating endoscopists were divided into 2 subgroups depending on their individual experience. Colonoscopy was performed by use of HD-WLC or 190-NBI upon withdrawal. RESULTS Five hundred fifty-three patients participated in the study. Eighty patients were excluded (insufficient bowel cleansing [n = 34], anticoagulation precluding polypectomy [n=15], partial colonic resection [n=9], other reasons [n = 22]). Mean age was 66.9 years (standard deviation 10.3 years), and 253 patients were male (53.5%). Bowel preparation and withdrawal time were not different. ADR among all subgroups was 39.4% using HD-WLC, but only 29.1% were using 190-NBI (P = .02). Number of polyps per patient was lower using 190-NBI than with HD-WLC (0.58 vs 0.86; P = .02). Subgroup analysis revealed that 190-NBI was inferior to HD-WLC only in unexperienced endoscopists. CONCLUSION In our stud,y ADR was lower by use of 190-NBI. These differences persisted only in unexperienced investigators. 190-NBI seems to be more challenging regarding ADR, requiring more intensive training prior to implementing this technology in daily clinical care. REGISTRATION ClinicalTrials.gov (identifier: NCT03081975).
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Affiliation(s)
- Martin Bürger
- Department of Gastroenterology, Hepatology and Infectious Diseases, Clinic for Internal Medicine IV, Jena University Hospital, Jena, Germany
- Clinic for Gastroenterology and Hepatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- *Correspondence: Martin Bürger, Department of Gastroenterology, Hepatology and Infectious Diseases, Clinic for Internal Medicine IV, Jena University Hospital, Am Klinikum 1, Jena 07747, Germany (e-mail: )
| | - Marko Weber
- Department of Gastroenterology, Hepatology and Infectious Diseases, Clinic for Internal Medicine IV, Jena University Hospital, Jena, Germany
| | - Iver Petersen
- Institute of Pathology, Jena University Hospital, Jena, Germany
- Institute of Pathology, Waldklinikum Gera, Gera, Germany
| | - Andreas Stallmach
- Department of Gastroenterology, Hepatology and Infectious Diseases, Clinic for Internal Medicine IV, Jena University Hospital, Jena, Germany
| | - Carsten Schmidt
- Department of Gastroenterology, Hepatology, Endocrinology, Diabetes and Infectious Diseases, Medical Clinic II, Fulda Hospital, Fulda, Germany
- Medical Faculty of the Friedrich Schiller University, Jena, Germany
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10
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Shaukat A, Tuskey A, Rao VL, Dominitz JA, Murad MH, Keswani RN, Bazerbachi F, Day LW. Interventions to improve adenoma detection rates for colonoscopy. Gastrointest Endosc 2022; 96:171-183. [PMID: 35680469 DOI: 10.1016/j.gie.2022.03.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/25/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Aasma Shaukat
- Division of Gastroenterology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Anne Tuskey
- Division of Gastroenterology, Department of Medicine, University of Virginia, Arlington, Virginia, USA
| | - Vijaya L Rao
- Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Jason A Dominitz
- Division of Gastroenterology, Department of Medicine, Puget Sound Veterans Affairs Medical Center and University of Washington, Seattle, Washington, USA
| | - M Hassan Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rajesh N Keswani
- Division of Gastroenterology, Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Fateh Bazerbachi
- Division of Gastroenterology, CentraCare, Interventional Endoscopy Program, St Cloud, Minnesota, USA
| | - Lukejohn W Day
- Division of Gastroenterology, Department of Medicine, Zuckerberg San Francisco General Hospital and University of San Francisco, San Francisco, California, USA
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11
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Hori K, Ikematsu H, Yamamoto Y, Matsuzaki H, Takeshita N, Shinmura K, Yoda Y, Kiuchi T, Takemoto S, Yokota H, Yano T. Detecting colon polyps in endoscopic images using artificial intelligence constructed with automated collection of annotated images from an endoscopy reporting system. Dig Endosc 2022; 34:1021-1029. [PMID: 34748658 DOI: 10.1111/den.14185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Artificial intelligence (AI) has made considerable progress in image recognition, especially in the analysis of endoscopic images. The availability of large-scale annotated datasets has contributed to the recent progress in this field. Datasets of high-quality annotated endoscopic images are widely available, particularly in Japan. A system for collecting annotated data reported daily could aid in accumulating a significant number of high-quality annotated datasets. AIM We assessed the validity of using daily annotated endoscopic images in a constructed reporting system for a prototype AI model for polyp detection. METHODS We constructed an automated collection system for daily annotated datasets from an endoscopy reporting system. The key images were selected and annotated for each case only during daily practice, not to be performed retrospectively. We automatically extracted annotated endoscopic images of diminutive colon polyps that had been diagnosed (study period March-September 2018) using the keywords of diagnostic information, and additionally collect the normal colon images. The collected dataset was devised into training and validation to build and evaluate the AI system. The detection model was developed using a deep learning algorithm, RetinaNet. RESULTS The automated system collected endoscopic images (47,391) from colonoscopies (745), and extracted key colon polyp images (1356) with localized annotations. The sensitivity, specificity, and accuracy of our AI model were 97.0%, 97.7%, and 97.3% (n = 300), respectively. CONCLUSION The automated system enabled the development of a high-performance colon polyp detector using images in endoscopy reporting system without the efforts of retrospective annotation works.
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Affiliation(s)
- Keisuke Hori
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan.,Division of Science and Technology for Endoscopy, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center Hospital East, Chiba, Japan
| | - Hiroaki Ikematsu
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan.,Division of Science and Technology for Endoscopy, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center Hospital East, Chiba, Japan
| | - Yoichi Yamamoto
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Hiroki Matsuzaki
- Medical Device Innovation Center, National Cancer Center Hospital East, Chiba, Japan
| | - Nobuyoshi Takeshita
- Medical Device Innovation Center, National Cancer Center Hospital East, Chiba, Japan
| | - Kensuke Shinmura
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Yusuke Yoda
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan.,Medical Device Innovation Center, National Cancer Center Hospital East, Chiba, Japan
| | - Takayoshi Kiuchi
- System Engineering Division, FUJIFILM Medical IT Solutions Co., Ltd., Tokyo, Japan
| | - Satoko Takemoto
- Image Processing Research Team, RIKEN Center for Advanced Photonics, Saitama, Japan
| | - Hideo Yokota
- Image Processing Research Team, RIKEN Center for Advanced Photonics, Saitama, Japan.,Advanced Data Science Project, RIKEN Information R&D and Strategy Headquarters, Saitama, Japan
| | - Tomonori Yano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan.,Medical Device Innovation Center, National Cancer Center Hospital East, Chiba, Japan
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12
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Lam AY, Duloy AM, Keswani RN. Quality Indicators for the Detection and Removal of Colorectal Polyps and Interventions to Improve Them. Gastrointest Endosc Clin N Am 2022; 32:329-349. [PMID: 35361339 DOI: 10.1016/j.giec.2021.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Modifiable risk factors for postcolonoscopy colorectal cancer include suboptimal lesion detection (missed neoplasms) and inadequate lesion removal (incomplete polypectomy) during colonoscopy. Competent detection and removal of colorectal polyps are thus fundamental to ensuring adequate colonoscopy quality. Several well-researched quality metrics for polyp detection have been implemented into clinical practice, chief among these the adenoma detection rate. Less data are available on quality indicators for polyp removal, which currently include complete resection rates and skills assessment tools. This review summarizes the available literature on quality indicators for the detection and removal of colorectal polyps, as well as interventions to improve them.
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Affiliation(s)
- Angela Y Lam
- Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, 2350 Geary Boulevard, San Francisco, CA 94115, USA
| | - Anna M Duloy
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, 1635 Aurora Court, Aurora, CO 80045, USA
| | - Rajesh N Keswani
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, 676 North Street, Clair, Suite 1400, Chicago, IL 60611, USA.
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13
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Staudenmann D, Liu K, Varma P, Wong M, Rai S, Tsoutsman T, Choi KH, Saxena P, Kaffes AJ. Narrow band imaging versus white light for detecting sessile serrated lesion: A prospective randomized multicenter study. DEN OPEN 2022; 2:e44. [PMID: 35310703 PMCID: PMC8828189 DOI: 10.1002/deo2.44] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/29/2021] [Accepted: 07/03/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Dominic Staudenmann
- AW Morrow Gastroenterology and Liver Centre Royal Prince Alfred Hospital Sydney Australia
- Department of Gastroenterology Praxis Balsiger Seibold und Partner Bern Switzerland
- Université de Fribourg Fribourg Switzerland
| | - Ken Liu
- AW Morrow Gastroenterology and Liver Centre Royal Prince Alfred Hospital Sydney Australia
- Sydney Medical School University of Sydney Sydney Australia
| | - Poornima Varma
- Department of Gastroenterology Austin Health Heidelberg Australia
| | - May Wong
- AW Morrow Gastroenterology and Liver Centre Royal Prince Alfred Hospital Sydney Australia
- Royal North Shore Hospital St. Leonards Sydney Australia
| | - Sonam Rai
- Sydney Medical School University of Sydney Sydney Australia
| | - Tatiana Tsoutsman
- AW Morrow Gastroenterology and Liver Centre Royal Prince Alfred Hospital Sydney Australia
- Sydney Medical School University of Sydney Sydney Australia
| | - Kyung Ho Choi
- AW Morrow Gastroenterology and Liver Centre Royal Prince Alfred Hospital Sydney Australia
- Sydney Medical School University of Sydney Sydney Australia
| | - Payal Saxena
- AW Morrow Gastroenterology and Liver Centre Royal Prince Alfred Hospital Sydney Australia
- Sydney Medical School University of Sydney Sydney Australia
| | - Arthur John Kaffes
- AW Morrow Gastroenterology and Liver Centre Royal Prince Alfred Hospital Sydney Australia
- Sydney Medical School University of Sydney Sydney Australia
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14
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Buchner AM, Sharma P, Wallace MB. Contrast‐Enhanced Endoscopy. SUCCESSFUL TRAINING IN GASTROINTESTINAL ENDOSCOPY 2022:177-194. [DOI: 10.1002/9781119529675.ch15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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15
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Kandel P, Wallace MB. Advanced Imaging Techniques and In vivo Histology: Current Status and Future Perspectives (Lower G.I.). GASTROINTESTINAL AND PANCREATICO-BILIARY DISEASES: ADVANCED DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2022:291-310. [DOI: 10.1007/978-3-030-56993-8_110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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16
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Chang WY, Chiu HM. Can image-enhanced endoscopy improve adenoma detection rate? Dig Endosc 2022; 34:284-296. [PMID: 34351014 DOI: 10.1111/den.14102] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/26/2021] [Accepted: 08/02/2021] [Indexed: 12/14/2022]
Abstract
An accumulating body of evidence has shown that detection and resection of pre-cancerous adenoma by colonoscopy could effectively prevent colorectal cancer (CRC) and its related mortality. Among various colonoscopy quality indicators, such as cecal intubation rate, withdrawal time, and adenoma detection rate (ADR); ADR is the most important and most closely associated with the subsequent risk of CRC. Image-enhanced endoscopy (IEE), including digital and dye-based IEE, was originally developed to discriminate neoplastic from non-neoplastic lesions but later studies have demonstrated that it can also enhance lesion detection by enhancing the contrast between the lesion and background colonic mucosa. Nevertheless, using IEE in colonoscopy for lesion detection is still not the standard way of practice in the real world. For a better understanding of current IEE modalities, this review introduces and compares the currently available IEE modalities and their efficacy in detecting adenoma from the results of randomized controlled trials or meta-analyses.
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Affiliation(s)
- Wei-Yuan Chang
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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17
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Lao W, Prasoon P, Cao G, Tan LT, Dai S, Devadasar GH, Huang X. Risk factors for incomplete polyp resection during colonoscopy. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2021. [DOI: 10.1016/j.lers.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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18
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Minamide T, Sashiyama H, Muramatsu Y, Yada T, Matsumura T, Takeda S, Suzuki T, Kakimoto T, Yano T, Yoshii K, Arai M, Uemura N, Yamaguchi T, Ikematsu H. Second-generation narrow-band imaging to detect colorectal adenomas: A prospective study including community hospitals. J Gastroenterol Hepatol 2021; 36:3084-3091. [PMID: 34251049 DOI: 10.1111/jgh.15621] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 06/14/2021] [Accepted: 07/06/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIM It is unclear whether second-generation narrow-band imaging (NBI) improves colorectal adenoma detection in clinical practice. We aimed to evaluate the ability of NBI to detect adenomas in academic and community hospitals. METHODS This observational, multicenter study was conducted in four academic and four community hospitals between July 2018 and April 2019. We enrolled patients aged ≥ 20 years who underwent colonoscopy for screening, polyp surveillance, or diagnostic workup. The primary endpoint was the adenoma detection rate (ADR) between NBI (NBI group) and white-light imaging colonoscopies (WLI group) after propensity score (PS) matching. RESULTS Of 1831 patients analyzed before PS matching, the NBI and WLI groups included 742 and 1089 patients, respectively. After PS matching, 711 pairs from both groups were analyzed. ADR and the mean number of adenomas per patient did not differ significantly between the NBI and WLI groups (43.5% vs 44.4%, P = 0.71; 0.90 ± 1.38 vs 0.91 ± 1.40, P = 0.95, respectively). Academic hospitals showed higher ADR in the NBI group (60.5% vs 53.8%), whereas community hospitals showed higher ADR in the WLI group (35.8% vs 40.5%). In the NBI group, ADR was significantly higher among NBI-screening-experienced endoscopists than among NBI-screening-inexperienced endoscopists (63.2% vs 39.2%, P < 0.001). The mean number of flat and depressed lesions detected per patient was significantly higher with NBI than with WLI (0.62 ± 1.34 vs 0.44 ± 1.01, P = 0.035). CONCLUSIONS Second-generation NBI could not surpass WLI in terms of ADR based on patient recruitment from both academic and community hospitals but improved the detection of easily overlooked flat and depressed lesions.
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Affiliation(s)
- Tatsunori Minamide
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Hiroshi Sashiyama
- Department of Coloproctological Surgery, Tsujinaka Hospital Kashiwanoha, Chiba, Japan
| | - Yusuke Muramatsu
- Department of Gastroenterology, Kobari General Hospital, Chiba, Japan
| | - Tomoyuki Yada
- Department of Gastroenterology and Hepatology, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Tomoaki Matsumura
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shinichiro Takeda
- Department of Gastroenterology, Matsudo City General Hospital, Chiba, Japan
| | - Takuto Suzuki
- Division of Endoscopy, Chiba Cancer Center, Chiba, Japan
| | | | - Tomonori Yano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Katsumi Yoshii
- Department of Gastroenterology, Kobari General Hospital, Chiba, Japan
| | - Makoto Arai
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naomi Uemura
- Department of Gastroenterology and Hepatology, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | | | - Hiroaki Ikematsu
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
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19
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A protease-activated, near-infrared fluorescent probe for early endoscopic detection of premalignant gastrointestinal lesions. Proc Natl Acad Sci U S A 2021; 118:2008072118. [PMID: 33443161 PMCID: PMC7817203 DOI: 10.1073/pnas.2008072118] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Fluorescence imaging is currently being actively developed for surgical guidance; however, it remains underutilized for diagnostic and endoscopic surveillance of incipient colorectal cancer in high-risk patients. Here we demonstrate the utility and potential for clinical translation of a fluorescently labeled cathepsin-activated chemical probe to highlight gastrointestinal lesions. This probe stays optically dark until it is activated by proteases produced by tumor-associated macrophages and accumulates within the lesions, enabling their detection using an endoscope outfitted with a fluorescence detector. We evaluated the probe in multiple murine models and a human-scale porcine model of gastrointestinal carcinogenesis. The probe provides fluorescence-guided surveillance of gastrointestinal lesions and augments histopathological analysis by highlighting areas of dysplasia as small as 400 µm, which were visibly discernible with significant tumor-to-background ratios, even in tissues with a background of severe inflammation and ulceration. Given these results, we anticipate that this probe will enable sensitive fluorescence-guided biopsies, even in the presence of highly inflamed colorectal tissue, which will improve early diagnosis to prevent gastrointestinal cancers.
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20
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Yang SY, Quan SY, Friedland S, Pan JY. Predictive factors for adenoma detection rates: a video study of endoscopist practices. Endosc Int Open 2021; 9:E216-E223. [PMID: 33553584 PMCID: PMC7857972 DOI: 10.1055/a-1321-0990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/19/2020] [Indexed: 12/18/2022] Open
Abstract
Background and study aims In 2015, the American Society for Gastrointestinal Endoscopy (ASGE) and American College of Gastroenterology (ACG) Task Force on Quality in Endoscopy deemed adenoma detection rate (ADR) the most important quality measure for colonoscopy. There has been much interest in factors that can increase ADR. To date, however, few studies have looked at what intra-procedural endoscopist practices are associated with improving ADR. We conducted a retrospective review of colonoscopy videos to evaluate intra-procedural practices that could be associated with ADR. Methods Videos were recorded of colonoscopies performed between September and December 2017 at the Palo Alto Veterans Affairs Health Care System. Colonoscopies for screening and surveillance were included for video review. Factors assessed included withdrawal time, intra-procedural cleaning, inspection technique, and other variables (colon distention, removal of equivocal/hyperplastic polyps). A series of multiple regression analyses was conducted on variables of interest before running a final model of significant predictors. Results A total of 130 videos were reviewed from nine endoscopists whose ADRs ranged between 37.5 % and 73.7 %. The final regression model was significant (F = 15.35, df = 2, P = 0.0044), R 2 = 0.8365) with close inspection of behind folds and quality of cecal inspection being the factors highly correlated with predicting ADR. Withdrawal and inspection times, colonic wall distention, removal of equivocal/hyperplastic polyps, quality of rectal inspection, suctioning, and washing were factors moderately correlated with predicting ADR. Conclusions We found that behind-fold inspection and a meticulous cecal inspection technique were predictive of a high ADR.
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Affiliation(s)
- Sun Young Yang
- Division of Gastroenterology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Susan Y. Quan
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States,Division of Gastroenterology & Hepatology, Stanford University School of Medicine, Palo Alto, California, United States
| | - Shai Friedland
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States,Division of Gastroenterology & Hepatology, Stanford University School of Medicine, Palo Alto, California, United States
| | - Jennifer Y. Pan
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States,Division of Gastroenterology & Hepatology, Stanford University School of Medicine, Palo Alto, California, United States
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21
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Abdelbary M, Hamdy S, Shehab H, ElGarhy N, Menesy M, Marzaban R. Colonoscopic techniques in polyp detection: An Egyptian study. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021. [DOI: 10.1016/j.rgmxen.2020.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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22
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Li JW, Ang TL. Narrow-Band Imaging. ENDOSCOPY IN EARLY GASTROINTESTINAL CANCERS, VOLUME 1 2021:111-119. [DOI: 10.1007/978-981-10-6769-3_13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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23
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Shinozaki S, Kobayashi Y, Hayashi Y, Sakamoto H, Sunada K, Lefor AK, Yamamoto H. Colon polyp detection using linked color imaging compared to white light imaging: Systematic review and meta-analysis. Dig Endosc 2020; 32:874-881. [PMID: 31869487 DOI: 10.1111/den.13613] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/15/2019] [Accepted: 12/17/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Linked color imaging (LCI) is a novel image-enhancing technology which enhances color differences between a colorectal lesion and surrounding mucosa with enough brightness to illuminate the wide colorectal lumen. The aim of this study is to compare colorectal polyp detection using LCI with that using white light imaging (WLI). METHODS Randomized controlled trials and prospective studies comparing LCI with WLI for colorectal polyp detection were selected. Outcomes included overall polyp/adenoma detection and additional polyp detection at a second observation. Outcomes were documented by pooled risk ratios (RR) with 95% confidence interval (CI) using the Mantel-Haenszel random effect model. RESULTS Seven studies were included. LCI showed significant superiority for polyp and adenoma detection compared with WLI (RR 1.16, 95% CI 1.09-1.25, P < 0.001 for polyp detection; RR 1.26, 95% CI 1.14-1.39 P < 0.001 for adenoma detection). LCI significantly increased the number of polyps detected per patient compared with WLI (mean difference 0.27, 95% CI 0.01-0.53, P = 0.040). LCI significantly increased the number of adenomas detected per patient compared with WLI (mean difference 0.22, 95% CI 0.08-0.36, P = 0.002). LCI significantly increased the number of flat polyps detected per patient compared with WLI (mean difference 0.14, 95% CI 0.01-0.27, P = 0.040). LCI had a significantly higher rate of additional polyp detection compared with WLI in the right colon (RR 2.68, 95% CI 1.71-4.19, P < 0.001). CONCLUSIONS Linked color imaging has significantly greater polyp and adenoma detection rates and detection rate of previously missed polyps compared with WLI. We recommend the initial use of LCI for routine colonoscopy.
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Affiliation(s)
- Satoshi Shinozaki
- Shinozaki Medical Clinic, Tochigi, Japan.,Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan
| | - Yasutoshi Kobayashi
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan
| | - Yoshikazu Hayashi
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan
| | - Hirotsugu Sakamoto
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan
| | - Keijiro Sunada
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan
| | | | - Hironori Yamamoto
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan
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Abdelbary M, Hamdy S, Shehab H, ElGarhy N, Menesy M, Marzaban R. Colonoscopic techniques in polyp detection: An Egyptian study. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2020; 86:36-43. [PMID: 32651028 DOI: 10.1016/j.rgmx.2020.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/17/2020] [Accepted: 02/26/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION AND AIMS The polyp detection rate (PDR) is defined as the percentage of colonoscopies in which one or more polyps are detected, and has been shown to be highly correlated with the adenoma detection rate. The aim of the present study was to evaluate the PDR at the Endoscopy Unit of the Kasr Al-Ainy Hospital, Cairo University, Egypt, through the i-SCAN, Endocuff, and underwater colonoscopy techniques. MATERIALS AND METHODS The study was conducted on 100 Egyptian subjects over 50 years of age. Their polyp detection rate was measured through 4 different colonoscopic techniques. An equal number of patients were divided into 4 groups: i-SCAN, Endocuff, underwater colonoscopy, and controls. The control group was examined using standard white light colonoscopy. The colonoscopy evaluation included the type of agent utilized for bowel preparation, preparation grade, and colonoscopy withdrawal time. RESULTS The general PDR was 48%. The i-SCAN technique had the highest rate (56%), followed by the underwater (52%) and the Endocuff (48%) techniques. CONCLUSION The i-SCAN and underwater colonoscopy techniques produced higher PDR than the Endocuff-assisted and standard techniques, but with no statistical significance.
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Affiliation(s)
- M Abdelbary
- Medicina Tropical, Facultad de Medicina, Universidad de El Cairo, El Cairo, Egipto
| | - S Hamdy
- Medicina Tropical, Facultad de Medicina, Universidad de El Cairo, El Cairo, Egipto
| | - H Shehab
- Medicina Tropical, Facultad de Medicina, Universidad de El Cairo, El Cairo, Egipto
| | - N ElGarhy
- Medicina Tropical, Facultad de Medicina, Universidad de El Cairo, El Cairo, Egipto
| | - M Menesy
- Medicina Tropical, Facultad de Medicina, Universidad de El Cairo, El Cairo, Egipto
| | - R Marzaban
- Medicina Tropical, Facultad de Medicina, Universidad de El Cairo, El Cairo, Egipto.
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Rath T, Morgenstern N, Vitali F, Atreya R, Neurath MF. Advanced Endoscopic Imaging in Colonic Neoplasia. Visc Med 2020; 36:48-59. [PMID: 32110657 PMCID: PMC7036553 DOI: 10.1159/000505411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 12/11/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Endoscopic imaging is a rapidly evolving field with a constant influx of new concepts and technologies. Since the introduction of video endoscopy and subsequently high-definition imaging as the first revolutions in gastrointestinal endoscopy, several technologies of virtual chromoendoscopy have been developed and brought to the market in the past decade, which have shaped and revolutionized for a second time our approach to endoscopic imaging. In parallel to these developments, microscopic imaging technologies, such as endomicroscopy and endocytoscopy, allow us to examine single cells within the mucosa in real time, thereby enabling histological diagnoses during ongoing endoscopy. SUMMARY In this review, we provide an overview on the technical background of different technologies of advanced endoscopic imaging, and then review and discuss their role and applications for the diagnosis and management of colorectal neoplasms as well as limitations and challenges that exist despite all technological improvements. KEY MESSAGES Technologies of advanced endoscopic imaging have profound impact not only on our imaging capabilities, they are also about to fundamentally change our approach to managing lesions in the gastrointestinal tract: not every lesion found during colonoscopy has to be excised or sent for histopathologic evaluation. However, before this becomes widespread reality, major obstacles such as patient acceptance, adoption by less trained endoscopists, and also legal aspects need to carefully addressed. The development of computer-aided diagnosis and artificial intelligence algorithms hold the potential to overcome the obstacles associated with the concept of optical biopsy and will most likely fundamentally facilitate, shape, and change decision making in the management of colorectal lesions.
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Affiliation(s)
- Timo Rath
- Ludwig Demling Endoscopy Center of Excellence, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Machicado JD, Kolb JM, Wani SB. Endoscopic Lesion Recognition and Advanced Imaging Modalities. GASTROINTESTINAL INTERVENTIONAL ENDOSCOPY 2020:3-23. [DOI: 10.1007/978-3-030-21695-5_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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27
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Leung WK, Guo CG, Ko MKL, To EWP, Mak LY, Tong TSM, Chen LJ, But DYK, Wong SY, Liu KSH, Tsui V, Lam FYF, Lui TKL, Cheung KS, Lo SH, Hung IFN. Linked color imaging versus narrow-band imaging for colorectal polyp detection: a prospective randomized tandem colonoscopy study. Gastrointest Endosc 2020; 91:104-112.e5. [PMID: 31276672 DOI: 10.1016/j.gie.2019.06.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 06/21/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Linked color imaging (LCI) is a newly available image-enhanced endoscopy (IEE) system that emphasizes the red mucosal color. No study has yet compared LCI with other available IEE systems. Our aim was to investigate polyp detection rates using LCI compared with narrow-band imaging (NBI). METHODS This is a prospective randomized tandem colonoscopy study. Eligible patients who underwent colonoscopy for symptoms or screening/surveillance were randomized in a 1:1 ratio to receive tandem colonoscopy with both colonoscope withdrawals using LCI or NBI. The primary outcome was the polyp detection rate. RESULTS Two hundred seventy-two patients were randomized (mean age, 62 years; 48.2% male; colonoscopy for symptoms, 72.8%) with 136 in each arm. During the first colonoscopy, the polyp detection rate (71.3% vs 55.9%; P = .008), serrated lesion detection rate (34.6% vs 22.1%; P = .02), and mean number of polyps detected (2.04 vs 1.35; P = .02) were significantly higher in the NBI group than in the LCI group. There was also a trend of higher adenoma detection rate in the NBI group compared with the LCI group (51.5% vs 39.7%, respectively; P = .05). Multivariable analysis confirmed that use of NBI (adjusted odds ratio, 1.99; 95% confidence interval, 1.09-3.68) and withdrawal time >8 minutes (adjusted odds ratio, 5.11; 95% confidence interval, 2.79-9.67) were associated with polyp detection. Overall, 20.5% of polyps and 18.1% of adenomas were missed by the first colonoscopy, but there was no significant difference in the miss rates between the 2 groups. CONCLUSION NBI was significantly better than LCI for colorectal polyp detection. However, both LCI and NBI missed 20.5% of polyps. (Clinical trial registration number: NCT03336359.).
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Affiliation(s)
- Wai K Leung
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Chuan-Guo Guo
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Michael K L Ko
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Elvis W P To
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Lung Yi Mak
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Teresa S M Tong
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Li-Jia Chen
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - David Y K But
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Siu Yin Wong
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Kevin S H Liu
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Vivian Tsui
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Frank Y F Lam
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Thomas K L Lui
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Ka Shing Cheung
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Siu Hung Lo
- Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Ivan F N Hung
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
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Shinozaki S, Osawa H, Hayashi Y, Lefor AK, Yamamoto H. Linked color imaging for the detection of early gastrointestinal neoplasms. Therap Adv Gastroenterol 2019; 12:1756284819885246. [PMID: 31700545 PMCID: PMC6826899 DOI: 10.1177/1756284819885246] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/04/2019] [Indexed: 02/04/2023] Open
Abstract
In routine upper and lower gastrointestinal endoscopy, overlooking neoplastic lesions is inevitable even for well-trained endoscopists. Various methods have been reported to improve the detection of gastrointestinal neoplasms including chromoendoscopy, special endoscopes, and processor and image enhanced technologies. Equipment-based image enhanced endoscopy (e-IEE) using narrow band imaging (NBI) and blue laser imaging (BLI) is useful to characterize known lesions with magnification at a close-up view. However, they are not useful for the early detection of superficial, pale neoplasms, or both because of the weak image at a distant view in a wide lumen such as the stomach or colon. Linked color imaging (LCI) is a novel pre- and post-processing technology developed by Fujifilm Corporation that has sufficient brightness to illuminate a wide lumen. LCI delineates early gastric cancers as orange-red and intestinal metaplasia as purple. LCI improves the adenoma detection rate in the colon and decreases the polyp miss rate. LCI contributes to the detection of superficial lesions throughout the gastrointestinal tract by enhancing the color contrast between the neoplasm and the surrounding mucosa. LCI can distinguish them by their specific color allocation based mainly on the distribution of capillaries. The authors believe that moving forward, LCI should be used in routine upper and lower gastrointestinal endoscopy.
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Affiliation(s)
- Satoshi Shinozaki
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan,Shinozaki Medical Clinic, Utsunomiya, Japan
| | - Hiroyuki Osawa
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Yoshikazu Hayashi
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
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Impact of Electronic Chromoendoscopy on Adenoma Miss Rates During Colonoscopy: A Systematic Review and Meta-analysis. Dis Colon Rectum 2019; 62:1124-1134. [PMID: 31162375 DOI: 10.1097/dcr.0000000000001419] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The impact of virtual chromoendoscopy such as narrow-band imaging, Fujinon intelligent chromoendoscopy, blue-light imaging, linked-color imaging, and i-SCAN on adenoma detection rate has been variable. However, adenoma miss rate (another measure suggested as a quality indicator) of electronic chromoendoscopy modalities has not been systematically evaluated. OBJECTIVES This study aimed to perform a systematic review and meta-analysis to examine the adenoma miss rate of white-light endoscopy compared with electronic chromoendoscopy. DATA SOURCES Medline, Embase, Scopus, Web of Knowledge, and Cochrane were the data sources for this study. STUDY SELECTION The studies selected were tandem randomized controlled trials of electronic chromoendoscopy modalities compared with white-light endoscopy. INTERVENTIONS Electronic chromoendoscopy compared with white light endoscopy was used to measure the adenoma miss rate. MAIN OUTCOME MEASURES Primary outcome was the pooled adenoma miss rate of electronic chromoendoscopy techniques compared with white-light endoscopy. Secondary outcomes were subgroup analysis, adenoma size analysis, and adenoma detection rate. RESULTS A total of 3507 patients were evaluated from 7 eligible tandem randomized control trials. A total of 1423 patients had white-light endoscopy as the first of the tandem examinations. The rest of the patients had electronic chromoendoscopy as the first of the tandem examination (narrow-band imaging, 988 patients; Fujinon intelligent chromoendoscopy, 728 patients; i-SCAN, 233 patients; blue-light imaging, 64 patients; and linked-color imaging, 71 patients). The pooled adenoma miss rate for electronic chromoendoscopy was not different than white-light endoscopy (17.9% vs 21%; OR, 0.72 (0.67-1.11); I 67%; p = 0.13). When only narrow-band imaging, blue-light imaging, and linked-color imaging were considered, the pooled rate was statistically significant (OR, 0.60 (0.37-0.98); p = 0.04). The pooled adenoma detection rate was not statistically different with electronic chromoendoscopy than white-light endoscopy (OR, 1.02 (0.88-1.19); p = 0.78). LIMITATIONS The small number of studies to assess the impact of each modality limited stratified conclusions. CONCLUSIONS Electronic chromoendoscopy is not associated with a significant reduction in adenoma miss rate compared with white-light colonoscopy.
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Kim H, Goong HJ, Ko BM, Myung YS, Ho Jung Y, Jeon SR, Kim HG, Lee MS. Randomized, back-to-back trial of a new generation NBI with a high-definition white light (HQ290) for detecting colorectal polyps. Scand J Gastroenterol 2019; 54:1058-1063. [PMID: 31430183 DOI: 10.1080/00365521.2019.1650953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: The benefits of narrow band imaging (NBI) for improving the detection rate of colorectal polyps remain unclear. New generation NBI using the 290 system (290-NBI) provides an at least two-fold brighter image than that of the previous version. We aimed to compare polyp miss rates between 290-NBI colonoscopy and high-definition white light endoscopy (HDWL). Methods: In total, 117 patients were randomized to undergo either 290-NBI or HDWL from June 2015 to February 2017. In the HDWL group, we performed HDWL as an initial inspection, followed by a second inspection with NBI. In the 290-NBI group, NBI was performed as the initial inspection, followed by a second inspection with HDWL. We compared polyp and adenoma detection rates and polyp miss rates (PMR) between the two groups and analyzed the factors associated with the PMR. Results: In total, 127 polyps were detected in the 117 patients. No differences in adenoma or polyp detection rates were observed between the two groups. The PMR for 290-NBI was 20.6% and that for HDWL was 33.9% (p = .068). However, the non-adenomatous PMR for 290-NBI was significantly lower than that of HDWL (11.5% vs. 52.2%, p = .002). Furthermore, the miss rates of polyps on the left side of the colon, flat-type polyps, and non-adenomatous polyps were significantly lower in the 290-NBI than HDWL. Conclusions: New generation NBI may reduce PMR, especially of flat-type and non-adenomatous polyps and those on the left side of the colon. (UMIN000025505).
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Affiliation(s)
- Haewon Kim
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine , Bucheon , Korea
| | - Hyeon Jeong Goong
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine , Bucheon , Korea
| | - Bong Min Ko
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine , Bucheon , Korea
| | - Yu Sik Myung
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine , Bucheon , Korea
| | - Yun Ho Jung
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine , Bucheon , Korea
| | - Seong Ran Jeon
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine , Bucheon , Korea
| | - Hyun Gun Kim
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine , Bucheon , Korea
| | - Moon Sung Lee
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine , Bucheon , Korea
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Atkinson NSS, Ket S, Bassett P, Aponte D, De Aguiar S, Gupta N, Horimatsu T, Ikematsu H, Inoue T, Kaltenbach T, Leung WK, Matsuda T, Paggi S, Radaelli F, Rastogi A, Rex DK, Sabbagh LC, Saito Y, Sano Y, Saracco GM, Saunders BP, Senore C, Soetikno R, Vemulapalli KC, Jairath V, East JE. Narrow-Band Imaging for Detection of Neoplasia at Colonoscopy: A Meta-analysis of Data From Individual Patients in Randomized Controlled Trials. Gastroenterology 2019; 157:462-471. [PMID: 30998991 DOI: 10.1053/j.gastro.2019.04.014] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 03/29/2019] [Accepted: 04/12/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS Adenoma detection rate (ADR) is an important quality assurance measure for colonoscopy. Some studies suggest that narrow-band imaging (NBI) may be more effective at detecting adenomas than white-light endoscopy (WLE) when bowel preparation is optimal. We conducted a meta-analysis of data from individual patients in randomized controlled trials that compared the efficacy of NBI to WLE in detection of adenomas. METHODS We searched MEDLINE, EMBASE, and Cochrane Library databases through April 2017 for randomized controlled trials that assessed detection of colon polyps by high-definition WLE vs NBI and from which data on individual patients were available. The primary outcome measure was ADR adjusted for bowel preparation quality. Multilevel regression models were used with patients nested within trials, and trial included as a random effect. RESULTS We collected data from 11 trials, comprising 4491 patients and 6636 polyps detected. Adenomas were detected in 952 of 2251 (42.3%) participants examined by WLE vs 1011 of 2239 (45.2%) participants examined by NBI (unadjusted odds ratio [OR] for detection of adenoma by WLE vs NBI, 1.14; 95% CI, 1.01-1.29; P = .04). NBI outperformed WLE only when bowel preparation was best: adequate preparation OR, 1.07 (95% CI, 0.92-1.24; P = .38) vs best preparation OR, 1.30 (95% CI, 1.04-1.62; P = .02). Second-generation bright NBI had a better ADR than WLE (second-generation NBI OR, 1.28; 95% CI, 1.05-1.56; P = .02), whereas first-generation NBI did not. NBI detected more non-adenomatous polyps than WLE (OR, 1.24; 95% CI, 1.06-1.44; P = .008) and flat polyps than WLE (OR, 1.24; 95% CI, 1.02-1.51; P = .03). CONCLUSIONS In a meta-analysis of data from individual patients in randomized controlled trials, we found NBI to have a higher ADR than WLE, and that this effect is greater when bowel preparation is optimal.
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Affiliation(s)
- Nathan S S Atkinson
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, UK; Oxford National Institute for Health Research Biomedical Research Centre, Oxford, UK; Department of Gastroenterology, Waitemata District Health Board, Auckland, New Zealand
| | - Shara Ket
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, UK; Oxford National Institute for Health Research Biomedical Research Centre, Oxford, UK; Department of Gastroenterology, Alfred Hospital, Melbourne, Australia; Monash University, Melbourne, Australia
| | - Paul Bassett
- Statsconsultancy Ltd, Amersham, Buckinghamshire, UK
| | - Diego Aponte
- Gastroenterology Department, Clínica Reina Sofía, Sanitas University Foundation, Bogota, Colombia
| | - Silvia De Aguiar
- General Practice Department, Clínica Reina Sofía, Bogota, Colombia
| | - Neil Gupta
- University of Kansas School of Medicine, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri
| | - Takahiro Horimatsu
- Department of Therapeutic Oncology, Kyoto University Hospital, Kyoto, Japan
| | - Hiroaki Ikematsu
- Division of Science and Technology for Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Takuya Inoue
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Tonya Kaltenbach
- San Francisco Veterans Affairs Medical Center, University of California, San Francisco, California
| | - Wai Keung Leung
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Takahisa Matsuda
- Endoscopy Division, National Cancer Centre Hospital, Tokyo, Japan
| | - Silvia Paggi
- Division of Gastroenterology, Valduce Hospital, Como, Italy
| | | | - Amit Rastogi
- University of Kansas School of Medicine, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri
| | - Douglas K Rex
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Luis C Sabbagh
- Gastroenterology Department, Clínica Reina Sofía, Sanitas University Foundation, Bogota, Colombia
| | - Yutaka Saito
- Endoscopy Division, National Cancer Centre Hospital, Tokyo, Japan
| | - Yasushi Sano
- Gastrointestinal Center and Institute of Minimally Invasive Endoscopic Care, Sano Hospital, Kobe, Japan
| | - Giorgio M Saracco
- Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Brian P Saunders
- Wolfson Unit for Endoscopy, St Mark's Hospital, Imperial College London, London, UK
| | - Carlo Senore
- Epidemiology and Screening Unit, Centro di Prevenzione Oncologica Piemonte, University Hospital Città della Salute e della Scienza, Turin, Italy
| | - Roy Soetikno
- Department of Medicine, Western University, London, Ontario, Canada
| | - Krishna C Vemulapalli
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Vipul Jairath
- Department of Medicine, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - James E East
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, UK; Oxford National Institute for Health Research Biomedical Research Centre, Oxford, UK.
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Sano Y, Chiu H, Li X, Khomvilai S, Pisespongsa P, Co JT, Kawamura T, Kobayashi N, Tanaka S, Hewett DG, Takeuchi Y, Imai K, Utsumi T, Teramoto A, Hirata D, Iwatate M, Singh R, Ng SC, Ho S, Chiu P, Tajiri H. Standards of diagnostic colonoscopy for early-stage neoplasia: Recommendations by an Asian private group. Dig Endosc 2019; 31:227-244. [PMID: 30589103 PMCID: PMC6850515 DOI: 10.1111/den.13330] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 12/24/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM In recent years, the incidence of colorectal cancer has been increasing, and it is now becoming the major cause of cancer death in Asian countries. The aim of the present study was to develop Asian expert-based consensus to standardize the preparation, detection and characterization for the diagnosis of early-stage colorectal neoplasia. METHODS A professional group was formed by 36 experts of the Asian Novel Bio-Imaging and Intervention Group (ANBI2 G) members. Representatives from 12 Asia-Pacific countries participated in the meeting. The group organized three consensus meetings focusing on diagnostic endoscopy for gastrointestinal neoplasia. The Delphi method was used to develop the consensus statements. RESULTS Through the three consensus meetings with debating, reviewing the literature and regional data, a consensus was reached at third meeting in 2016. The consensus was reached on a total of 10 statements. Summary of statements is as follows: (i) Adequate bowel preparation for high-quality colonoscopy; (ii) Antispasmodic agents for lesion detection; (iii) Image-enhanced endoscopy (IEE) for polyp detection; (iv) Adenoma detection rate for quality indicators; (v) Good documentation of colonoscopy findings; (vi) Complication rates; (vii) Cecal intubation rate; (viii) Cap-assisted colonoscopy (CAC) for polyp detection; (ix) Macroscopic classification using indigocarmine spray for characterization of colorectal lesions; and (x) IEE and/or magnifying endoscopy for prediction of histology. CONCLUSION This consensus provides guidance for carrying out endoscopic diagnosis and characterization for early-stage colorectal neoplasia based on the evidence. This will enhance the quality of endoscopic diagnosis and improve detection of early-stage colorectal neoplasia.
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Affiliation(s)
- Yasushi Sano
- Gastrointestinal Center and Institute of Minimally invasive Endoscopic Care (iMEC)Sano HospitalHyogo
| | - Han‐Mo Chiu
- Department of Internal MedicineCollege of MedicineNational Taiwan UniversityTaipeiTaiwan
| | - Xiao‐bo Li
- Division of Gastroenterology and HepatologyKey Laboratory of Gastroenterology and HepatologyMinistry of HealthRenji HospitalSchool of MedicineShanghai Institute of Digestive DiseaseShanghai Jiao Tong UniversityShanghaiChina
| | - Supakij Khomvilai
- Surgical EndoscopyColorectal SurgeryDepartment of SurgeryChulalongkorn UniversityBangkokThailand
| | - Pises Pisespongsa
- Digestive Disease CenterBumrungrad International HospitalBangkokThailand
| | - Jonard Tan Co
- St. Luke's Medical Centre ‐ Global CityTaguig City, Metro ManilaPhilippines
| | - Takuji Kawamura
- Department of GastroenterologyKyoto Second Red Cross HospitalKyotoJapan
| | | | - Shinji Tanaka
- Department of EndoscopyHiroshima University HospitalHiroshimaJapan
| | - David G. Hewett
- Faculty of MedicineUniversity of QueenslandBrisbaneAustralia
| | - Yoji Takeuchi
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Kenichiro Imai
- Division of EndoscopyShizuoka Cancer CenterShizuokaJapan
| | - Takahiro Utsumi
- Department of Gastroenterology and HepatologyKyoto University Graduate School of MedicineKyotoJapan
| | - Akira Teramoto
- Gastrointestinal Center and Institute of Minimally invasive Endoscopic Care (iMEC)Sano HospitalHyogo
| | - Daizen Hirata
- Gastrointestinal Center and Institute of Minimally invasive Endoscopic Care (iMEC)Sano HospitalHyogo
| | - Mineo Iwatate
- Gastrointestinal Center and Institute of Minimally invasive Endoscopic Care (iMEC)Sano HospitalHyogo
| | - Rajvinder Singh
- Gastroenterology UnitDivision of MedicineLyell McEwin HospitalSchool of MedicineThe University of AdelaideAdelaideAustralia
| | - Siew C. Ng
- Departments of Medicine and TherapeuticsInstitute of Digestive DiseaseState Key Laboratory of Digestive DiseasesLKS Institute of Health ScienceThe Chinese University of Hong KongHong KongChina
| | - Shiaw‐Hooi Ho
- Department of MedicineFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Philip Chiu
- SurgeryInstitute of Digestive DiseaseState Key Laboratory of Digestive DiseasesLKS Institute of Health ScienceThe Chinese University of Hong KongHong KongChina
| | - Hisao Tajiri
- Department of Innovative Interventional Endoscopy ResearchThe Jikei University School of MedicineTokyoJapan
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Yeh JH, Hsu MH, Tseng CM, Chen TH, Huang RY, Lee CT, Lin CW, Wang WL. The benefit of adding oral simethicone in bowel preparation regimen for the detection of colon adenoma: A systematic review and meta-analysis. J Gastroenterol Hepatol 2019; 34:830-836. [PMID: 30311262 DOI: 10.1111/jgh.14508] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/21/2018] [Accepted: 10/03/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Simethicone is an anti-foaming agent commonly used during colonoscopy. Although several randomized trials have shown that oral simethicone in the bowel preparation regimen may improve bowel cleanness, whether it improves adenoma detection rate (ADR) or polyp detection rate remains undetermined. The aim of this study was to determine if oral simethicone in bowel preparation regimen before colonoscopy improves the ADR. METHODS A comprehensive literature review was conducted using PubMed, SDOL, Cochrane Library, and ProQuest databases through December 2017. Randomized controlled trials that compared bowel preparation regimens with simethicone versus those without it were included. Effect estimates from each study were extracted and underwent meta-analysis using appropriate models. The primary outcomes were ADR and polyp detection rate, and secondary outcomes included bowel preparation, bubble score, and withdrawal time. RESULTS Twelve published randomized controlled studies with 6003 participants were included for meta-analysis. There was no difference in the overall ADR (pooled risk ratio = 1.06, 95% confidence interval = 0.91-1.24) and right-side ADR (risk ratio = 1.50, 95% confidence interval = 0.82-2.75) between the groups with or without simethicone. However, the addition of simethicone improved adenoma detected per patient (2.20 ± 1.36 vs 1.63 ± 0.89) according to one of the included studies. Meta-regression revealed that the baseline ADR < 25% of the included studies was associated with significant benefit of oral simethicone; the number needed to treat was 15. CONCLUSIONS The adjunction of oral simethicone significantly improved bowel preparation quality and might benefit adenoma detection in specific settings with low baseline ADR.
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Affiliation(s)
- Jen-Hao Yeh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Hospital/I-shou University, Kaohsiung, Taiwan.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Hospital/I-shou University, Da-Chung Branch, Kaohsiung, Taiwan
| | - Ming-Hung Hsu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Hospital/I-shou University, Kaohsiung, Taiwan
| | - Chao-Ming Tseng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Hospital/I-shou University, Kaohsiung, Taiwan
| | - Tzu-Haw Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Hospital/I-shou University, Kaohsiung, Taiwan
| | - Ru-Yi Huang
- Division of Gastroenterology and Hepatology, Department of Family Medicine, E-DA Hospital/I-shou University, Kaohsiung, Taiwan
| | - Ching-Tai Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Hospital/I-shou University, Kaohsiung, Taiwan
| | - Chi-Wei Lin
- Division of Gastroenterology and Hepatology, Department of Family Medicine, E-DA Hospital/I-shou University, Kaohsiung, Taiwan
| | - Wen-Lun Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Hospital/I-shou University, Kaohsiung, Taiwan
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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; 17:701-708.e1. [PMID: 29935326 DOI: 10.1016/j.cgh.2018.06.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/12/2018] [Accepted: 06/13/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS I-scan is an electronic chromoendoscopy technology that improves resolution of epithelial and mucosal surfaces and vessels. We performed a randomized controlled trial to compare detection of adenomas by i-scan vs standard high-definition white-light (HDWL) colonoscopy. METHODS From February 1 through December 31, 2017, 740 outpatients (50-75 years old) undergoing screening and surveillance for colorectal neoplasia were randomly assigned to groups that received colonoscopies with i-scan 1 (surface and contrast enhancement) or HDWL. When lesions and polyps were detected, endoscopists could switch between i-scan 1 and HDWL imaging to confirm their finding; polyps were collected and analyzed by histology. The primary outcome was adenoma detection rate (ADR, proportion of subjects with at least 1 adenoma of any size); secondary outcomes included detection of sessile serrated polyps and neoplasias, along with location, size, and morphology of polyps. We performed intent to treat and per-protocol analyses (on 357 patients evaluated by i-scan and 358 evaluated by HDWL colonoscopy) to assess the primary and secondary outcomes. RESULTS There were no differences in baseline characteristics between the groups. In the intent to treat analysis, the ADR was significantly higher in the i-scan 1 group (47.2%) than in the HDWL colonoscopy group (37.7%) (P = .01). In the per-protocol analysis, the ADR in the i-scan 1 group (47.6%) was also significantly higher than in the HDWL group (37.2%) (P = .005), but this effect was not consistent among all endoscopists. There was no difference between groups in detection of sessile serrated polyps. However, the rate of neoplasia detection was significantly higher in the i-scan 1 group (56.4%) than in the than the HDWL group (46.1%) (P = .005). In secondary analyses, the increase in ADR was associated with improved detection of diminutive flat adenomas in the right colon. CONCLUSION In a prospective randomized trial, higher proportions of patients with adenomas were identified in a group that underwent colonoscopy with i-scan 1 than in a group evaluated by HDWL colonoscopy. This effect was mainly due to improved detection of diminutive, flat right sided adenomas. I-scan 1 technology may benefit some endoscopists. ClinicalTrials.gov no: NCT02811419.
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Affiliation(s)
- Trilokesh D Kidambi
- Division of Gastroenterology, City of Hope National Medical Center, Duarte, California
| | - Jonathan P Terdiman
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California
| | - Najwa El-Nachef
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California
| | - Aparajita Singh
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California
| | | | - Jeffrey K Lee
- Division of Research, Kaiser Permanente, Oakland, California; Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California.
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Lee HH, Lee BI. Image-Enhanced Endoscopy in Lower Gastrointestinal Diseases: Present and Future. Clin Endosc 2018; 51:534-540. [PMID: 30508878 PMCID: PMC6283767 DOI: 10.5946/ce.2018.187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 11/14/2018] [Indexed: 12/28/2022] Open
Abstract
From dye-assisted conventional chromoendoscopy to novel virtual chromoendoscopy, image-enhanced endoscopy (IEE) is continuously evolving to meet clinical needs and improve the quality of colonoscopy. Dye-assisted chromoendoscopy using indigo carmine or crystal violet, although slightly old-fashioned, is still useful to emphasize the pit patterns of the colonic mucosa and predict the histological structures of relevant lesions. Equipment-based virtual chromoendoscopy has the advantage of being relatively easy to use. There are several types of virtual chromoendoscopy that vary depending on the manufacturer and operating principle. IEE plays distinctive roles with respect to histologic characterization of colorectal polyps and prediction of the invasion depth of colorectal cancers. In addition, the newest models of IEE have the potential to increase adenoma and polyp detection rates in screening colonoscopy.
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Affiliation(s)
- Han Hee Lee
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Catholic Photomedicine Research Institute, Seoul, Korea
| | - Bo-In Lee
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Catholic Photomedicine Research Institute, Seoul, Korea
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Is narrow-band imaging a useful tool in screening colonoscopy performed by an experienced endoscopist? A prospective randomised study on 533 patients. GASTROENTEROLOGY REVIEW 2018; 13:206-212. [PMID: 30302164 PMCID: PMC6173075 DOI: 10.5114/pg.2018.78286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 02/02/2018] [Indexed: 11/17/2022]
Abstract
Introduction The detection of adenomas is the basic goal for colorectal cancer screening programs; therefore, every possibility to improve the adenoma detection rate is valuable. Aim To answer the question of whether narrow-band imaging (NBI) can enhance detection quality in screening for colonoscopy. Material and methods A group of 533 patients (202 men: 331 women; average age: 56.1 years) included in a colorectal cancer screening program were randomised into two groups (NBI n = 266 and white light (WL) n = 267). Five hundred and twenty-seven patients were finally included in the assessment. Examinations were performed by three experienced colonoscopists. The NBI was used only at the withdrawal of the instrument. Results Comparing WL and NBI colonoscopies, differences in the mean number of detected polyps per patient (1.36 ±2.79 WL vs. 1.65 ±2.11 NBI; p = 0.012), polyp detection rate (PDR) (48.5% WL vs. 57.2% NBI; p = 0.049), PDR for polyps ≤ 5 mm (44.7% WL vs. 54% NBI; p = 0.033), and PDR for left-sided polyps (43.3% WL vs. 52.7% NBI; p = 0.033) were observed. The difference in adenoma detection rate (ADR) as well as in adenomas/patient was not significant. Narrow-band imaging enhanced significantly one of three operators' ADR (15.6% WL vs. 25.7% NBI; p = 0.038). Conclusions It seems that NBI improves only detection of hyperplastic polyps, especially those that are diminutive and left-sided. However, after analysis of particular endoscopists, it can clearly be seen that some of them may benefit from NBI.
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Hassan C, Kaminski MF, Repici A. New technology for the old polyp: Does the benefit justify the cost? Gastrointest Endosc 2018; 88:117-118. [PMID: 29935608 DOI: 10.1016/j.gie.2018.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 03/25/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Cesare Hassan
- Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Michal F Kaminski
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial Cancer Centre, Institute of Oncology, Warsaw, Poland
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Pioche M, Denis A, Allescher HD, Andrisani G, Costamagna G, Dekker E, Fockens P, Gerges C, Groth S, Kandler J, Lienhart I, Neuhaus H, Petruzziello L, Schachschal G, Tytgat K, Wallner J, Weingart V, Touzet S, Ponchon T, Rösch T. Impact of 2 generational improvements in colonoscopes on adenoma miss rates: results of a prospective randomized multicenter tandem study. Gastrointest Endosc 2018; 88:107-116. [PMID: 29410020 DOI: 10.1016/j.gie.2018.01.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/18/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Numerous randomized studies have shown that changing certain features of colonoscopes, usually incorporated when switching from one endoscope generation to the next, mostly do not increase adenoma yield. There is, however, indirect evidence that it may be necessary to skip one instrument generation (ie, changing from one generation to the next but one) to achieve this effect. METHODS We compared the latest-generation colonoscopes from one company (Olympus Exera III, 190-C) with the next to last one (Olympus 160/5-C) in a prospective multicenter study randomized for the order of colonoscopes in a tandem fashion, involving 2 different examiners. Patients with increased risk for colorectal neoplasia undergoing colonoscopy (positive fecal occult blood test, personal/familial history of colorectal cancer/adenoma, rectal bleeding, recent change in bowel movements) were included. The primary outcome was the adenoma miss rate with the 190 (190-C) colonoscope in comparison with the 160/5 colonoscope (160/5-C). RESULTS A total of 856 patients (48.8% male; mean age, 58.3 years) with a personal (41%) or family (38%) history of colorectal neoplasia, rectal bleeding (19%), and other indications were included. Of the 429 patients in the 190-C first group, 16.6% (95% confidence interval [CI], 13.0%-20.1%) had at least one adenoma missed during the first procedure, compared with 30.2% (95% CI, 25.9%-34.6%) in the group with 160/5-C first (P < .001). Similarly, the adenoma detection rate during the first colonoscopy was 43.8% versus 36.5% (P = .030) for 190-C versus 160/5-C, respectively. CONCLUSIONS This randomized tandem trial showed lower adenoma miss rates and higher adenoma detection rates for the newer 190 colonoscopes compared with the 160/5 series. These results suggest that it takes multiple improvements, such as those implemented over 2 instrument generations, before an effect on adenoma (miss) rate can be observed. (Study registration number: ISRCTN 2010-A01256-33.).
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Affiliation(s)
- Mathieu Pioche
- Gastroenterology and Endoscopy Division, Hôpital Edouard Herriot, Lyon, France
| | - Angélique Denis
- Hospices Civils de Lyon, Pôle Information médicale Evaluation Recherche, Lyon, France; Université de Lyon, Laboratoire Health Services and Performance Research (HESPER) Lyon, France
| | - Hans-Dieter Allescher
- Department of Medicine, Klinikum Garmisch-Partenkirchen, Academic Teaching Hospital of the LMU Munich, Garmisch-Partenkirchen, Germany
| | | | | | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, Netherlands
| | - Christian Gerges
- Department of Gastroenterology, Evangelisches Krankenhaus, Dusseldorf, Germany
| | - Stefan Groth
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jennis Kandler
- Department of Gastroenterology, Evangelisches Krankenhaus, Dusseldorf, Germany
| | - Isabelle Lienhart
- Gastroenterology and Endoscopy Division, Hôpital Edouard Herriot, Lyon, France
| | - Horst Neuhaus
- Department of Gastroenterology, Evangelisches Krankenhaus, Dusseldorf, Germany
| | | | - Guido Schachschal
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Kristien Tytgat
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, Netherlands
| | - Jürgen Wallner
- Department of Medicine, Klinikum Garmisch-Partenkirchen, Academic Teaching Hospital of the LMU Munich, Garmisch-Partenkirchen, Germany
| | - Vincens Weingart
- Department of Medicine, Klinikum Garmisch-Partenkirchen, Academic Teaching Hospital of the LMU Munich, Garmisch-Partenkirchen, Germany
| | - Sandrine Touzet
- Hospices Civils de Lyon, Pôle Information médicale Evaluation Recherche, Lyon, France; Université de Lyon, Laboratoire Health Services and Performance Research (HESPER) Lyon, France
| | - Thierry Ponchon
- Gastroenterology and Endoscopy Division, Hôpital Edouard Herriot, Lyon, France
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Yeung DCM, Vlantis AC, Wong EWY, Tong MCF, Chan JYK. A meta-analysis of narrow-band imaging for the diagnosis of primary nasopharyngeal carcinoma. F1000Res 2018; 7:759. [PMID: 30026934 PMCID: PMC6039959 DOI: 10.12688/f1000research.15183.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2018] [Indexed: 01/03/2023] Open
Abstract
Background: Narrow band imaging (NBI), an endoscopic technique featuring an augmented definition of microvasculature and mucosal patterns. NBI is increasingly advocated as a tool to characterize neoplasia and intestinal metaplasia in endoscopic standards, such as for colorectal polyps and tumors. Recently NBI has also been studied in the detection of Nasopharyngeal Carcinoma (NPC). Here we aimed to assess the diagnostic utility of NBI for the diagnosis of NPC. Methods: A meta-analysis of studies comparing narrow-band imaging and white light endoscopy in the diagnosis of primary nasopharyngeal carcinoma was performed. The review process involved two independent investigators. The databases used were MEDLINE, PubMed, the Cochrane library, Embase, and the Web of Science. Statistical analysis was performed with OpenMetaAnalyst, MetaDiSc version 1.4, and Medcalc version 17.9.7. Results: Five studies including 2480 patients were included. The sensitivity and specificity for narrow-band imaging were 0.90 (0.73-0.97) and 0.95 (0.81-0.99) respectively. The positive likelihood ratio and negative likelihood ratio were 18.82 (0.31-82.1) and 0.08 (0.02-0.31). For white light endoscopy, the sensitivity and specificity were 0.77 (0.58-0.89) and 0.91 (0.79-0.96). The positive likelihood ratio was 7.61 (3.61-16.04), and the negative likelihood ratio was 0.21 (0.11-0.39). The odds ratio for detection rates between narrow-band imaging and white light endoscopy was 4.29 (0.56-33.03, p = 0.16). Area under the curve for narrow-band imaging was 0.98 (SE: 0.02), and for white light it was 0.93 (SE: 0.03). There was no significant difference in the receiver operating characteristic curves between the two modalities (p = 0.14). Conclusion: Narrow-band imaging showed a higher sensitivity and positive likelihood ratio for the diagnosis of nasopharyngeal carcinoma. However, there was no significant difference in detection rates compared to white light endoscopy. Further investigation with a uniform diagnostic criteria and terminology is needed for narrow-band imaging in the diagnosis of nasopharyngeal carcinoma.
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Affiliation(s)
- David CM Yeung
- Department of Otorhinolaryngology, Head & Neck Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories , Hong Kong
| | - Alexander C Vlantis
- Department of Otorhinolaryngology, Head & Neck Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories , Hong Kong
| | - Eddy WY Wong
- Department of Otorhinolaryngology, Head & Neck Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories , Hong Kong
| | - Michael CF Tong
- Department of Otorhinolaryngology, Head & Neck Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories , Hong Kong
| | - Jason YK Chan
- Department of Otorhinolaryngology, Head & Neck Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories , Hong Kong
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Development of Image-enhanced Endoscopy of the Gastrointestinal Tract: A Review of History and Current Evidences. J Clin Gastroenterol 2018; 52:295-306. [PMID: 29210900 DOI: 10.1097/mcg.0000000000000960] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Endoscopy imaging of the gastrointestinal (GI) tract has evolved tremendously over the last few decades. Key milestones in the development of endoscopy imaging include the use of various dyes for chromoendoscopy, the application of optical magnification in endoscopy, the introduction of high-definition image capturing and display technology and the application of altered illuminating light to achieve vascular and surface enhancement. Aims of this review paper are to summarize the development and evolution of modern endoscopy imaging and in particular, imaged-enhanced endoscopy (IEE), to promote appropriate usage, and to guide future development of good endoscopy practice. A search of PubMed database was performed to identify articles related to IEE of the GI tract. Where appropriate, landmark trials and high-quality meta-analyses and systematic reviews were used in the discussion. In this review, the developments and evolutions in endoscopy imaging and in particular, IEE, were summarized into discernible eras and the literature evidence with regard to the strengths and weaknesses in term of their detection and characterization capability in each of these eras were discussed. It is in the authors' opinion that IEE is capable of fairly good detection and accurate characterization of various GI lesions but such benefits may not be readily reaped by those who are new in the field of luminal endoscopy. Exposure and training in making confident diagnoses using these endoscopy imaging technologies are required in tandem with these new developments in order to fully embrace and adopt the benefits.
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Barbeiro S, Libânio D, Castro R, Dinis-Ribeiro M, Pimentel-Nunes P. Narrow-Band Imaging: Clinical Application in Gastrointestinal Endoscopy. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2018; 26:40-53. [PMID: 30675503 DOI: 10.1159/000487470] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 01/29/2018] [Indexed: 12/11/2022]
Abstract
Narrow-band imaging is an advanced imaging system that applies optic digital methods to enhance endoscopic images and improves visualization of the mucosal surface architecture and microvascular pattern. Narrow-band imaging use has been suggested to be an important adjunctive tool to white-light endoscopy to improve the detection of lesions in the digestive tract. Importantly, it also allows the distinction between benign and malignant lesions, targeting biopsies, prediction of the risk of invasive cancer, delimitation of resection margins, and identification of residual neoplasia in a scar. Thus, in expert hands it is a useful tool that enables the physician to decide on the best treatment (endoscopic or surgical) and management. Current evidence suggests that it should be used routinely for patients at increased risk for digestive neoplastic lesions and could become the standard of care in the near future, at least in referral centers. However, adequate training programs to promote the implementation of narrow-band imaging in daily clinical practice are needed. In this review, we summarize the current scientific evidence on the clinical usefulness of narrow-band imaging in the diagnosis and characterization of digestive tract lesions/cancers and describe the available classification systems.
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Affiliation(s)
- Sandra Barbeiro
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Diogo Libânio
- Department of Gastroenterology, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Rui Castro
- Department of Gastroenterology, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Mário Dinis-Ribeiro
- Department of Gastroenterology, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Pedro Pimentel-Nunes
- Department of Gastroenterology, Instituto Português de Oncologia do Porto, Porto, Portugal
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Min M, Deng P, Zhang W, Sun X, Liu Y, Nong B. Comparison of linked color imaging and white-light colonoscopy for detection of colorectal polyps: a multicenter, randomized, crossover trial. Gastrointest Endosc 2017; 86:724-730. [PMID: 28286095 DOI: 10.1016/j.gie.2017.02.035] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/23/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Linked color imaging (LCI), a recently developed technology, uses a laser endoscopic system to enhance the color separation of red color to depict red and white colors more vividly. The benefits of LCI in the detection of colorectal polyps remain unknown. The aim of this study was to assess the ability of LCI to improve the detection of colorectal polyps compared with white-light (WL) endoscopy. METHODS We performed a multicenter, crossover, prospective, randomized controlled trial in 3 hospitals in China. All patients underwent crossover colonoscopies with LCI and WL endoscopy in a randomized order. All lesions were removed during the second endoscopic procedure. The primary outcome measure was the difference in sensitivity between LCI and WL endoscopy for the detection of colorectal polyps. The secondary outcome measures were the adenoma detection rate per patient in the 2 groups and the factors associated with polyp miss rates. RESULTS A total of 152 patients were randomized, and 141 were included in the analysis. The overall polyp detection rate increased significantly by 24% for LCI colonoscopy, corresponding to a higher sensitivity with LCI than with WL endoscopy (91% vs 73%, P < .0001). Furthermore, LCI identified significantly more patients (32%) with polyps. The per-patient adenoma detection rate was significantly higher for LCI than for WL endoscopy (37% vs 28%; 95% confidence interval, 2.39%-19.41%). CONCLUSIONS LCI improves the detection of colorectal polyps and adenomas during colonoscopy. (Clinical trial registration number: NCT02724397.).
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Affiliation(s)
- Min Min
- Department of Gastroenterology and Hepatology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China
| | - Pei Deng
- Department of Gastroenterology and Hepatology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China
| | - Wenhua Zhang
- Department of Gastroenterology and Hepatology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nan Ning, Guangxi, China
| | - Xiaomin Sun
- Department of Gastroenterology and Hepatology, Shanghai Tenth People's Hospital, Shanghai, 200000, China
| | - Yan Liu
- Department of Gastroenterology and Hepatology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China
| | - Bing Nong
- Department of Gastroenterology and Hepatology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nan Ning, Guangxi, China
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Saber T, Bedran K, Ghandour F, El Khoury M, Bou Khalil R, Farhat S. Results from a retrospective analysis of colonoscopies for Inflammatory bowel disease and colorectal cancer in a Lebanese tertiary care centre. BMJ Open Gastroenterol 2017; 4:e000167. [PMID: 29018541 PMCID: PMC5623263 DOI: 10.1136/bmjgast-2017-000167] [Citation(s) in RCA: 3] [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: 07/15/2017] [Revised: 09/02/2017] [Accepted: 09/04/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND AIMS Inflammatory bowel diseases (IBDs) and colorectal cancer have an increased impact on the Lebanese population's morbidity and mortality. This study evaluated the situation of IBD and colorectal cancer at a tertiary hospital centre in Lebanon. METHODS 1007 patients underwent colonoscopy over a period of 12 months by qualified physicians. 91 patients were excluded from the study. Biopsy results were divided into normal versus abnormal colonic tissue. The abnormal section was further subdivided into number of polyps, IBD, dysplasia and cancer. RESULTS Out of 916 individuals included, 61 cases of Crohn's colitis (CC) (6.7%) and 24 cases of ulcerative colitis (UC) (2.7%) were identified. A total of 92 cases of colorectal cancer (10.04%) were also identified. There was a slight male predominance in both groups of IBD without any statistical significance. One statistical significance was reported in favour to age<50 years in both IBD groups with a mean age of 37.9±9.7 years and 34.4±6.4 years for CC and UC, respectively. The incidence of granuloma in the CC group was 8.9% without any correlation compared with age or gender. No correlation was made between colorectal cancer and the existence of any IBD type. The data showed that age >50 years and male gender significantly correlate with an increased incidence of precancerous and cancerous polyps in the colon. They significantly correlate with adenocarcinoma. The estimated incidence of colorectal cancer, CC and UC was 54.1, 35.8 and 14.1 per 100 000, respectively, with a denominator of 169 959 patients per year. CONCLUSION Within the limitations of this study, the incidence of colorectal cancer and IBD falls in the high range compared with similar European and American studies. Our data are biased because of the tertiary centre setting but they can be considered as base for further investigations.
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Affiliation(s)
- Toufic Saber
- Saint Georges Hospital Medical Center Beirut Lebanon, Beirut, Lebanon
| | - Khalil Bedran
- Departmentof Gastroenterology, Saint Georges Hospital Medical Center Beirut Lebanon, Beirut, Lebanon
| | - Fatima Ghandour
- Departmentof Pathology, Saint Georges Hospital Medical Center Beirut Lebanon, Beirut, Lebanon
| | - Mansour El Khoury
- Departmentof General Surgery, Saint Georges Hospital Medical Center Beirut Lebanon, Beirut, Lebanon
| | - Roula Bou Khalil
- Departmentof Endocrinology, Saint Georges Hospital Medical Center Beirut, Beirut, Lebanon
| | - Said Farhat
- Departmentof Gastroenterology, Saint Georges Hospital Medical Center Beirut Lebanon, Beirut, Lebanon
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Allen JE, Sharma P. Polyp characterization at colonoscopy: Clinical implications. Best Pract Res Clin Gastroenterol 2017; 31:435-440. [PMID: 28842053 DOI: 10.1016/j.bpg.2017.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 07/05/2017] [Indexed: 01/31/2023]
Abstract
Although advancements in endoscopic imaging of colorectal mucosa have outstripped the pace of research in the field, the potential clinical applications of these novel technologies are promising. Chief among these is the ability to diagnose colorectal polyps in vivo. This feature appears most applicable to diminuitive polyps, which have very little malignant potential yet represent over 70% of resected polyps. In an ideal application, the capability to predict diminutive hyperplastic polyp histology in vivo precludes the need for excision whereas dimunitive adenomas do require excision, but not necessarily histopathologic analysis if the diagnosis is made in vivo with adequate confidence. However, the vast array of new advanced imaging modalities and polyp classification tools have been difficult to reconcile. We aim to highlight the current status of real-time colorectal polyp diagnosis and identify the barriers that remain to its widespread implementation.
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Affiliation(s)
- James E Allen
- Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, USA
| | - Prateek Sharma
- Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, USA.
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Ishaq S, Siau K, Harrison E, Tontini GE, Hoffman A, Gross S, Kiesslich R, Neumann H. Technological advances for improving adenoma detection rates: The changing face of colonoscopy. Dig Liver Dis 2017; 49:721-727. [PMID: 28454854 DOI: 10.1016/j.dld.2017.03.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 03/06/2017] [Accepted: 03/27/2017] [Indexed: 12/11/2022]
Abstract
Worldwide, colorectal cancer is the third commonest cancer. Over 90% follow an adenoma-to-cancer sequence over many years. Colonoscopy is the gold standard method for cancer screening and early adenoma detection. However, considerable variation exists between endoscopists' detection rates. This review considers the effects of different endoscopic techniques on adenoma detection. Two areas of technological interest were considered: (1) optical technologies and (2) mechanical technologies. Optical solutions, including FICE, NBI, i-SCAN and high definition colonoscopy showed mixed results. In contrast, mechanical advances, such as cap-assisted colonoscopy, FUSE, EndoCuff and G-EYE™, showed promise, with reported detections rates of up to 69%. However, before definitive recommendations can be made for their incorporation into daily practice, further studies and comparison trials are required.
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Affiliation(s)
- Sauid Ishaq
- Gastroenterology Department, Dudley Group Hospitals, Dudley, United Kingdom; Birmingham City University, Birmingham, United Kingdom; St. George's University, Grenada, West Indies.
| | - Keith Siau
- Gastroenterology Department, Dudley Group Hospitals, Dudley, United Kingdom
| | - Elizabeth Harrison
- Gastroenterology Department, Dudley Group Hospitals, Dudley, United Kingdom
| | - Gian Eugenio Tontini
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato, Italy
| | - Arthur Hoffman
- Department of Internal Medicine and Gastroenterology, St. Marienkrankenhaus Frankfurt, Frankfurt, Germany
| | - Seth Gross
- Division of Gastroenterology, NYU Langone Medical Center, New York, NY, USA
| | - Ralf Kiesslich
- Department of Internal Medicine and Gastroenterology, St. Marienkrankenhaus Frankfurt, Frankfurt, Germany
| | - Helmut Neumann
- Interventional Endoscopy Center, University Hospital Mainz, Germany
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Singh R, Cheong KL, Zorron Cheng Tao Pu L, Mangira D, Koay DSC, Kee C, Ng SC, Rerknimitr R, Aniwan S, Ang TL, Goh KL, Ho SH, Lau JYW. Multicenter randomised controlled trial comparing the high definition white light endoscopy and the bright narrow band imaging for colon polyps. World J Gastrointest Endosc 2017; 9:273-281. [PMID: 28690771 PMCID: PMC5483420 DOI: 10.4253/wjge.v9.i6.273] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/04/2017] [Accepted: 05/19/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To compare high definition white light endoscopy and bright narrow band imaging for colon polyps’ detection rates.
METHODS Patients were randomised to high definition white light endoscopy (HD-WLE) or the bright narrow band imaging (bNBI) during withdrawal of the colonoscope. Polyps identified in either mode were characterised using bNBI with dual focus (bNBI-DF) according to the Sano’s classification. The primary outcome was to compare adenoma detection rates (ADRs) between the two arms. The secondary outcome was to assess the negative predictive value (NPV) in differentiating adenomas from hyperplastic polyps for diminutive rectosigmoid lesions.
RESULTS A total of 1006 patients were randomised to HD-WLE (n = 511) or bNBI (n = 495). The mean of adenoma per patient was 1.62 and 1.84, respectively. The ADRs in bNBI and HD-WLE group were 37.4% and 39.3%, respectively. When adjusted for withdrawal time (OR = 1.19, 95%CI: 1.15-1.24, P < 0.001), the use of bNBI was associated with a reduced ADR (OR = 0.69, 95%CI: 0.52-0.92). Nine hundred and thirty three polyps (86%) in both arms were predicted with high confidence. The sensitivity (Sn), specificity (Sp), positive predictive value and NPV in differentiating adenomatous from non-adenomatous polyps of all sizes were 95.9%, 87.2%, 94.0% and 91.1% respectively. The NPV in differentiating an adenoma from hyperplastic polyp using bNBI-DF for diminutive rectal polyps was 91.0%.
CONCLUSION ADRs did not differ between bNBI and HD-WLE, however HD-WLE had higher ADR after adjustment of withdrawal time. bNBI surpassed the PIVI threshold for diminutive polyps.
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Vișovan II, Tanțău M, Pascu O, Ciobanu L, Tanțău A. The role of narrow band imaging in colorectal polyp detection. Bosn J Basic Med Sci 2017; 17:152-158. [PMID: 28378694 DOI: 10.17305/bjbms.2017.1686] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 11/16/2016] [Accepted: 11/17/2016] [Indexed: 12/19/2022] Open
Abstract
Colonoscopic detection and removal of polyps represent the most important prevention method for colorectal cancer. We aimed to investigate the diagnostic yield of narrow band imaging (NBI) colonoscopy for polyp detection compared with standard colonoscopy. In this prospective study, 505 patients that underwent total colonoscopy were randomized into two groups: 226 patients in NBI group and 279 in non-NBI group (standard colonoscopy). The primary endpoints were polyp detection rate (PDR) and adenoma detection rate (ADR) in both groups. Polyps detected with NBI technique were characterized according to the NBI International Colorectal Endoscopic (NICE) classification. The total number of polyps detected in NBI group was significantly higher compared with non-NBI group (325 polyps in 226 patients versus 189 polyps in 279 patients, respectively). PDR in NBI group was 55.3%, versus 43.3% in non-NBI group. ADR in NBI group was significantly higher compared with non-NBI group (35.3% versus 20%, respectively). The proportion of detected adenomas in the left-sided colon was significantly higher in NBI group (72.8% versus 61.06% in non-NBI group), which was related to an increased number of small adenomas detected in NBI group. Also, in NBI group, a significant number of flat adenomas were detected (28 versus 9 in non-NBI group). A total of 147 (45.2%) polyps were classified according to the NICE classification, and showed a good correlation with histological analysis. In conclusion, this study demonstrated increased PDR and ADR for NBI colonoscopy. A good correlation between the NICE classification and histological analysis was also observed.
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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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Cheng W, Liu H, Gu Z, Hu Z, Wang L, Wang X. Narrow-band imaging endoscopy is advantageous over conventional white light endoscopy for the diagnosis and treatment of children with Peutz-Jeghers syndrome. Medicine (Baltimore) 2017; 96:e6671. [PMID: 28489743 PMCID: PMC5428577 DOI: 10.1097/md.0000000000006671] [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] [Indexed: 11/25/2022] Open
Abstract
Using narrow-band imaging (NBI), the micro morphology of polyp surfaces was visualized at high resolution when the contrast between the lesions and the surrounding tissue areas was intensified. The objective of the study was to compare NBI and conventional white light endoscopy (C-WLI) for diagnostic efficacy and treatment of children with Peutz-Jeghers syndrome (PJS), a rare autosomal dominant-genetic disease.We retrospectively analyzed the clinical data of 18 patients diagnosed with PJS and 72 diagnosed with juvenile polyps during the same time period. Endoscopy was used to observe the morphology of polyps, which were classified according to the Kudo pit pattern. Eighty-two and 76 polyps were resected using endoscopy from PJS and juvenile polyp patients, respectively, and pathologically examined for comparison with NBI or C-WLI endoscopic observations.With NBI, 57 (69.5%) type I, 10 (12.2%) type II, and 13 (15.9%) type III polyps were identified in 82 (100%) polyps excised from 18 PJS patients, whereas 69 (88.5%) type I, 5 (6.4%) type II and 4 (5.1%) type III were identified in 78 (100%) of polyps removed from 72 juvenile polyp patients. The combined ratios of types II and III were higher in PJS (28.1%) than in juvenile polyp patients (11.5%). Pathological diagnosis identified 69 of 82 PJS polyps as hamartoma and 13 as adenoma, whereas NBI detected 10 adenomas and C-WLI only 4. The sensitivity, specificity, and accuracy of NBI in the diagnosis of adenoma were 76.9%, 97.1%, and 93.9%, respectively, whereas those of C-WLI were 30.8%, 94.2%, and 84.1%.NBI endoscopy had higher sensitivity and specificity than C-WLI for the diagnosis of adenomatous polyps and is recommended for the diagnosis, characterization, and resection of polyps in children with PJS.
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Khosroshahi HT, Abedi B, Daneshvar S, Sarbaz Y, Shakeri Bavil A. Future of the Renal Biopsy: Time to Change the Conventional Modality Using Nanotechnology. Int J Biomed Imaging 2017; 2017:6141734. [PMID: 28316612 PMCID: PMC5337808 DOI: 10.1155/2017/6141734] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 12/20/2016] [Accepted: 01/05/2017] [Indexed: 12/19/2022] Open
Abstract
At the present time, imaging guided renal biopsy is used to provide diagnoses in most types of primary and secondary renal diseases. It has been claimed that renal biopsy can provide a link between diagnosis of renal disease and its pathological conditions. However, sometimes there is a considerable mismatch between patient renal outcome and pathological findings in renal biopsy. This is the time to address some new diagnostic methods to resolve the insufficiency of conventional percutaneous guided renal biopsy. Nanotechnology is still in its infancy in renal imaging; however, it seems that it is the next step in renal biopsy, providing solutions to the limitations of conventional modalities.
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Affiliation(s)
| | - Behzad Abedi
- Medical Bioengineering Department, School of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sabalan Daneshvar
- Medical Bioengineering Department, School of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
- Faculty of Electrical and Computer Engineering, University of Tabriz, Tabriz, Iran
| | - Yashar Sarbaz
- School of Engineering-Emerging Technologies, University of Tabriz, Tabriz, Iran
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