Abstract
Background and Aims Missed polyps are a pitfall of colonoscopy. In this study, we analyzed the efficacy of an additional 30 seconds observation using linked color imaging (LCI) for detecting adenoma and sessile serrated adenoma/polyp (SSA/P). Materials and Methods We enrolled patients undergoing colonoscopy from February to October 2017 in two institutions. In all patients, the cecum and ascending colon were observed with white light imaging (WLI) first. The colonoscope was inserted again, and the cecum and ascending colon were observed for an additional 30 seconds using either LCI or WLI. The method for the 30 sec observation was to insufflate the cecum and ascending colon sufficiently and observe them in a distant view, because the length of the second observation was determined to be precisely 30 sec. For the second observation, LCI was performed for the first 65 patients and WLI for the next 65. Adenoma and SSA/P detection rate (ASDR) in the second observation were examined in both groups. According to a pilot study, the sample size was estimated 65. Results In the first observation, ASDR were 30.7% in the LCI group and 32.2% in the WLI group (p = 0.85). For the second observation, 13 polyps were detected in the LCI group and 5 polyps in the WLI group (p = 0.04). Additionally, ASDR for the second observation were 18.5% and 6.1%, respectively (p = 0.03). There were no significant differences between the LCI and WLI groups with respect to morphology (ratio of polypoid) (38.5% versus 60.0%, p = 0.52) and histology (ratio of adenoma) (92.3% versus 100.0%, p = 0.91). Total adenoma and SSA/P number were 48 in the LCI group and 36 in the WLI group (p = 0.02). Conclusion The 30 seconds additional observation with LCI improved the detection of adenoma and SSA/P in the right-sided colon.
Highlights
Removal of adenomatous polyps by colonoscopy has been proven to prevent colorectal cancer and associated with the reduction in the incidence of proximal and distal colorectal cancers [1,2,3]
The diagnosis of adenoma and sessile serrated adenoma/polyp (SSA/P) was performed with blue laser imaging (BLI) magnification according to previous reports and local protocols based on the Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) statements, and all polyps diagnosed as either adenoma or SSA/P were resected using polypectomy, endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD) according to size and morphology [9, 15, 16]
There was no significant difference in the ratio of local Boston bowel preparation score (BBPS) ≥ 2 for the cecum and the ascending colon (LCI versus white light imaging (WLI): 84.6 versus 87.6, p = 0 61)
Summary
Removal of adenomatous polyps by colonoscopy has been proven to prevent colorectal cancer and associated with the reduction in the incidence of proximal and distal colorectal cancers [1,2,3]. The rate of missed polyps by white light imaging (WLI) observation was reported at 20–27% [4, 5]. A LASER endoscopic system (LASEREO: Fujifilm Co., Tokyo, Japan) was developed in 2012 It allows blue laser imaging (BLI), BLI-bright, and linked color imaging (LCI). We analyzed the efficacy of an additional 30 seconds observation using linked color imaging (LCI) for detecting adenoma and sessile serrated adenoma/polyp (SSA/P). The cecum and ascending colon were observed with white light imaging (WLI) first. The colonoscope was inserted again, and the cecum and ascending colon were observed for an additional 30 seconds using either LCI or WLI. According to a pilot study, the sample size was estimated
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