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Does the Use of High Definition White Light Colonoscopy Leads to Higher Adenoma Detection Rates Compared to Standard Definition White Light Colonoscopy. An Effectiveness Study in 1225 Patients

2008; Elsevier BV; Volume: 67; Issue: 5 Linguagem: Inglês

10.1016/j.gie.2008.03.227

1097-6779

Anna M. Buchner, Marwan Ghabril, Seth A. Gross, Patrick Cleveland, Kanwar R. Gill, Anthony Schore, Michael F. Picco, David S. Loeb, John R. Cangemi, Massimo Raimondo, Herbert C. Wolfsen, Timothy A. Woodward, Kenneth R. DeVault, Michael B. Wallace,

Global Cancer Incidence and Screening

Background/Aims: Improving adenoma detection rates during colonoscopy is one of the important measures of quality of colonoscopy. Our recent prospective randomized back to back trial comparing HD-NBI to conventional white light colonoscopy in 49 patients revealed that the misrate for adenomas was lower with HD-NBI than with standard definition colonoscopy (Gross et al. DDW 2008, submitted). The two aims of this study were 1) to determine the effectiveness of HD-white light (HDWL) to standard definition white light (SDWL) for adenoma detection and 2) to determine if the results in a controlled clinical trial could be generalized to a clinical practice setting. Methods: We performed a retrospective case control study comparing SDWL (Olympus 140-160 series) colonoscopy to HDWL (Olympus 180 series) colonoscopy. Study participants included patients who underwent screening, surveillance and diagnostic colonoscopies in our GI suite between 09/2006 and 05/2007. The HD scopes were randomly placed in 2 out of 6 rooms. The default mode of the colonoscope in 2 out of 6 rooms was HD; therefore, the endoscopist could not choose between the HD mode and standard mode. The assignment of cases and endoscopists to all rooms was random. Poisson regression was used to estimate the rate of occurrence and compare the number of adenomas detected between the SD and HD colonoscopy recipients. Results: A total of 1225 patients participated in the study, of whom 604 patients were assigned to SDWL, and 621 were assigned to HDWL. The patients were matched based on demographics characteristics, screening indications, bowel prep status, and family history of colon cancer. Overall, 25% of patients screened had at least one adenoma. The estimated rate of occurrence was 0.45 adenomas per person (95% CI 0.42, 0.49). Among those with at least one adenoma, the estimated frequency was 1.8 per person (1.67, 1.97). The estimated rate of adenoma among HDWL participants was 0.43 (0.38, 0.49) which was not statistically different compared to SDWL participants (0.47, 0.34-0.60, p = 0.30).The rates of small adenomas (0-5 mm) per patient was the same; 0.27 (0.24, 0.30) in both groups (p = 0.98).Among patients receiving colonoscopy for screening (n = 559), HDWL recipients had an estimated adenoma rate of 0.47, while SDWL recipients had an adenoma rate of 0.52 (p = 0.34). When the surveillance patients were considered (n = 322), the estimated adenoma rates were 0.63 per person for HDWL and 0.68 per person for SDWL (p = 0.56). Conclusion: The use of HDWL colonoscopy did not result in an increased rate of adenoma detection in a general clinical practice setting.