Standard Definition White Light Research Articles

DOP18 Advanced optical diagnosis technology for assessment of endoscopic and histological remission in Ulcerative Colitis: A systematic review and meta-analysis

Abstract Background Advanced endoscopic technologies led to significant progress in the definition of endoscopic remission of ulcerative colitis (UC), and correlate better with histological changes, compared to standard endoscopy. However, whilst studies have assessed the diagnostic accuracy of endoscope technologies individually, there is current limited data comparing between technologies. As such, we aimed to compare the correlations between endoscopy and histology disease activity scores across endoscope technologies Methods We searched PubMed and Embase in January 2021 for eligible studies reporting the correlation between endoscopy and histology activity scores in UC. Studies were grouped by endoscope technology as standard-definition white light (SD-WLE), high-definition white light (HD-WLE), or electronic virtual chromoendoscopy (VCE), and comparisons made between these groups Results A total of N=27 studies were identified, of which N=12 were included in a meta-analysis of correlations between endoscopic and histological activity scores. Combining these returned a pooled correlation coefficient (rho) for the SD-WLE group of 0.61, which did not differ significantly from HD-WLE (rho: 0.79, p=0.140) or VCE (rho: 0.70, p=0.471) [Fig 1a]. In addition, N=4 studies reported the accuracy of endoscopic activity scores on WLE and VCE to diagnose histological remission. Pooling these found significantly higher accuracy for VCE, compared to WLE (risk ratio: 1.13, 95% CI: 1.07–1.19, p<0.001).[Fig 1b] Conclusion Activity scores assessed using endoscopy are strongly correlated with activity on histology. VCE appears to have better accuracy for the diagnosis of histological remission in UC, compared to WLE.

Advanced technology for assessment of endoscopic and histological activity in ulcerative colitis: a systematic review and meta-analysis.

Background:Advanced endoscopic technologies led to significant progress in the definition of endoscopic remission of ulcerative colitis (UC) and correlate better with histological changes, compared with standard endoscopy. However, while studies have assessed the diagnostic accuracy of endoscope technologies individually, there are currently limited data comparing between technologies. As such, the aim of this systematic review was to pool data from the existing literature and compare the correlations between endoscopy and histologic disease activity scores across endoscope technologies.Methods:We searched PubMed and Embase until February 2021 for eligible studies reporting the correlation between endoscopy and histology activity scores in UC. Studies were grouped by endoscope technology as standard-definition white light (SD-WLE), high-definition white light (HD-WLE) or electronic virtual chromoendoscopy (VCE) and comparisons made between these groups.Results:A total of N = 27 studies were identified, of which N = 12 were included in a meta-analysis of correlations between endoscopic and histological activity scores. Combining these studies identified considerable heterogeneity (I2: 89–93%) and returned a pooled correlation coefficient (ρ) for the SD-WLE group of 0.74, which did not differ significantly from HD-WLE (ρ: 0.65, p = 0.521) or VCE (ρ: 0.70, p = 0.801). In addition, N = 4 studies reported the accuracy of endoscopic activity scores on WLE and VCE to diagnose histological remission. Pooling these found significantly higher accuracy for VCE, compared with WLE [risk ratio: 1.13, 95% confidence interval (CI): 1.07–1.19, p < 0.001].Conclusion:Activity scores assessed using endoscopy are strongly correlated with activity on histology regardless of endoscopic technology. VCE seems to be more accurate in predicting histological remission than WLE. However, given the heterogeneity between the included studies, head-to-head trials are warranted to confirm these findings.

Multicentre randomised controlled trial on virtual chromoendoscopy in the detection of neoplasia during colitis surveillance high-definition colonoscopy (the VIRTUOSO trial)

BackgroundLongstanding colonic IBD increases the risk of developing colorectal cancer. The utility of chromoendoscopy with standard-definition white light technology has been established. However, the use of high-definition virtual chromoendoscopy (HDV)...

Comparison of the detection of colorectal lesions in different endoscopic modalities: A network meta-analysis and systematic review.

A colonoscopy is considered to be the standard diagnostic test used to detect early colorectal lesions. Detection rates are expected to improve with optimised visualisation. A systematic review and network meta-analysis was conducted to evaluate detection efficiency in several colonoscopic modalities. Relevant articles were identified in searches of the PubMed, EMBASE and Cochrane Library databases. The modalities, comprising of standard-definition white light (SDWL), high-definition white light (HDWL), narrow-band imaging (NBI), autofluorescence imaging (AFI), PENTAX image enhanced technology (i-SCAN), Fuji Intelligent Color Enhancement (FICE), dye-based chromoendoscopy and novel image enhanced systems, including blue laser imaging (BLI) and linked color imaging (LCI), were compared to identify the most efficient modalities that could be used to detect colorectal lesions. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated. As a result, 40 studies fulfilled the inclusion criteria. Overall, in the network meta-analyses, NBI (OR, 1.29; 95% CI, 1.04-1.58), FICE (OR, 1.39; 95% CI, 1.11-1.77), chromoendoscopy (OR, 1.53; 95% CI, 1.22-1.93) and AFI (OR, 1.81; 95% CI, 1.07-2.87) were significantly better compared with SDWL at identifying adenoma in patients, and chromoendoscopy also proved significantly superior to HDWL (OR, 1.30; 95% CI, 1.06-1.60). In pairwise analyses, it was demonstrated that chromoendoscopy was significantly superior to HDWL at detecting the number of polyps (MD, -1.11; 95% CI, -1.46, -0.76) and flat lesions (MD, -0.30; 95% CI, -0.49, -0.10) per subject. Additionally, FICE detected a significantly greater number of subjects with polyps (OR, 0.78; 95% CI, 0.64-0.96) and NBI was significantly better at detecting the number of subjects with flat lesions (OR, 0.77; 95% CI, 0.60-0.99) compared with HDWL. Based on the meta-analysis, NBI, FICE and AFI were significantly better compared with SDWL at detecting patients with adenoma. Additionally, chromoendoscopy was significantly better than SDWL and HDWL at detecting the number of colorectal adenoma, however additional studies are needed to confirm these findings.

949 An Assessment High and Standard Definition White Light Chromo-Colonoscopy on the Detection of Sessile Serrated Polyps in a Community Setting Advancing Towards Establishing a SSP Detection Rate

949 An Assessment High and Standard Definition White Light Chromo-Colonoscopy on the Detection of Sessile Serrated Polyps in a Community Setting Advancing Towards Establishing a SSP Detection Rate

Evaluation and Detection of Dysplasia in IBD: the Role of Chromoendoscopy and Enhanced Imaging Techniques.

Patients with ulcerative colitis (UC) and Crohn's disease (CD) colitis are at significantly higher risk for the development of colitis-associated colorectal cancer (CAC), a risk associated with increased duration and extent of disease [1]. CAC in patients with ulcerative colitis and Crohn's colitis arises from dysplastic tissue in the background of mucosal inflammatory changes. Regular surveillance by colonoscopy is a recommended cancer prevention strategy endorsed by the US and European GI societies [2-4]. Until recently, random sampling of the mucosa throughout the colon has been the mainstay of this conventional surveillance. This requires multiple biopsies to be taken and processed, a practice which is time consuming, expensive, and has a low diagnostic yield. The growth pattern of dysplastic tissue is often multifocal and diffuse, and thus, its detection may not be optimal with the use of traditional white light colonoscopy. According to recent studies, most dysplastic lesions appear to be visible to careful endoscopic inspection [5-7]. Thus, the approach focusing on targeted biopsies of any mucosal abnormalities instead of only random biopsies has been advocated [8]. In addition, the detection and further delineation of any mucosal abnormalities are thought to be improved by the application of dyes that highlight more subtle abnormalities known as chromoendoscopy (CE) as well as a new generation endoscopic system with high-definition white light endoscopy (HDWL). The application of CE in patients with long-term UC was deemed to be beneficial based upon the results of previous clinical trials comparing CE with standard definition white light endoscopy (SDWL) [9•, 10•]. However, there are limited data available comparing CE with the currently broadly used high-definition colonoscopies (HDWL) [11•, 12•, 13•]. High-definition (HD) endoscopy uses a high-definition monitor and a high-resolution CCD (charge-coupled device) providing images of substantially higher resolution than standard video endoscopy. Thus, HDWL colonoscopy may be an alternative to CE in IBD surveillance without the need for the extra time and required experience with CE. Further longitudinal studies are necessary to determine the ultimate advantage of chromoendoscopy or lack of the advantages of chromoendoscopy over that of high-definition colonoscopy in detection of dysplasia. Once lesions are identified by HDWL and CE, they can be further evaluated with evolving technologies to perform in vivo microscopy. Small-field technologies such as confocal endomicroscopy (CLE) permit in vivo microscopic assessment of the colonic mucosa. This evolving technology can be utilized in combination with HDWL and CE in selected cases to further define the lesions and assess their histology, and thus, facilitate real-time in vivo diagnosis and decisions regarding resection of lesions. Further studies to determine the applicability of these newer enhanced technologies in evaluation of dysplasia in routine clinical practice are needed.

PTH-053 High Definition (HD) Versus Standard Definition (SD) White Light Endoscopy for Detecting Early Neoplasia (EN) in Barrett’S Oesophagus (BO) During Surveillance Endoscopy. is It Time to Change the Standard of Care?

IntroductionHD endoscopy systems provide superior image resolution. However, the utility of this new and more expensive technology in lesion detection has not been evaluated so far.Our aim was to assess...

OC-045 High Definition White Light Endoscopy and I-Scan for small Colonic Polyp Evaluation : Results of the Hiscope Study: Abstract OC-045 Table 1

<h3>Introduction</h3> Standard definition white light endoscopy is inadequate for in-vivo characterisation of small colonic polyps. The ASGE has identified prediction of polyp surveillance intervals and negative predictive value for adenomatous histology of diminutive recto-sigmoid polyps as key targets for new technologies. High definition white light endoscopy is now available but there is little data on it’s use. <h3>Methods</h3> We aimed to examine the in-vivo characterisation accuracy of high definition white light endoscopy (HDWL) plus a novel electronic imaging modality – i-Scan (Pentax, Japan). Patients undergoing colonoscopy through the UK Bowel Cancer Screening Programme were prospectively recruited. All colonoscopies were performed by a single expert endoscopist with extensive experience in in-vivo diagnosis. Procedures were performed with Pentax EC-3890Li 1.2 Megapixel HD+ colonoscopes and EPKi processor. An initial classification &amp; validation exercise was carried out to determine the optimum i-Scan settings for in-vivo diagnosis, and to develop a novel in-vivo diagnosis assessment tool. All polyps &lt; 10mm in size were assessed sequentially with HDWL and i-Scan. Optical magnification was not used. Predicted histology (non-neoplastic, adenoma, cancer) was recorded for both modalities and compared to the final histopathological diagnosis as reported by an expert gastrointestinal pathologist. Predictions were rated as high or low confidence assessments. Results were analysed for sensitivity and specificity for neoplasia, overall accuracy, and negative predictive value for rectosigmoid polyps ≤5 mm as recommended by the ASGE PIVI statement. <h3>Results</h3> 84 patients were recruited, in whom 209 polyps &lt; 10 mm were included. Mean polyp diameter was 4.3mm, median 4mm. 134 polyps were neoplastic and 75 non-neoplastic. There were no significant differences in sensitivity (95.5% vs 97.0%) and specificity (89.3% vs 90.7%) for neoplasia and overall diagnostic accuracy (93.3% vs 94.7%) between HDWL and i-Scan. Negative predictive value for adenomatous histology of rectosigmoid polyps ≤5 mm was 100% with both modalities. Polyp surveillance intervals using in-vivo assessment of diminutive polyps were correct in 95% and 97% of patients with HDWL and i-Scan respectively. <h3>Conclusion</h3> Excellent in vivo diagnostic accuracy, in excess of 90% can be achieved with HDWL alone. No significant gains in accuracy over HDWL were noted with i-Scan when used with a 1.2Megapixel HD colonoscope Both HDWL and i-Scan fulfil the ASGE criteria for ‘resect and discard’ and ‘do not resect’ strategies for diminutive polyps <h3>Disclosure of Interest</h3> None Declared

Tu1471 Resect and Discard Strategy With Standard-Definition White Light (SD) and High Definition White-Light With Narrow-Band Image (NBI) Colonoscopy: a Prospective Study

Accurate optical analysis of small colorectal polyps (<1cm) could allow a “resect and discard” strategy with surveillance intervals determined based on these results. This strategy has been evaluated with narrow-band image (NBI), but not with standard-definition white light (SD) conventional colonoscopy.

Tu1424 Accuracy of Kudo Pit Pattern Clasification With Standard-Definition White Light (SD) and High Definition Narrow-Band Image (NBI) Colonoscopy for Predicting Adenomas: a Prospective Study

The colonic pit pattern is recognized as an aid to the differential diagnosis between neoplastic and non-neoplastic polyps. Accuracy of pit pattern visualization for predicting neoplastic polyps with non-magnification colonoscopy has not been clearly evaluated.

Tu1482 High Definition White Light Endoscopy and I-SCAN for in-Vivo Characterisation of Small Colonic Polyps: No Need to Push the Button

a conventional image, the lesion was each observed by NBI magnification. The diagnosis of NBI magnification was based on Sano’s classification. Also irregular findings of microvessels including “caliber change of microvessel” (CCM), “long irregular vessel” (LIV) and “decline of microvessel density” (DMD) were analyzed. When type V pit pattern was suspected, the lesion was observed after crystal-violet dye-stain. The diagnosis of chromoendoscopic magnification was based on Kudo’s classification. Both capillary pattern and pit pattern were compared with final histological diagnosis. This study was performed retrospectively and consecutively. Histological diagnosis on resected specimen was determined according to Vienna classification. Submucosal massively invasive cancer (SM-M) was defined as an invasive depth greater than 1000 m. Results: As to histological diagnoses, there were 380 intramucosal cancers, 60 submucosal slightly invasive cancers, and 81 cancers with submucosal massively invasion. The values of the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) and accuracy of type IIIB for the diagnosis of SM-M were 70.4%, 98.6%, 90.5%, 94.8% and 94.3%, respectively. Those of VI highly irregular and VN were 81.5%, 98.4%, 90.4%, 96.7% and 95.8%, respectively. Type IIIB was observed in 19 (73.1%) of 26 protruded type SM-M, 8 (40.0%) of 20 flat type SM-M and 30 (85.7%) of 35 depressed type SM-M. The values of specificity of CCM, LIV and DMD for the diagnosis of SM-M were 99.1%, 99.8% and 99.5%, respectively. CCM was observed in 14 (51.9%) of 26 protruded type SM-M. And DMD were observed in 23 (67.6%) of 35 depressed type SM-M. Conclusion: NBI magnification would have clinical advantage to diagnose the invasion depth of early colorectal cancers. Submucosal massively invasive cancers had characteristic irregular findings that depended on the morphological type. These irregular findings had high specificity for the diagnosis of submucosal massively invasive cancers. Tu1482 High Definition White Light Endoscopy and I-SCAN for in-Vivo Characterisation of Small Colonic Polyps: No Need to Push the Button Peter J. Basford*, Gaius R. Longcroft-Wheaton, Pradeep Bhandari Gastroenterology, Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom Introduction: Standard definition white light endoscopy is inadequate for in-vivo characterisation of small colonic polyps. Chromoendoscopy and electronic imaging techniques are shown to improve accuracy. The ASGE has identified prediction of polyp surveillance intervals and negative predictive value for adenomatous histology of diminutive recto-sigmoid polyps as key targets for new technologies. High definition white light endoscopy incorporating charge coupled device chips with resolution in excess of 1 million pixels are now available but there is little data on their use. Aims&Methods: We aimed to examine the in-vivo characterisation accuracy of high definition white light endoscopy (HDWL) plus a novel electronic imaging modality i-Scan (Pentax, Japan). Patients undergoing colonoscopy through the UK Bowel Cancer Screening Programme were prospectively recruited. All colonoscopies were performed by a single expert endoscopist with extensive experience in in-vivo diagnosis. Procedures were performed with Pentax EC-3890Li 1.2 Megapixel HD colonoscopes and EPKi processor. An initial classification & validation exercise was carried out to determine the optimum i-Scan settings for in-vivo diagnosis, and to develop a novel in-vivo diagnosis assessment tool. All polyps 10mm in size were assessed sequentially with HDWL and i-Scan. Optical magnification was not used. Predicted histology (non-neoplastic, adenoma, cancer) was recorded for both modalities and compared to the final histopathological diagnosis as reported by an expert gastrointestinal pathologist. Predictions were rated as high or low confidence assessments. Results were analysed for sensitivity and specificity for neoplasia, overall accuracy, and negative predictive value for rectosigmoid polyps 5mm as recommended by the ASGE PIVI statement. Results: 84 patients were recruited, in whom 209 polyps 10mm were included. Mean polyp diameter was 4.3mm, median 4mm. 134 polyps were neoplastic and 75 non-neoplastic. There were no significant differences in sensitivity (95.5% vs 97.0%) and specificity (89.3% vs 90.7%) for neoplasia and overall diagnostic accuracy (93.3% vs 94.7%) between HDWL and i-Scan. Negative predictive value for adenomatous histology of rectosigmoid polyps 5mm was 100% with both modalities. Polyp surveillance intervals using in-vivo assessment of diminutive polyps were correct in 95% and 97% of patients with HDWL and i-Scan respectively. Conclusion: 1) Excellent in vivo diagnostic accuracy, in excess of 90% can be achieved with HDWL alone.2) No significant gains in accuracy over HDWL were noted with i-Scan when used with a 1.2Megapixel HD colonoscope therefore, there is no need to push the button or spray dye to improve accuracy. 3) Both HDWL and i-Scan fulfill the ASGE criteria for ‘resect and discard’ and ‘do not resect’ strategies for diminutive polyps

Comparison of High Definition with Standard White Light Endoscopy for Detection of Dysplastic Lesions During Surveillance Colonoscopy in Patients with Colonic Inflammatory Bowel Disease

Dysplasia in colonic inflammatory bowel disease (IBD) is often multifocal and flat. High-definition (HD) colonoscopy improves adenoma detection rates by improving the ability to detect subtle mucosal changes. The utility of HD colonoscopy in dysplasia detection in patients with IBD has not been reported so far. We aimed to compare the yield of dysplastic lesions detected by standard definition (SD) white light endoscopy with HD endoscopy. A retrospective cohort study of patients with long-standing (>7 years) colonic IBD undergoing surveillance colonoscopy at Nottingham University Hospital was studied between September 2008 and February 2010. Details of diagnosis, duration of disease, and outcomes of the colonoscopy were collected from the endoscopy database, electronic patient records, and patient notes. There were 160 colonoscopies (101 ulcerative colitis [UC] and 59 Crohn's disease [CD]) in the SD group and 209 colonoscopies (147 UC and 62 CD) in the HD group. The groups were well matched for all demographic variables. Thirty-two dysplastic lesions (27 on targeted biopsy) were detected in 24 patients in the HD group and 11 dysplastic lesions (six on targeted biopsy) were detected in eight patients the SD group. The adjusted prevalence ratio of detecting any dysplastic lesion and dysplastic lesion on targeted biopsy was 2.21 (95% confidence interval [CI] 1.09-4.45) and 2.99 (95% CI 1.16-7.79), respectively, for HD colonoscopy. HD colonoscopy improves targeted detection of dysplastic lesions during surveillance colonoscopy of patients with colonic IBD in routine clinical practice. Randomized controlled studies are required to confirm these findings.

Narrow band imaging versus conventional white light colonoscopy for the detection of colorectal polyps

It has been suggested that narrow band imaging colonoscopy (NBI) might be better for detection of colorectal polyps than white light colonoscopy (WLC). To compare standard or high definition white light colonoscopy with narrow band imaging colonoscopy for detection of colorectal polyps. We searched The Cochrane Library, MEDLINE, and EMBASE to August 2011. We scanned bibliographies of relevant publications and wrote to experts for additional trials. Two authors (NA and GB) independently applied the inclusion criteria and extracted the data to all potential studies without blinding. Authors extracted data independently. Trials with adequate randomisation, allocation concealment, and complete outcome data reporting, as well as without selective outcome reporting or other bias were classified as having a lowest risk of bias. Random-effects and fixed-effect meta-analyses were conducted. We identified 11 randomised trials comparing WLC with NBI for detection of colorectal polyps. In total eight randomised trials with 3673 participants provided data for our analyses. There was no statistically significant difference between WLC (standard definition and high definition pooled) and NBI for the detection of patients with colorectal polyps (6 trials, n = 2832, RR 0.97, 95% CI 0.91 to 1.04), patients with colorectal adenomas (8 trials, n = 3673, RR 0.94, 95% CI 0.87 to 1.02), or patients with colorectal hyperplastic polyps (2 trials, n = 645, RR 0.87, 95% CI 0.76 to 1.00). Number of patients with at least one colorectal adenoma was not significantly different between WLC and NBI group irrespective of adenoma size (< 5 mm:RR 0.95, 95% CI 0.84 to 1.08, I(2) = 56%; 6 to 9 mm: RR 1.06, 95% CI 0.81 to 1.39, I(2) = 0%; ≥ 10 mm: RR 1.06, 95% CI 0.77 to 1.45, I(2) = 0%). Number of patients with at least one colorectal polyp, or colorectal adenoma was significantly lower in the standard definition WLC group compared to NBI group in fixed-effect meta-analysis (RR 0.87, 95% CI 0.78 to 0.97, I(2) = 78%; RR 0.87, 95% CI 0.77 to 0.99, I(2) = 0%, respectively), but not significantly different in random-effects meta-analysis (RR 0.86, 95% CI 0.68 to 1.10, I(2) = 78%). There was no statistically significant difference between high definition WLC and NBI in the number of patiens with at least one colorectal polyp or colorectal adenoma (RR 1.10, 95% CI 0.95 to 1.28; RR 0.87, 95% CI 0.77 to 0.99, I(2) = 0%, respectively). We could not find convincing evidence that NBI is significantly better than high definition WLC for the detection of patients with colorectal polyps, or colorectal adenomas. We found evidence that NBI might be better than standard definition WLC and equal to high definition WLC for detection the patients with colorectal polyps, or colorectal adenomas.

A comparison of high definition-image enhanced colonoscopy and standard white-light colonoscopy for colorectal polyp detection

Colonoscopy is widely used to detect and remove precancerous polyps, but fails to detect some polyps. Recent studies evaluating different image-enhanced methods have revealed conflicting results. The efficacy of colonoscopy imaging with simultaneous use of commercially available improvements, including high definition narrow band imaging (HD-NBI), and monochromatic charge-coupled device (CCD) video, was compared with a widely used standard definition white light (SDWL) colonoscopy system for detecting colorectal polyps. The primary aim was to determine whether the combination of image-enhanced colonoscopy systems resulted in fewer missed polyps compared with conventional colonoscopy. In a randomized controlled trial (Clinicaltrials.gov. study number NCT00825292) patients having routine screening and surveillance underwent tandem colonoscopies with SDWL and image-enhanced (HD-NBI) colonoscopy. The main outcome measurement was the per-polyp false-negative ("miss") rate. Secondary outcomes were adenoma miss rate, and per-patient polyp and adenoma miss rates. 100 patients were randomized and 96 were included in the analysis. In total, 177 polyps were detected; of these, 72 (41 %) were adenomatous. Polyp and adenoma miss rates for SDWL colonoscopy were 57 % (60/105) and 49 % (19/39); those for image-enhanced colonoscopy were 31 % (22/72) and 27 % (9/33) (P = 0.005 and P = 0.036 for polyps and adenomas, respectively). Image-enhanced and SDWL approaches had similar per-patient miss rates for polyps (6/35 vs. 9/32, P = 0.27) and adenomas (4/22 vs. 8/20, P = 0.11). Utilization of multiple recent improvements in image-enhanced colonoscopy was associated with a reduced miss rate for all polyps and for adenomatous polyps. It is not known which individual feature or combination of image-enhancement features led to the improvement.

Randomized, controlled trial of standard-definition white-light, high-definition white-light, and narrow-band imaging colonoscopy for the detection of colon polyps and prediction of polyp histology

Missing adenomas and the inability to accurately differentiate between polyp histology remain the main limitations of standard-definition white-light (SD-WL) colonoscopy. To compare the adenoma detection rates of SD-WL with those of high-definition white-light (HD-WL) and narrow-band imaging (NBI) as well as the accuracy of predicting polyp histology. Multicenter, prospective, randomized, controlled trial. Two academic medical centers in the United States. Subjects undergoing screening or surveillance colonoscopy. Subjects were randomized to undergo colonoscopy with one of the following: SD-WL, HD-WL, or NBI. The proportion of subjects detected with adenomas, adenomas detected per subject, and the accuracy of predicting polyp histology real time. A total of 630 subjects were included. The proportion of subjects with adenomas was 38.6% with SD-WL compared with 45.7% with HD-WL and 46.2% with NBI (P = .17 and P = .14, respectively). Adenomas detected per subject were 0.69 with SD-WL compared with 1.12 with HD-WL and 1.13 with NBI (P = .016 and P = .014, respectively). HD-WL and NBI detected more subjects with flat and right-sided adenomas compared with SD-WL (all P values <.005). NBI had a superior sensitivity (90%) and accuracy (82%) to predict adenomas compared with SD-WL and HD-WL (all P values <.005). Academic medical centers with experienced endoscopists. There was no difference in the proportion of subjects with adenomas detected with SD-WL, HD-WL, and NBI. However, HD-WL and NBI detected significantly more adenomas per subject (>60%) compared with SD-WL. NBI had the highest accuracy in predicting adenomas in real time during colonoscopy. ( NCT 00614770.).

Comparison of high definition with standard white light endoscopy for detection of dysplastic lesions during surveillance colonoscopy in patients with inflammatory bowel disease

IntroductionDysplasia in colonic inflammatory bowel disease (IBD) is often multifocal and flat, making it easy for significant lesions to be overlooked. Dye spraying the mucosal surface is believed to enhance...

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

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.

714 A Multicenter, Prospective Comparison of Standard Definition White Light (SDWL) Colonoscopy, High Definition White Light (HDWL) Colonoscopy and Narrow Band Imaging (NBI) Without Magnification in the Real-Time Characterization of Small Polyps

714 A Multicenter, Prospective Comparison of Standard Definition White Light (SDWL) Colonoscopy, High Definition White Light (HDWL) Colonoscopy and Narrow Band Imaging (NBI) Without Magnification in the Real-Time Characterization of Small Polyps

1080c: A Multicenter, Prospective, Randomized Controlled Trial Comparing Standard Definition White Light (SDWL), High Definition White Light (HDWL) and Narrow Band Imaging (NBI) Colonoscopy for the Detection of Colon Polyps and Real Time Prediction of Histology

HDWL colonoscopes and NBI are recent developments in colon imaging. Their ability to detect and characterize colon polyps compared to SDWL is unclear.

S1544: Comparison of Standard Definition White Light (SD-WL), High Definition White Light (HD-WL), and Narrow Band Imaging (NBI) Colonoscopy: Impact on Surveillance Interval Recommendations

S1544: Comparison of Standard Definition White Light (SD-WL), High Definition White Light (HD-WL), and Narrow Band Imaging (NBI) Colonoscopy: Impact on Surveillance Interval Recommendations