i-SCAN Group Research Articles

Diagnostic value of i-Scan high definition endoscopy for screening polypoid lesions in right hemicolon

Objective To explore the diagnostic value of the i-Scan for detection of polypoid lesions in right hemicolon during colonoscopy. Methods A total of 200 patients who underwent colonoscopy in Beijing Shijitan Hospital from January 2015 to December 2015 were enrolled. After completion of the first colonoscopy in right hemicolon, a second withdrawal was performed, using white light mode (white light group, n=93) and i-Scan mode (i-scan group, n=96) to detect polypoid lesions in the proximal colon. The detection rates of polyp and adenoma were compared between the two groups. Results During the twice withdrawal, compared with white light group, more polyps and adenomas were detected in i-Scan group (1.469 VS 1.011, P=0.028; 0.979 VS 0.624, P=0.039). The proportion of patients with more polyps and adenomas in the i-Scan group was significantly higher than that in the white light group [37.5% (36/96) VS 22.6% (21/93), P=0.025; 24.0% (23/96) VS 11.8% (11/93), P=0.030]. i-Scan mode detected more small polyps with diameter 0.05). The polyp detection rates of the i-Scan group and white light group were 61.5% (59/96) and 48.4% (45/93), respectively (P=0.071), and the adenoma detection rates were 47.9% (46/96) and 35.5% (33/93), respectively (P=0.083). Conclusion i-Scan mode can increase the detection rate of polyps and adenomas in right hemicolon, and improve detection of polypoid lesions and small polyps in patients with multiple polyps and adenomas. Key words: Intestinal polyps; Endoscopy; Pattern recognition; i-Scan mode; Adenoma detection rate

Clinical Significance of Diminutive Colonic Polyps in Elderly Patients.

Background and Objectives:Colorectal cancer is the third leading cause of cancer-related death. Excision of premalignant polyps has a significant impact on reducing colorectal cancer mortality and morbidity. Colonoscopy is considered to be the gold standard for the diagnosis and affords an opportunity for treatment of colonic polyps. In recent years, serious debates have taken place because of the biological characteristics of diminutive polyps (DPs), polypectomy complications, and serious costs. There has not yet been a consensus on the management of DPs. The objectives of this study were to demonstrate the real clinical importance of DPs smaller than 5 mm in diameter, which are frequently seen in geriatric patients by new endoscopic techniques, and to help in determining screening and surveillance programs.Methods:The patients who underwent colonoscopy and were found to have a diminutive colorectal polyp (<5 mm from September 1, 2016 through September 1, 2017), were classified into 3 groups according to the imaging method used: flexible spectral imaging color enhancement (FICE), narrow band imaging (NBI), or I-SCAN. In all groups, demographic data were compared according to Paris classification (morphologic) and Kudo classification (correlation between the prediction of endoscopic diagnosis and final pathological examination) in terms of sensitivity, specificity, and negative and positive predictive values.Results:Two hundred sixty-seven patients were included in the study: 97 in the NBI group, 83 in the FICE group, and 87 in the I-SCAN group. There were no statistically significant differences between NBI, FICE, and I-SCAN in differentiating neoplastic and nonneoplastic polyps, according to the Kruskal-Wallis test (P = .809).Conclusions:The estimated progression rates of DPs to advanced adenomas or colorectal cancer (CRC) are very low. Missing these polyps or not excising them may lead to failure to diagnose some cancers. There is a need for further comprehensive studies of removing all polyps to determine whether non–high-risk lesions require further pathologic examination and to re-examine routine surveillance programs.

Virtual chromoendoscopy (I-SCAN) detects more polyps in patients with Lynch syndrome: a randomized controlled crossover trial.

ClinicalTrials.gov (NCT01823471).

Enhanced flat adenoma detection rate with high definition colonoscopy plus i-scan for average-risk colorectal cancer screening.

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.

The value of I-SCAN technology for diagnosis of colorectal polyps

Objective To investigate the value of I-SCAN technology for diagnosis of colorectal polyps by comparing the difference of detection rate in polyp and adenoma between I-SCAN and normal high-definition endoscopy groups. Methods This study was a single-center, prospective, randomized case controlled study. The patients of two groups were allocated at random using the table of random numbers. The intubation procedures in experimental group were under normal high-definition mode while the withdrawal procedures were under I-SCAN mode. In the controlled group, all the procedures were under normal high-definition mode.The photographing and biopsy operation was done only in withdrawal procedures. All the lesions were diagnosed by pathology. The polyp detection rate and adenoma detection rate were evaluated. Results A total of 228 patients were included in the study, 115 patients in experimental group while 113 in controlled group. There was no significant difference in withdraw time [(7.3±3.6)min VS (6.4±4.3)min, P=0.07] and the colon cleanliness[(7.4±1.5) VS (7.4±2.3), P=0.942] between the experimental group and the controlled group. And there was no complication in either group. The detection rate of colorectal polyps of the experimental group was 57.39% (66/115), while that of controlled group was 33.62%(38/113), with significant statistical difference(P=0.001). The detection rate of colorectal adenoma of the experimental group was 35.65% (41/115), while that of the controlled group was 24.78% (28/113), with no significant difference(P=0.074). Conclusion The polyp detection rate of I-SCAN group is higher than normal high-definition endoscopy group. I-SCAN has broad prospects. Key words: Colorectal neoplasms; Colorectal polyps; Colorectal adenoma; I-SCAN; Detection rate

High Definition Colonoscopy Combined with i-SCAN Imaging Technology Is Superior in the Detection of Adenomas and Advanced Lesions Compared to High Definition Colonoscopy Alone.

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.

PTH-119 High Definition (hd) Endoscopy With I-scan For The Detection Of Markers Of Coeliac Disease: A Feasibility Study

IntroductionCoeliac disease (CD) remains underdiagnosed. Previous studies have shown that up to 13% of patients with CD have undergone a previous gastroscopy where the opportunity to take duodenal biopsies and...

PTH-015 Prospective Comparison of Fice and I-Scan for In-Vivo Characterisation of Small Colonic Polyps

IntroductionIn-vivo characterisation of small colonic polyps has been reported using several technologies but with few prospective comparisons between them. We aimed to compare the accuracy of Flexible Spectral Imaging Colour...

Tu1962 Prospective Comparison of FICE and I-SCAN for in-Vivo Characterisation of Small Colonic Polyps

Introduction In-vivo characterisation of small colonic polyps has been reported using several technologies but with few prospective comparisons between them. We aimed to compare the accuracy of Flexible Spectral Imaging Colour Enhancement (FICE) and i-Scan in the assessment of polyps Methods Patients undergoing screening colonoscopy through the UK BCSP were prospectively recruited. All procedures were performed by a single endoscopist with extensive experience in in-vivo diagnosis. For the FICE group Fujinon 410,000 pixel CCD and 650,000 pixel CCD colonoscopes were used with an EPX 4400 processor. For the i-Scan group Pentax 1.2 Megapixel colonoscopes were used with an EPKi processor. All polyps Results In the FICE group 293 polyps of mean size 4.7mm were assessed in 170 patients. In the i-Scan group 209 polyps of mean size 4.3mm were assessed in 84 patients. There was no significant difference in WL accuracy between SD and HD endoscopes (70% vs 72.7%, p = 0.606), however accuracy was significantly higher with the HD+ 1.2megapixel CCD endoscopes (93.3%) compared to both the SD (70.0%, p = 0.0001) and HD (72.7%, p = 0.0001) endoscopes. Sensitivity was significantly greater with FICE using an HD endoscope compared to an SD endoscope (92.6% vs 83.3%, p = 0.048). Overall accuracy was significantly greater with HD+ i-Scan (94.7%) than SD FICE (82.7%, p = 0.0003) and HD FICE (88.8%, p = 0.0439). The use of FICE improved accuracy from 70.0% with WL to 82.7% (p = 0.014) and from 72.7% with WL to 88.8% (p Conclusion Only a small, non-significant gain in WL accuracy is seen between a 410K pixel SD endoscope and a 650K pixel HD endoscope. However diagnostic accuracy with WL improves significantly with a 1.2 megapixel endoscope. FICE significantly improves accuracy when used with an SD or HD endoscope but the very high WL accuracy of a 1.2 megapixel endoscope allows no significant additional improvement with i-Scan. Disclosure of Interest None Declared.

The efficacy of i-SCAN for detecting reflux esophagitis: a prospective randomized controlled trial

New imaging technologies have been applied in endoscopy to improve the detection and differentiation of subtle mucosal changes using a digital contrast method. Among them, i-SCAN technology is the most recently developed image-enhancing technology. We investigated whether i-SCAN could improve the detection rate of reflux esophagitis. Interobserver agreement between endoscopists was compared with conventional white light (WL) endoscopic examination. We performed a prospective randomized controlled trial. A consecutive series of 514 subjects that underwent an esophagogastroduodenoscopy for health inspection were enrolled and randomized into the i-SCAN group (n = 246) and WL group (n = 268). An esophagogastroduodenoscopy with video recording was used for detecting reflux esophagitis, and reflux esophagitis were categorized by the modified Los Angeles (LA) classification. The total number of reflux esophagitis identified by WL and i-SCAN was 58 (21.7%) and 74 (30.1%), respectively. The diagnostic yield of reflux esophagitis was significantly higher (P = 0.034) in the i-SCAN group (30.1%) as compared to the WL group (21.6%). Using the modified LA classification, the detection rate of minimal changes was significantly higher (P = 0.017) in the i-SCAN group (11.8%) as compared to the WL group (5.6%), but the detection rates of LA-A and LA-B were not significantly different between the two groups (P = 0.897 and P = 0.311, respectively). After comparison of the interobserver agreement using randomly selected video clips, the i-SCAN group showed better agreement than the WL group (Kappa value, 0.793 vs. 0.473). Compared to WL endoscopy, applying i-SCAN in daily practice can improve the diagnostic yield of reflux esophagitis by detecting more minimal changes in the squamo-columnar junction of the esophagus and can improve the interobserver agreement of the modified Los Angeles classification.

P111 “EARS” (Erlanger Activity Related Score) of IBD: A new tool that allows accurate in vivo assessment of inflammatory activity in ulcerative colitis

Background: Increased vascular permeability and angiogenesis play a crucial role in the pathogenesis of inflammatory bowel disease (IBD). Previously, magnifying endoscopy and chromoendoscopy have been shown to be reliable tools for predicting histological assessment of severity in patients with mild or even inactive disease. i-scan (Pentax, Tokyo, Japan) was recently introduced as a novel computed virtual chromoendoscopy technique which enables a clear visualization of the mucosal vascular pattern within the gastrointestinal tract. Aim was to determine whether i-scan has the potential to enhance assessment of disease severity and extent in patients with mild or inactive IBD in comparison to high-definition white light endoscopy (HD-WL). Methods: Consecutive patients with IBD were randomly assigned at a 1:1 ratio to undergo colonoscopy with HD-WL (Group 1) or i-scan (Group 2). The mucosal vascular pattern and any mucosal abnormalities were recorded. Inflammation in ulcerative colitis was recorded according to Mayo ulcerative endoscopic score and in Crohn’s disease according to Crohn’s Disease Endoscopic Index of Severity (CDEIS). Subsequent to endoscopic characterization targeted biopsies were obtained from every segment for subsequent histopathological analysis of disease activity. Results: Overall, 100 patients were screened to participate in this study of whom 78 patients (HD white light, n = 39; i-scan, n = 39) completed the study protocol thereby matching the previously calculated sample size. Average duration of the examination was 18 minutes in group A and 20.5 minutes in group B which was not statistically significant. When comparing the endoscopic prediction of inflammatory extent and activity with the histological results an overall agreement of 51.28% and 56.41% (group A) and 92.31% and 89.74% (group B) was found, respectively. These differences were statistically significant (p = 0.0009 and p = 0.011). Conclusions: The present study indicates that i-scan significantly improves the diagnosis of the severity and extent of mucosal inflammation in patients with IBD. This newly developed imaging technique will therefore have important implications for diagnostic and therapeutic interventions in patients with IBD.