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Abstract
Background. Improved detection of adenomatous polyps using i-SCAN has mixed results in small studies. Utility of i-SCAN as a primary surveillance modality for colorectal cancer screening during colonoscopy is uncertain. Aim. Comparing high definition white light endoscopy (HDWLE) to i-SCAN in their ability to detect adenomas during colonoscopy. Methods. Prospective cohort study of 1936 average risk patients who had a screening colonoscopy at an ambulatory procedure center. Patients underwent colonoscopy with high definition white light endoscopy withdrawal versus i-SCAN withdrawal during endoscopic screening exam. Primary outcome measurement was adenoma detection rate for i-SCAN versus high definition white light endoscopy. Secondary measurements included polyp size, pathology, and morphology. Results. 1007 patients underwent colonoscopy with i-SCAN and 929 with HDWLE. 618 adenomas were detected in the i-SCAN group compared to 402 in the HDWLE group (p < 0.01). More advanced adenomas (≥10 mm) were found by i-SCAN, 79 versus 47 (p = 0.021) and based upon histology alone 37 versus 18 (p = 0.028). Conclusions. i-SCAN detected significantly more adenomas and advanced adenomas compared to high definition white light endoscopy.
Highlights
Colorectal cancer is a leading cause of cancer related deaths in the US today
Adenomatous polyps were detected more frequently in the i-SCAN group compared to the control group (33% versus 27%, p = 0.033)
There were significantly more adenomas detected with i-SCAN in the ascending (p = 0.01), transverse (p < 0.01), and left colon (p = 0.02) with a trend towards increased detection in the cecum (p = 0.06)
Summary
Colorectal cancer is a leading cause of cancer related deaths in the US today. It is the second most common cause of cancer mortality in the US and is the third most common cancer among US men and women [1]. Various different endoscopic imaging modalities have been developed to optimize the detection of mucosal abnormalities and adenomatous polyps. Aim. Comparing high definition white light endoscopy (HDWLE) to i-SCAN in their ability to detect adenomas during colonoscopy. Patients underwent colonoscopy with high definition white light endoscopy withdrawal versus i-SCAN withdrawal during endoscopic screening exam. Primary outcome measurement was adenoma detection rate for i-SCAN versus high definition white light endoscopy. I-SCAN detected significantly more adenomas and advanced adenomas compared to high definition white light endoscopy. CE results in a slightly blue tinted image from the suppression of certain red and green wavelengths in the white light spectrum to help augment differences in depth within the mucosal surface. The purpose of this study was to compare high definition colonoscopy with i-SCAN mode 1 (SE + CE) to standard high definition colonoscopy in the ability to detect adenomas polyps
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