Increased polyp detection using narrow band imaging compared with high resolution endoscopy in patients with hyperplastic polyposis syndrome
62
Citation
0
Reference
10
Related Paper
Citation Trend
Abstract:
Background and study aims: Hyperplastic polyposis syndrome (HPS) is associated with colorectal cancer and is characterized by multiple hyperplastic polyps, sessile serrated adenomas (SSAs) and adenomas. Narrow band imaging (NBI) may improve the detection of polyps in HPS. We aimed to compare polyp miss rates with NBI with those of high resolution endoscopy (HRE).Keywords:
Hyperplastic Polyp
Narrow-band imaging
Peutz–Jeghers syndrome
The usefulness of high definition colonoscopy plus i-scan (HD+i-SCAN) for average-risk colorectal cancer screening has not been fully assessed. The detection rate of adenomas and other measurements such as the number of adenomas per colonoscopy and the flat adenoma detection rate have been recognized as markers of colonoscopy quality. The aim of the present study was to compare the diagnostic performance of an HD+i-SCAN with that of standard resolution white-light colonoscope.This is a retrospective analysis of a prospectively collected screening colonoscopy database. A comparative analysis of the diagnostic yield of an HD+i-SCAN or standard resolution colonoscopy for average-risk colorectal screening was conducted.During the period of study, 155/163 (95.1%) patients met the inclusion criteria. The mean age was 56.9 years. Sixty of 155 (39%) colonoscopies were performed using a HD+i-SCAN. Adenoma-detection-rates during the withdrawal of the standard resolution versus HD+i-SCAN colonoscopies were 29.5% and 30% (p = n.s.). Adenoma/colonoscopy values for standard resolution versus HD+i-SCAN colonoscopies were 0.46 (SD = 0.9) and 0.72 (SD = 1.3) (p = n.s.). A greater number of flat adenomas were detected in the HD+i-SCAN group (6/60 versus 2/95) (p < .05). Likewise, serrated adenomas/polyps per colonoscopy were also higher in the HD+i-SCAN group.A HD+i-SCAN colonoscopy increases the flat adenoma detection rate and serrated adenomas/polyps per colonoscopy compared to a standard colonoscopy in average-risk screening population. HD+i-SCAN is a simple, available procedure that can be helpful, even for experienced providers. The performance of HD+i-SCAN and substantial prevalence of flat lesions in our average-risk screening cohort support its usefulness in improving the efficacy of screening colonoscopies.
Withdrawal time
Cite
Citations (5)
Purpose: Background and Aim: The adenoma detection rate is an independent predictor of the risk of interval colorectal cancer after screening colonoscopy. A number of techniques have been shown to maximize adenoma detection. We incorporated a comprehensive colonoscopy screening protocol that includes: 1. Ensuring a clean quality of colon preparation; 2. Cecal intubation in over 95%; 3. Colonoscope withdrawal time > 6 min; 4. Colonoscopy Screening Techniques for better adenoma detection (a. Use of a cap fitted endoscope to examine behind the folds; b. Patient position change to optimize distention of the colon; c. Eyes trained to detect flat lesions after looking at several flat lesions' images & videos). We have reported the effect of combining all these various techniques to maximize adenoma detection rate in 100 consecutive average risk patients (pts) undergoing screening colonoscopy previously. We report the adenoma detection rate in larger pool of 535 consecutive patients undergoing their first screening colonoscopy from 2009-2011. Methods: Endoscopist: Screening colonoscopy was performed by a single operator. Patients (pts): 535 consecutive patients undergoing screening colonoscopy from 2009-2011 were included in the study. Average risk pts: 495. Increased risk pts (Family history of colorectal cancer or polyps <60 years): 40. We used the comprehensive colonoscopy screening protocol to maximize adenoma detection in all patients during screening. Colonoscopy Report: The data was recorded in a structured colonoscopy report with well-defined fields to capture all the data. Main Outcome Measurements: We analyzed the adenoma detection rates. Results: Mean age: 58.3 ± 7.7; Sex: Men: Women: 220:315; BMI: 27.4 ± 5.4. Caucasians: 395(73.8%).The adenoma detection rate in screening population: 64.9%. The advanced adenoma detection rate (>1 cm adenoma or villous histology of any size or high grade dysplasia):14%.The multiple adenoma (≥ 3 adenomas) detection rate: 17%. The combined adenoma or proximal hyperplastic polyp detection rate: 69.7%. The proximal hyperplastic polyp detection rate: 15.3%. The serrated adenoma detection rate: 15%. The proximal hyperplastic polyp or serrated adenoma detection rate: 26.7%. See Table 1.Table: [1974] Prevalence of adenomas in 535 consecutive patients undergoing screening colonoscopies using a comprehensive colonoscopy screening protocolConclusion: Routine use of techniques to maximize adenoma detection result in persistent increase in adenoma detection rates, several fold higher than the adenoma detection rate set by the U.S Multi-Society Task Force on Colorectal Cancer (25% in men & 15% in women).
Withdrawal time
Insertion time
Colorectal cancer screening
Cite
Citations (0)
Peutz–Jeghers syndrome
Hyperplastic Polyp
Desmin
Lamina propria
Muscularis mucosae
Cite
Citations (52)
Background and study aims: Hyperplastic polyposis syndrome (HPS) is associated with colorectal cancer and is characterized by multiple hyperplastic polyps, sessile serrated adenomas (SSAs) and adenomas. Narrow band imaging (NBI) may improve the detection of polyps in HPS. We aimed to compare polyp miss rates with NBI with those of high resolution endoscopy (HRE).
Hyperplastic Polyp
Narrow-band imaging
Peutz–Jeghers syndrome
Cite
Citations (62)
Narrow-band imaging
Cite
Citations (33)
Colorectal Polyp
Withdrawal time
Bowel preparation
Colorectal adenoma
Cite
Citations (118)
To determine the incidence of hyperplastic polyps in patients undergoing surveillance colonoscopy and to compare with the prevalence in individuals undergoing index colonoscopy.This prospective observational study included patients with index colonoscopy findings of adenomas, adenoma with concomitant hyperplastic polyps and advanced neoplasia who subsequently underwent surveillance colonoscopy. Patient characteristics, indications for colonoscopy, interval between examinations and findings were recorded. These findings were compared with our control group that comprised of patients who underwent index colonoscopy during the same period.Study group consisted of 108 patients (median age 61.5 years) who underwent index colonoscopy for indications including, weight loss, rectal bleeding, altered bowel habits and anaemia. On index colonoscopy, adenomas, adenoma with concomitant hyperplastic polyps and advanced neoplasia were present in 61, 35 and 12 patients, respectively. Surveillance colonoscopy was performed after a mean follow-up period of 29 +/- 17 months. Findings on surveillance examination included hyperplastic polyps in 35 and 57% of patients with past adenomas and adenoma with concomitant hyperplastic polyps, respectively. Control group included 3852 symptomatic patients who had index colonoscopy (median age, 65 years). Hyperplastic polyps, adenomas and advanced neoplasia were found in 155 (4%), 388 (10%) and 60 (1.5%) of patients, respectively. Hyperplastic polyps and adenoma were significantly higher in study group as compared with control group (P >0.5).Incidence of hyperplastic polyps is significantly higher on surveillance colonoscopy as compared with the prevalence on index colonoscopy. This may signify a continuous spectrum of biological evolution between hyperplastic polyps and adenomas.
Hyperplastic Polyp
Concomitant
Cite
Citations (3)
Background Postcolonoscopy surveillance colonoscopy based on positive fecal occult blood testing (FOBT) is often performed, although its long-term efficacy has not been established. The aim of this study was to clarify the low potency of FOBT surveillance at short intervals after colonoscopy. Methods Colonoscopy was performed in 1308 average-risk patients, based on positive results of immunological FOBT [fecal immunological test (FIT)]. Patients were stratified according to the length of time since their last colonoscopy and their colonoscopy results [no adenoma or 1–2 small (<10 mm) adenomas]. Tumor detection rates were determined. Results The baseline patients characteristics did not differ between the groups. The advanced lesion detection rate (ALDR) among the patients who had never undergone a colonoscopy was 21.9% [95% confidence interval (CI), 19.1–25.0%]. Among the patients who had no adenoma detected in the previous colonoscopy within the past 5 years, the past 5–10 years and over 10 years, the ALDRs were 2.5% (95% CI, 1.0–5.5%), 4.1% (95% CI, 1.5–9.4%) and 9.3% (95% CI, 3.1–22.2%), respectively. Among the patients who had 1–2 small adenomas, the ALDRs were 7.4% (95% CI, 3.4–14.8%), 12.1% (95% CI, 4.2–27.9%) and 27.8% (95% CI, 12.2–51.2%), respectively. Invasive cancer was not observed in any patients within 5 years since the prior colonoscopy. Conclusion In average-risk patients whose prior colonoscopy detected no adenomas or low-risk adenomas, postcolonoscopy surveillance by FIT has a low positive predictive value within a 5-year interval.
Fecal occult blood
Cite
Citations (2)
Purpose: Colonoscopy (C) is now an accepted standard as a screening test for colon cancer (CA). A recent published article demonstrated greater effeciently at polyp detection with colonoscopy withdrawal times >6 min. We hypothesized that the majority of polyps found would be small and hyperplastic.TableMethods: 300 consecutive outpatient colonoscopies from Feb 2007 to May 2007 were evaluated and compared to 300 similiarly aged colonoscopies from Feb 2006 to May 2006. All were performed by a single fellowship trained gastroenterologist. Study exclusions were incomplete colonoscopy, colonoscopy associated with complications, previous colonoscopy in the past 2 yrs, poor prep and previous colon resection. All 2007 colonoscopies had withdrawal times > 6 min as defined as the time from cecal identification to withdrawal across the anus. No withdrawal information was available for 2006 data but was assumed to be less then 6 minutes by experience. All polyps were measured and removed in a standard fashion. Results: See table below. Conclusion: Colonoscopy with withdrawal times > 6 minutes leads to higher polyp detection rates, especially for small ( < 5 mm) hyperplastic polyps. However, 4 additional cancers and 3 adenomatous polyps > 10 mm were seen in the study group over the control group. Since 4 of the 5 cancers were large and obvious, one must suspect an effect of sampling error. Repeating the study with a higher # of study patients would be beneficial.
Hyperplastic Polyp
Adenomatous polyps
Withdrawal time
Cite
Citations (0)
AIM: Inadequate bowel preparation is associated with reduced adenoma detection. We sought to determine whether the adenoma miss rate during colonoscopy with inadequate preparation is significantly greater than the adenoma miss rate reported with tandem colonoscopy. METHODS: We reviewed records of all patients at our tertiary care center with an inadequately cleansed index colonoscopy between 2/1/2009-2/28/2010, who underwent repeat colonoscopy within 18 months. The primary endpoint was the overall adenoma miss rate. A two-sided test with alpha 0.05 had 80% power to distinguish an adenoma miss rate of about 33% compared to 22% reported with tandem colonoscopy. 910 patients had inadequate cleansing, and 127 met inclusion criteria including repeat colonoscopy within 18 months. RESULTS: The overall adenoma miss rate was significantly greater than reported with tandem colonoscopy (52% vs. 22%, p=0.001). Miss rates were higher for all adenoma size categories (57% vs. 26% for 1 year (OR=11.0, 95% CI: 5.81 to 20.9). CONCLUSION: The adenoma miss rate during colonoscopy with inadequate preparation is significantly higher than reported with tandem colonoscopy. Our findings support performing early repeat colonoscopy after inadequate preparation. © 2013 ACT. All rights reserved.
Bowel preparation
Insertion time
Clinical endpoint
Cite
Citations (2)