High Definition Colonoscopy: Detects More Polyps But Are They Clinically Significant?

Abstract

Purpose: High definition white light colonoscopy (HD) is a relatively new technology that provides brighter images, higher resolution, and a wider view angle compared to standard definition white light colonoscopy (SD). The impact of these innovations has yet to be clearly defined. The aim of this study is to compare polyp and adenoma detection rates between HD and SD to determine if this advancement leads to improvement in clinical care. A secondary aim is to compare polyp and adenoma detection rates between HD and SD in patients undergoing colonoscopy solely for colorectal cancer screening. Methods: We performed a retrospective review of the endoscopic and pathologic findings of 1313 patients undergoing colonoscopy with either HD (n=684) or SD (n=629). We collected data from all gastroenterologists performing consecutive screening, surveillance, and diagnostic colonoscopies over a 3 month period at an academic tertiary medical center before and after the introduction of HD technology in the endoscopy suite. Results: The mean age in the HD and SD groups was 59 (±14.7) years and 57 (±15) years, respectively. The groups were similar with respect to gender (P=0.41) and bowel preparation (P=0.37). In colonoscopies performed for all indications, the polyp detection rate (defined as the ratio of patients with one or more polyps to the total number of patients) was higher in the HD group compared to SD group (37.8% vs. 28.5%, P < 0.0001). Similarly, the adenoma detection rate (defined as the ratio of patients with one or more adenomas to the total number of patients) was higher in the HD group than the SD group (22.8% vs. 7.2%, P=0.01). When we analyzed data solely from screening colonoscopies, the overall polyp detection rate was increased in the HD group compared to the SD group (43.6% vs. 30.2%, P=0.001). However, although the adenoma detection rate was increased (25.8% vs. 19.3%), it was not statistically significant (P=0.06). HD identified a higher proportion of polyps measuring less than 6 mm in comparison to SD in all colonoscopies (68.1% vs. 58.9%, P = 0.01). No significant differences were found in pathology (P=0.89) or location of these lesions. Conclusion: HD will increase the polyp and adenoma detection rates over SD in patients undergoing colonoscopy for all indications. In patients undergoing screening colonoscopies, although HD improves the detection of polyps overall, it does not appear to significantly improve the adenoma detection rate. This finding has significant consequences in an era when we are focusing on the economic burden of medical costs. Resection of potentially insignificant polyps on screening colonoscopies due to improved optics may increase the costs related to pathology, duration, and risks of procedure.