Advanced Colorectal Polyp Detection Techniques
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A long-term follow-up of the landmark National Polyp Study recently showed that colonoscopy was associated with critical clinical benefit, including reduced overall death rate, colorectal cancer (CRC) death rate, and CRC incidence Zauber et al. (N Engl J Med 366(8):687–96, 2012). This and other recent studies emphasize the need for high-quality colonoscopy to realize maximal benefit. Adenoma detection has emerged as an important predictor of quality colonoscopy. Studies from Europe have shown that individuals whose colonoscopy was performed by a physician with high adenoma detection have a much lower likelihood of interval CRC. Studies now suggest that it is possible to train endoscopists to improve their adenoma detection rate. The specific methods associated with higher quality colonoscopy include careful inspection behind folds, washing the colon surface, adequate insufflation, and recognition of subtle flat polyps. Use of high-definition white light colonoscopy, chromoendoscopy, and cap-fitted colonoscopy has also been studied as potential methods for increasing adenoma detection. We will review these methods and techniques in this article.
KeywordsAdenoma detection Quality colonoscopy Serrated adenomas Cap-assisted colonoscopy Mucosal imaging Chromoendoscopy
Dr. M. Wallace receives research funding from Olympus Corp (Center Valley, PA) unrelated to this work.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.•• 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(8):687-96. Epub 2012/02/24. This is a recent study in the NEJM highlighting the long-term protective effect of screening colonocopy. Google Scholar
- 2.• Merrill RM, Anderson AE. Risk-adjusted colon and rectal cancer incidence rates in the United States. Dis Colon Rectum. 2011;54(10):1301-6. Epub 2011/09/10. This is one of the best studies estimating the prevalance of colorectal cancer in the population. Google Scholar
- 3.Siegel RL, Ward EM, Jemal A. Trends in colorectal cancer incidence rates in the United States by tumor location and stage, 1992-2008. Cancer Epidemiol Biomarkers Prev. 2012;21(3):411–6. Epub 2012/01/04.Google Scholar
- 7.• Wang Y, Cangemi J, Loftus E, Picco M. Decreased risk of colorectal cancer after colonoscopy compared with flexible sigmoidoscopy or No lower endoscopy among older patients in the United States, 1998-2005. Am J Gastroenterol. 2011;106:S559. Colonoscopy is protective of right-colon cancer.CrossRefGoogle Scholar
- 11.Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on colorectal cancer, and the American College of Radiology. Gastroenterology. 2008;134(5):1570–95.PubMedCrossRefGoogle Scholar
- 13.Rex DK, Bond JH, Winawer S, et al. Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: recommendations of the U.S. Multi-Society Task Force on colorectal cancer. Am J Gastroenterol. 2002;97(6):1296–308. Epub 2002/07/04.PubMedCrossRefGoogle Scholar
- 14.•• Kaminski MF, Regula J, Kraszewska E. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med. 2010;362:1795–803. This large study clearly linked adenoma detection rate to the risk of developing interval colon cancer after screening colonoscopy.PubMedCrossRefGoogle Scholar
- 17.• Coe S, Diehl N, Wallace MB. A randomized controlled trial of an endoscopic quality improvement program (EQUIP) results in improved detection of colorectal adenomas. Am J Gastroenterol. 2011;106:s576. Adenoma detection rate can be improved using rather simple and inexpensive educational tools.Google Scholar
- 20.• Gellad ZF, Weiss DG, Ahnen DJ, et al. Colonoscopy withdrawal time and risk of neoplasia at 5 years: results from VA Cooperative Studies Program 380. Am J Gastroenterol. 2010;105(8):1746-52. Epub 2010/03/18. This study did not find an association between withdrawl time and interval colon cancer development. Google Scholar
- 24.• Teriaky A, Driman DK, Chande N. Outcomes of a 5-year follow-up of patients with sessile serrated adenomas. Scand J Gastroenterol. 2012;47(2):178-83. Epub 2012/01/11. One of the few studies about long-term outocme of sessile serrated adenomas. Google Scholar
- 27.Min YW, Lee JH, Lee SH, et al. Prevalence of proximal colon serrated polyps in a population at average risk undergoing screening colonoscopy: a multicenter study. Clin Res Hepatol Gastroenterol. 2012. doi: 10.1016/j.clinre.2011.12.016.
- 29.• Lu FI, van Niekerk de W, Owen D, et al. Longitudinal outcome study of sessile serrated adenomas of the colorectum: an increased risk for subsequent right-sided colorectal carcinoma. Am J Surg Pathol. 2010;34(7):927-34. Epub 2010/06/17. Highlights the impotance of serrated adenomas in right-sided colon cancer.Google Scholar
- 34.• Subramanian V, Mannath J, Hawkey CJ, Ragunath K. High definition colonoscopy vs. standard video endoscopy for the detection of colonic polyps: a meta-analysis. Endoscopy. 2011;43(6):499-505. Epub 2011/03/02. This provides convincing evidence for the use of chromoendoscopy in screening IBD patients. Google Scholar
- 39.Morgan J, Thomas K, Lee-Robichaud H, Nelson RL. Transparent cap colonoscopy versus standard colonoscopy for investigation of gastrointestinal tract conditions. Cochrane Database of Syst Rev. 2011;(2):CD008211. doi: 10.1002/14651858.CD008211.pub2
- 40.de Wijkerslooth TR, Stoop EM, Bossuyt PM, et al. Adenoma detection with cap-assisted colonoscopy versus regular colonoscopy: a randomised controlled trial. Gut. 2011. doi: 10.1136/gutjnl-2011-301327.
- 54.• Dinesen L, Chua TJ, Kaffes AJ. Meta-analysis of narrow-band imaging versus conventional colonoscopy for adenoma detection. Gastrointest Endosc. 2012;75(3):604-11. Epub 2012/02/22. This is the most recent meta-analysis on the use of NBI vs. white light colonoscopy for adenoma detection. Google Scholar
- 57.Rex DK, Kahi C, O'Brien M, et al. The American Society for Gastrointestinal Endoscopy PIVI (Preservation and Incorporation of Valuable Endoscopic Innovations) on real-time endoscopic assessment of the histology of diminutive colorectal polyps. Gastrointest Endosc. 2011;73(3):419–22. Mar.PubMedCrossRefGoogle Scholar