Digestive Diseases and Sciences

, Volume 55, Issue 8, pp 2357–2364 | Cite as

A Prospective Randomized Study on Computed Virtual Chromoendoscopy Versus Conventional Colonoscopy for the Detection of Small Colorectal Adenomas

  • Jae Myung Cha
  • Joung Il Lee
  • Kwang Roo Joo
  • Sung Won Jung
  • Hyun Phil Shin
Original Article

Abstract

Background

Colonoscopy is considered to be the standard diagnostic test for detecting colonic neoplasia, particularly for small lesions. However, recent publications have suggested that 15–27% of small adenomas might be missed during conventional colonoscopy.

Aims

To determine whether computed virtual chromoendoscopy (CVC) can improve the detection of small adenomas as compared to conventional colonoscopy.

Methods

We examined 135 consecutive patients by total colonoscopy and 128 patients were randomized to compare white-light colonoscopy (65 patients) and CVC-mode colonoscopy (63 patients) after the exclusion of seven patients because of poor bowel preparation (n = 4) or other causes (one sigmoid colon cancer, two intestinal tuberculosis).

Results

There were no differences between the patient characteristics for the two study groups, i.e., age, sex, body mass index, quality of bowel preparations, indications for the procedure, conscious sedation, and examination times—both insertion time and withdrawal time. The groups did not differ in the number of patients with all polyps, adenomas, or hyperplastic polyps. In the patients with adenomas, however, there was a significant difference in the detection rate for the patients with small adenomas less than 5 mm in size (P = 0.006).

Conclusions

Colonoscopy with the CVC mode identified more patients with small colorectal adenomas than conventional white-light colonoscopy. Therefore, CVC might be a supplementary tool aiding the colonoscopist in the detection of small adenomas; however, further studies will need to demonstrate whether these results are reproducible across patients in varied clinical settings.

Keywords

Colon Colonoscopy Adenoma Computed virtual chromoendoscopy 

References

  1. 1.
    Rex DK, Cutler CS, Lemmel GT, et al. Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology. 1997;112:24–28. doi:10.1016/S0016-5085(97)70214-2.CrossRefPubMedGoogle Scholar
  2. 2.
    Hixson LJ, Fennerty MB, Sampliner RE, et al. Prospective study of the frequency and size distribution of polyps missed by colonoscopy. J Natl Cancer Inst. 1990;82:1769–1772. doi:10.1093/jnci/82.22.1769.CrossRefPubMedGoogle Scholar
  3. 3.
    Atkin WS, Morson BC, Cuzick J. Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med. 1992;326:658–662.PubMedCrossRefGoogle Scholar
  4. 4.
    Bond JH. Is the small colorectal polyp clinically diminutive? Gastrointest Endosc. 1993;39:592–593.CrossRefPubMedGoogle Scholar
  5. 5.
    Lane N, Lev R. Observations on the origin of adenomatous epithelium of the colon. Serial section of minute polyps in familial polyposis. Cancer. 1963;16:751–764. doi: 10.1002/1097-0142(196306)16:6<751::AID-CNCR2820160610>3.0.CO;2-0 CrossRefPubMedGoogle Scholar
  6. 6.
    Arthur JF. Structure and significance of metaplastic nodules in the rectal mucosa. J Clin Pathol. 1968;21:735–743. doi:10.1136/jcp.21.6.735.CrossRefPubMedGoogle Scholar
  7. 7.
    Blue MG, Sivak MV Jr, Achkar E, et al. Hyperplastic polyps seen at sigmoidoscopy are markers for additional adenomas seen at colonoscopy. Gastroenterology. 1991;100:564–566.PubMedGoogle Scholar
  8. 8.
    Pabby A, Schoen RE, Weissfeld JL, et al. Analysis of colorectal cancer occurrence during surveillance colonoscopy in the dietary Polyp Prevention Trial. Gastrointest Endosc. 2005;61:385–391. doi:10.1016/S0016-5107(04)02765-8.CrossRefPubMedGoogle Scholar
  9. 9.
    Farrar WD, Sawhney MS, Nelson DB, et al. Colorectal cancers found after a complete colonoscopy. Clin Gastroenterol Hepatol. 2006;4:1259–1264. doi:10.1016/j.cgh.2006.07.012.CrossRefPubMedGoogle Scholar
  10. 10.
    Kiesslich R, von Bergh M, Hahn M, et al. Chromoendoscopy with indigocarmine improves the detection of adenomatous and nonadenomatous lesions in the colon. Endoscopy. 2001;33:1001–1006. doi:10.1055/s-2001-18932.CrossRefPubMedGoogle Scholar
  11. 11.
    Le Rhun M, Coron E, Parlier D, et al. High resolution colonoscopy with chromoscopy versus standard colonoscopy for the detection of colonic neoplasia: a randomized study. Clin Gastroenterol Hepatol. 2006;4:349–354. doi:10.1016/j.cgh.2005.12.009.CrossRefPubMedGoogle Scholar
  12. 12.
    Brooker JC, Saunders BP, Shah SG, et al. Total colonic dye-spray increases the detection of diminutive adenomas during routine colonoscopy: a randomized controlled trial. Gastrointest Endosc. 2002;56:333–338. doi:10.1016/S0016-5107(02)70034-5.CrossRefPubMedGoogle Scholar
  13. 13.
    Hurlstone DP, Cross SS, Slater R, et al. Detecting diminutive colorectal lesions at colonoscopy: a randomised controlled trial of pan-colonic versus targeted chromoscopy. Gut. 2004;53:376–380. doi:10.1136/gut.2003.029868.CrossRefPubMedGoogle Scholar
  14. 14.
    Rex DK, Helbig CC. High yields of small and flat adenomas with high-definition colonoscopes using either white light or narrow band imaging. Gastroenterology. 2007;133:42–47. doi:10.1053/j.gastro.2007.04.029.CrossRefPubMedGoogle Scholar
  15. 15.
    Adler A, Pohl H, Papanikolaou IS, et al. A prospective randomised study on narrow-band imaging versus conventional colonoscopy for adenoma detection: does narrow-band imaging induce a learning effect? Gut. 2008;57:59–64. doi:10.1136/gut.2007.123539.CrossRefPubMedGoogle Scholar
  16. 16.
    Pohl J, May A, Rabenstein T, et al. Computed virtual chromoendoscopy: a new tool for enhancing tissue surface structures. Endoscopy. 2007;39:80–83. doi:10.1055/s-2006-945045.CrossRefPubMedGoogle Scholar
  17. 17.
    Pohl J, May A, Rabenstein T, et al. Comparison of computed virtual chromoendoscopy and conventional chromoendoscopy with acetic acid for detection of neoplasia in Barrett’s esophagus. Endoscopy. 2007;39:594–598. doi:10.1055/s-2007-966649.CrossRefPubMedGoogle Scholar
  18. 18.
    Pohl J, Nguyen-Tat M, Pech O, et al. Computed virtual chromoendoscopy for classification of small colorectal lesions: a prospective comparative study. Am J Gastroenterol. 2008;103:562–569. doi:10.1111/j.1572-0241.2007.01670.x.CrossRefPubMedGoogle Scholar
  19. 19.
    Participants in the Paris Workshop. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc. 2003;58:S3–S43. doi:10.1016/S0016-5107(03)02159-X.CrossRefGoogle Scholar
  20. 20.
    Kudo S, Hirota S, Nakajima T, et al. Colorectal tumours and pit pattern. J Clin Pathol. 1994;47:880–885. doi:10.1136/jcp.47.10.880.CrossRefPubMedGoogle Scholar
  21. 21.
    Helbig C. Chromoendoscopy and its alternatives for colonoscopy: useful in the United States? Rev Gastroenterol Disord. 2006;6:209–220.PubMedGoogle Scholar
  22. 22.
    Hamilton SR, Aaltonen LA, eds. World Health Organization Classification of Tumours: Pathology and Genetics of Tumours of the Digestive System. Lyon, France: IARC Press; 2000:104–109.Google Scholar
  23. 23.
    Morson BC. Evolution of cancer of the colon and rectum. Cancer. 1974;34:845–849. doi:10.1002/1097-0142(197409)34:3+<845::AID-CNCR2820340710>3.0.CO;2-H.CrossRefPubMedGoogle Scholar
  24. 24.
    Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. N Engl J Med. 1993;329:1977–1981. doi: 10.1056/NEJM199312303292701.CrossRefPubMedGoogle Scholar
  25. 25.
    Citarda F, Tomaselli G, Capocaccia R, et al. Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence. Gut. 2001;48:812–815. doi: 10.1136/gut.48.6.812.CrossRefPubMedGoogle Scholar
  26. 26.
    Rex DK, Rahmani EY, Haseman JH, et al. Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice. Gastroenterology. 1997;112:17–23. doi:10.1016/S0016-5085(97)70213-0.CrossRefPubMedGoogle Scholar
  27. 27.
    Atkin W, Rogers P, Cardwell C, et al. Wide variation in adenoma detection rates at screening flexible sigmoidoscopy. Gastroenterology. 2004;126:1247–1256. doi:10.1053/j.gastro.2004.01.023.CrossRefPubMedGoogle Scholar
  28. 28.
    Chen SC, Rex DK. Endoscopist can be more powerful than age and male gender in predicting adenoma detection at colonoscopy. Am J Gastroenterol. 2007;102:856–861. doi:10.1111/j.1572-0241.2006.01054.x.CrossRefPubMedGoogle Scholar
  29. 29.
    Machida H, Sano Y, Hamamoto Y, et al. Narrow-band imaging in the diagnosis of colorectal mucosal lesions: a pilot study. Endoscopy. 2004;36:1094–1098. doi:10.1055/s-2004-826040.CrossRefPubMedGoogle Scholar
  30. 30.
    Gono K, Yamazaki K, Doguchi N, et al. Endoscopic observation of tissue by narrowband illumination. Opt Rev. 2003;10:211–215. doi:10.1007/s10043-003-0211-8.CrossRefGoogle Scholar
  31. 31.
    Uraoka T, Saito Y, Matsuda T, et al. Detectability of colorectal neoplastic lesions using a narrow-band imaging system: a pilot study. J Gastroenterol Hepatol. 2008;23:1810–1815. doi:10.1111/j.1440-1746.2008.05635.x.CrossRefPubMedGoogle Scholar
  32. 32.
    Barclay RL, Vicari JJ, Doughty AS, et al. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med. 2006;355:2533–2541. doi:10.1056/NEJMoa055498.CrossRefPubMedGoogle Scholar
  33. 33.
    Froehlich F, Wietlisbach V, Gonvers JJ, et al. Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study. Gastrointest Endosc. 2005;61:378–384. doi:10.1016/S0016-5107(04)02776-2.CrossRefPubMedGoogle Scholar
  34. 34.
    Kim DH, Lee SY, Choi KS, et al. The usefulness of colonoscopy as a screening test for detecting colorectal polyps. Hepatogastroenterology. 2007;54:2240–2242.PubMedGoogle Scholar
  35. 35.
    Adler A, Roll S, Marowski B, et al. Appropriateness of colonoscopy in the era of colorectal cancer screening: a prospective, multicenter study in a private-practice setting (Berlin Colonoscopy Project 1, BECOP 1). Dis Colon Rectum. 2007;50:1628–1638. doi:10.1007/s10350-007-9029-y.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Jae Myung Cha
    • 1
  • Joung Il Lee
    • 1
  • Kwang Roo Joo
    • 1
  • Sung Won Jung
    • 1
  • Hyun Phil Shin
    • 1
  1. 1.Department of Internal Medicine, Kyunghee University College of MedicineEast–West Neo Medical CenterGangdong-gu, SeoulKorea

Personalised recommendations