High-Definition White-Light (HDWL) Colonoscopy and Higher Adenoma Detection Rate and the Potential for Paradoxical Over Surveillance
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Patients undergoing high-definition white-light colonoscopy by a high adenoma detector may have a lower risk of interval adenoma detection on follow-up colonoscopy and may require less frequent follow-up but may paradoxically be assigned to more frequent surveillance when more adenomas are detected.
To evaluate whether high-definition white-light colonoscopy (vs. standard-definition white-light colonoscopy) and endoscopist adenoma detection rate (ADR) at index colonoscopy are associated with increased likelihood of adenomas at follow-up.
Longitudinal follow-up of prior cross-section cohort study of patients who underwent colonoscopy at baseline with at least one detected adenoma was included. Associations of type of white-light at index colonoscopy and the ADR of the endoscopist at index colonoscopy (high vs. low adenoma detector) were evaluated with various adenoma and polyp detection endpoints. Eighteen endoscopists were classified as high and low adenoma detectors based on the median ADR of 0.255.
There were no significant differences in subsequent interval adenoma or polyp detection endpoints with regard to whether baseline exam was performed with high-definition white-light or standard-definition white-light colonoscopy nor between high and low ADR after adjusting for multiple testing (P ≤ 0.0029 considered significant). Prior to multiple testing adjustment, there was a significantly lower detection rate of hyperplastic polyps in the left colon (24 vs. 35 %, OR: 0.56, P = 0.033) at follow-up colonoscopy when baseline exam was performed with high-definition white-light index colonoscopy.
The results of this study do not support adjusting colonoscopy surveillance guidelines based on type of colonoscopy performed or the endoscopist’s ADR.
- Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012;62:10–29. CrossRef
- Zauber AG, Winawer SJ, O’Brien MJ, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012;366:687–696. CrossRef
- Rex DK, Johnson DA, Anderson JC, et al. American college of gastroenterology guidelines for colorectal cancer screening 2009. Am J Gastroenterol. 2009;104:739–750. CrossRef
- Rex DK, Petrini JL, Baron TH, et al. Quality indicators for colonoscopy. Am J Gastroenterol. 2006;101:873–885.
- Rex DK. Maximizing detection of adenomas and cancers during colonoscopy. Am J Gastroenterol. 2006;101:2866–2877. CrossRef
- Qumseya BJ, Wallace MB. Advanced colorectal polyp detection techniques. Curr Gastroenterol Rep. 2012;14:414–420. CrossRef
- van Rijn JC, Reitsma JB, Stoker J, et al. Polyp miss rate determined by tandem colonoscopy: a systematic review. Am J Gastroenterol. 2006;101:343–350. CrossRef
- Buchner AM, Shahid MW, Heckman MG, et al. High-definition colonoscopy detects colorectal polyps at a higher rate than standard white-light colonoscopy. Clin Gastroenterol Hepatol. 2010;8:364–370. CrossRef
- Lieberman DA, Rex DK, Winawer SJ, et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the us multi-society task force on colorectal cancer. Gastroenterology. 2012;143:844–857. CrossRef
- Kaminski MF, Regula J, Kraszewska E, et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med. 2010;362:1795–1803. CrossRef
- Rogal SS, Pinsky PF, Schoen RE. Relationship between detection of adenomas by flexible sigmoidoscopy and interval distal colorectal cancer. Clin Gastroenterol Hepatol. 2013;11:73–78. CrossRef
- Corley DAJ, Christopher D, Marks AR, et al. Physician adenoma detection rate variability and subsequent colorectal cancer risk following a negative colonoscopy. Gastroenterology. 2013;144:S2–S3. CrossRef
- Raju GS, Vadyala V, Slack R, et al. Adenoma detection in patients undergoing a comprehensive colonoscopy screening. Cancer Med. 2013;2:391–402. CrossRef
- Lebwohl B, Kastrinos F, Glick M, et al. The impact of suboptimal bowel preparation on adenoma miss rates and the factors associated with early repeat colonoscopy. Gastrointest Endosc. 2011;73:1207–1214. CrossRef
- Kahi CJ, Hewett DG, Norton DL, Eckert GJ, Rex DK. Prevalence and variable detection of proximal colon serrated polyps during screening colonoscopy. Clin Gastroenterol Hepatol. 2011;9:42–46. CrossRef
- High-Definition White-Light (HDWL) Colonoscopy and Higher Adenoma Detection Rate and the Potential for Paradoxical Over Surveillance
Digestive Diseases and Sciences
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- Springer US
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- Adenoma detection rate
- High-definition and standard-definition white-light colonoscopy
- Interval cancer
- Polyp paradox
- Industry Sectors
- Author Affiliations
- 1. Department of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA
- 2. Department of Internal Medicine, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA
- 3. Section of Biostatistics in the Department of Health Sciences Research, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA