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New Colonoscopic Technologies for Colorectal Cancer Screening

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Colorectal Cancer Screening

Part of the book series: Clinical Gastroenterology ((CG))

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Abstract

Colonoscopy is an imperfect and operator-dependent technology with regard to detection of colorectal neoplasia. The evidence for operator dependency is overwhelming, and the extent of variation is alarming [1–10]. These detection problems with colonoscopy are particularly problematic, given that the technology is used for almost all colorectal cancer detection and prevention [11]. In the United States and some European countries, colonoscopy is used as a primary screening modality, and in essentially all countries it is used to evaluate other positive screening tests, including fecal occult blood testing, flexible sigmoidoscopy, barium enema, CT colonography, and in the near future serum-based markers for colorectal cancer.

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References

  1. Rex D, Cutler CS, Lemmel GT, Rahmani EY, Clark D, Helper D, et al. Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology. 1997;112:24–8.

    Article  PubMed  CAS  Google Scholar 

  2. Atkin W, Rogers P, Cardwell C, Cook C, Cuzick J, Wardle J, et al. Wide variation in adenoma detection rates at screening flexible sigmoidoscopy. Gastroenterology. 2004;126:1247–56.

    Article  PubMed  Google Scholar 

  3. Sanchez W, Harewood GC, Petersen BT. Evaluation of polyp detection in relation to procedure time of screening or surveillance colonoscopy. Am J Gastroenterol. 2004;99:1941–5.

    Article  PubMed  Google Scholar 

  4. Rex DK. Colonoscopic withdrawal technique is associated with adenoma miss rates. Gastrointest Endosc. 2000;51:33–6.

    Article  PubMed  CAS  Google Scholar 

  5. Barclay RL, Vicari JJ, Doughty AS, Johanson JF, Greenlaw RL. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med. 2006;355:2533–41.

    Article  PubMed  CAS  Google Scholar 

  6. Chen SC, Rex DK. Endoscopist can be more powerful than age and male gender in predicting adenoma detection at colonoscopy. Am J Gastroenterol. 2007;102:856–61.

    Article  PubMed  Google Scholar 

  7. Rex DK, Rahmani EY, Haseman JH, Lemmel GT, Kaster S, Buckley JS. Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice. Gastroenterology. 1997;112:17–23.

    Article  PubMed  CAS  Google Scholar 

  8. Imperiale TF, Glowinski EA, Juliar BE, Azzouz F, Ransohoff DF. Variation in polyp detection rates at screening colonoscopy. Gastrointest Endosc. 2009;69:1288–95.

    Article  PubMed  Google Scholar 

  9. Rabeneck L, Paszat LF, Saskin R. Endoscopist specialty is associated with incident colorectal cancer after a negative colonoscopy. Clin Gastroenterol Hepatol. 2010;8:275–9.

    Article  PubMed  Google Scholar 

  10. Singh H, Nugent Z, Mahmud SM, Demers AA, Bernstein CN. Predictors of colorectal cancer after negative colonoscopy: a population-based study. Am J Gastroenterol. 2010;105:663–73. quiz 674.

    Article  PubMed  Google Scholar 

  11. Rex DK, Eid E. Considerations regarding the present and future roles of colonoscopy in colorectal cancer prevention. Clin Gastroenterol Hepatol. 2008;6:506–14.

    Article  PubMed  Google Scholar 

  12. Rex DK. Narrow-band imaging without optical magnification for histologic analysis of colorectal polyps. Gastroenterology. 2009;136:1174–81.

    Article  PubMed  Google Scholar 

  13. Ignjatovic A, East J, Suzuki N, Vance M, Guenther T, Saunders B. Optical diagnosis of small colorectal polyps at routine colonoscopy (Detect InSpect ChAracterise Resect and Discard; DISCARD trial): a prospective cohort study. Lancet Oncol. 2009;10:1171–8.

    Article  PubMed  Google Scholar 

  14. Rex DK. Maximizing detection of adenomas and cancers during colonoscopy. Am J Gastroen-terol. 2006;101:2866–77.

    Article  PubMed  Google Scholar 

  15. Deenadayalu VP, Chadalawada V, Rex DK. 170 Degrees wide-angle colonoscope: effect on efficiency and miss rates. Am J Gastroenterol. 2004;99:2138–42.

    Article  PubMed  Google Scholar 

  16. Fatima H, Rex DK, Rothstein R, Rahmani E, Nehme O, Dewitt J, et al. Cecal insertion and withdrawal times with wide-angle versus standard colonoscopes: a randomized controlled trial. Clin Gastroenterol Hepatol. 2008;6:109–14.

    Article  PubMed  Google Scholar 

  17. Rex D, Chadalawada V, Helper DJ. Wide angle colonoscopy with a prototype instrument: impact on miss rates and efficiency determined by back-to-back colonoscopies. Am J Gastroen-terol. 2003;98:2000–5.

    Article  PubMed  Google Scholar 

  18. East JE, Saunders BP, Burling D, Boone D, Halligan S, Taylor SA. Surface visualization at CT colonography simulated colonoscopy: effect of varying field of view and retrograde view. Am J Gastroenterol. 2007;102:2529–35.

    Article  PubMed  Google Scholar 

  19. Horiuchi A, Nakayama Y. Improved colorectal adenoma detection with a transparent retractable extension device. Am J Gastroenterol. 2008;103:341–5.

    Article  PubMed  Google Scholar 

  20. Matsushita M, Hajiro K, Okazaki K, Takakuwa H, Tominaga M. Efficacy of total colonoscopy with a transparent cap in comparison with colonoscopy without the cap. Endoscopy. 1998;30:444–7.

    Article  PubMed  CAS  Google Scholar 

  21. Lee YT, Hui AJ, Wong VW, Hung LC, Sung JJ. Improved colonoscopy success rate with a distally attached mucosectomy cap. Endoscopy. 2006;38:739–42.

    Article  PubMed  CAS  Google Scholar 

  22. Kondo S, Yamaji Y, Watabe H, Yamada A, Sugimoto T, Ohta M, et al. A randomized controlled trial evaluating the usefulness of a transparent hood attached to the tip of the colonoscope. Am J Gastroenterol. 2007;102:75–81.

    Article  PubMed  Google Scholar 

  23. Harada Y, Hirasawa D, Fujita N, Noda Y, Kobayashi G, Ishida K, et al. Impact of a transparent hood on the performance of total colonoscopy: a randomized controlled trial. Gastrointest Endosc. 2009;69:637–44.

    Article  PubMed  Google Scholar 

  24. Lee YT, Lai LH, Hui AJ, Wong VW, Ching JY, Wong GL, et al. Efficacy of cap-assisted colonoscopy in comparison with regular colonoscopy: a randomized controlled trial. Am J Gastroenterol. 2009;104:41–6.

    Article  PubMed  Google Scholar 

  25. Dafnis GM. Technical considerations and patient comfort in total colonoscopy with and ­without a transparent cap: initial experiences from a pilot study. Endoscopy. 2000;32:381–4.

    Article  PubMed  CAS  Google Scholar 

  26. Shida T, Katsuura Y, Teramoto O, Kaiho M, Takano S, Yoshidome H, et al. Transparent hood attached to the colonoscope: does it really work for all types of colonoscopes? Surg Endosc. 2008;22:2654–8.

    Article  PubMed  Google Scholar 

  27. Tada M, Inoue H, Yabata E, Okabe S, Endo M. Feasibility of the transparent cap-fitted colonoscope for screening and mucosal resection. Dis Colon Rectum. 1997;40:618–21.

    Article  PubMed  CAS  Google Scholar 

  28. Horiuchi A, Nakayama Y, Kato N, Ichise Y, Kajiyaya M, Tanaka N. Hood-assisted colonoscopy is more effective in detection of colorectal adenomas than narrow-band imaging. Clin Gastroenterol Hepatol. 2010;8(4):379–83.

    Article  PubMed  Google Scholar 

  29. Hixson LJ, Fennerty MB, Sampliner RE, Garewal HS. Prospective blinded trial of the colonoscopic miss-rate of large colorectal polyps. Gastrointest Endosc. 1991;37:125–7.

    Article  PubMed  CAS  Google Scholar 

  30. Kaltenbach T, Friedland S, Soetikno R. A randomised tandem colonoscopy trial of narrow band imaging versus white light examination to compare neoplasia miss rates. Gut. 2008;57:1406–12.

    Article  PubMed  CAS  Google Scholar 

  31. van Rijn JC, Reitsma JB, Stoker J, Bossuyt PM, van Deventer SJ, Dekker E. Polyp miss rate determined by tandem colonoscopy: a systematic review. Am J Gastroenterol. 2006;101:343–50.

    Article  PubMed  Google Scholar 

  32. Heresbach D, Barrioz T, Lapalus MG, Coumaros D, Bauret P, Potier P, et al. Miss rate for colorectal neoplastic polyps: a prospective multicenter study of back-to-back video colonoscopies. Endoscopy. 2008;40:284–90.

    Article  PubMed  CAS  Google Scholar 

  33. Hewett DG, Rex DK. Cap-fitted colonoscopy reduces adenoma miss rates: a randomized tandem study. Gastrointest Endosc. 2010;72(4):775–81.

    Article  PubMed  Google Scholar 

  34. Waye JD, Heigh RI, Fleischer DE, Leighton JA, Gurudu S, Aldrich LB, Li J, Ramrakhiani S, Edmundowicz SA, Early DS, Jonnalagadda S, Bresalier RS, Kessler WR, Rex DK. A retrograde-viewing device improves detection of adenomas in the colon: a prospective efficacy evaluation (with videos). Gastrointest Endosc. 2010;71:551–6.

    Google Scholar 

  35. Brooker J, Saunders B, Shah S, Thapar CJ, Thomas HJ, Atkin WS, et al. Total colonic dye-spray increases the detection of diminutive adenomas during routine colonoscopy: a randomized controlled trial. Gastrointest Endosc. 2002;56:333–8.

    Article  PubMed  Google Scholar 

  36. Hurlstone DP, Cross SS, Slater R, Sanders DS, Brown S. Detecting diminutive colorectal lesions at colonoscopy: a randomised controlled trial of pan-colonic versus targeted chromoscopy. Gut. 2004;53:376–80.

    Article  PubMed  CAS  Google Scholar 

  37. Kiesslich R, von Bergh M, Hahn M, Hermann G, Jung M. Chromoendoscopy with indigocarmine improves the detection of adenomatous and nonadenomatous lesions in the colon. Endoscopy. 2001;33:1001–6.

    Article  PubMed  CAS  Google Scholar 

  38. Le Rhun M, Coron E, Parlier D, Nguyen JM, Canard JM, Alamdari A, et al. High resolution colonoscopy with chromoscopy versus standard colonoscopy for the detection of colonic neoplasia: a randomized study. Clin Gastroenterol Hepatol. 2006;4:349–54.

    Article  PubMed  Google Scholar 

  39. Rutter MD, Saunders BP, Schofield G, Forbes A, Price AB, Talbot IC. Pancolonic indigo carmine dye spraying for the detection of dysplasia in ulcerative colitis. Gut. 2004;53:256–60.

    Article  PubMed  CAS  Google Scholar 

  40. Kiesslich R, Fritsch J, Holtmann M, Koehler HH, Stolte M, Jung M, et al. Chromoendoscopy as a novel method for the detection of colitis-associated dysplasias and colon carcinoma in ulcerative colitis: results of a prospective randomised trial. Gastrointest Endosc. 2002;55:AB91.

    Google Scholar 

  41. Adler A, Pohl H, Papanikolaou IS, Abou-Rebyeh H, Schachschal G, Veltzke-Schlieker W, 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.

    Article  PubMed  CAS  Google Scholar 

  42. Adler A, Aschenbeck J, Yenerim T, Mayr M, Aminalai A, Drossel R, et al. Narrow-band versus white-light high definition television endoscopic imaging for screening colonoscopy: a prospective randomized trial. Gastroenterology. 2009;136:410–6.

    Article  PubMed  Google Scholar 

  43. Inoue T, Murano M, Murano N, Kuramoto T, Kawakami K, Abe Y, et al. Comparative study of conventional colonoscopy and pan-colonic narrow-band imaging system in the detection of neoplastic colonic polyps: a randomized, controlled trial. J Gastroenterol. 2008;43:45–50.

    Article  PubMed  Google Scholar 

  44. Paggi S, Radaelli F, Amato A, Meucci G, Mandelli G, Imperiali G, et al. The impact of narrow band imaging in screening colonoscopy: a randomized controlled trial. Clin Gastroenterol Hepatol. 2009;7:1049–54.

    Article  PubMed  Google Scholar 

  45. 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;133:42–7.

    Article  PubMed  Google Scholar 

  46. Pohl J, Lotterer E, Balzer C, Sackmann M, Schmidt KD, Gossner L, et al. Computed virtual chromoendoscopy versus standard colonoscopy with targeted indigocarmine chromoscopy: a randomised multicentre trial. Gut. 2009;58:73–8.

    Article  PubMed  CAS  Google Scholar 

  47. Hoffman A, Sar F, Goetz M, Tresch A, Mudter J, Biesterfeld S, Galle PR, Neurath MF, Kiesslich R. High definition colonoscopy combined with i-Scan is superior in the detection of colorectal neoplasias compared with standard video colonoscopy: a propective randomized controlled trial. Endoscopy. 2010;42(10):827–33.

    Article  Google Scholar 

  48. Aihara H, Sumiyama K, Saito S, Tajiri H, Ikegami M. Numerical analysis of the autofluorescence intensity of neoplastic and non-neoplastic colorectal lesions by using a novel videoendoscopy system. Gastrointest Endosc. 2009;69:726–33.

    Article  PubMed  Google Scholar 

  49. McCallum AL, Jenkins JT, Gillen D, Molloy RG. Evaluation of autofluorescence colonoscopy for the detection and diagnosis of colonic polyps. Gastrointest Endosc. 2008;68:283–90.

    Article  PubMed  Google Scholar 

  50. Winawer SJ, Zauber AG, Fletcher RH, Stillman JS, O’Brien MJ, Levin B, et al. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. Gastroenterology. 2006;130:1872–85.

    Article  PubMed  Google Scholar 

  51. Atkin WS, Saunders BP. Surveillance guidelines after removal of colorectal adenomatous polyps. Gut. 2002;51 Suppl 5:V6–9.

    Article  PubMed  Google Scholar 

  52. Kudo S, Hirota S, Nakajima T, Hosobe S, Kusaka H, Kobayashi T, et al. Colorectal tumours and pit pattern. J Clin Pathol. 1994;47:880–5.

    Article  PubMed  CAS  Google Scholar 

  53. Wada Y, Kudo SE, Kashida H, Ikehara N, Inoue H, Yamamura F, et al. Diagnosis of colorectal lesions with the magnifying narrow-band imaging system. Gastrointest Endosc. 2009;70:522–31.

    Article  PubMed  Google Scholar 

  54. Katagiri A, Fu KI, Sano Y, Ikematsu H, Horimatsu T, Kaneko K, et al. Narrow band imaging with magnifying colonoscopy as diagnostic tool for predicting histology of early colorectal neoplasia. Aliment Pharmacol Ther. 2008;27:1269–74.

    Article  PubMed  CAS  Google Scholar 

  55. Kanao H, Tanaka S, Oka S, Hirata M, Yoshida S, Chayama K. Narrow-band imaging magnification predicts the histology and invasion depth of colorectal tumors. Gastrointest Endosc. 2009;69:631–6.

    Article  PubMed  Google Scholar 

  56. East JE, Suzuki N, Saunders BP. Comparison of magnified pit pattern interpretation with narrow band imaging versus chromoendoscopy for diminutive colonic polyps: a pilot study. Gastrointest Endosc. 2007;66:310–6.

    Article  PubMed  Google Scholar 

  57. Sano Y, Ikematsu H, Fu KI, Emura F, Katagiri A, Horimatsu T, et al. Meshed capillary vessels by use of narrow-band imaging for differential diagnosis of small colorectal polyps. Gastrointest Endosc. 2009;69:278–83.

    Article  PubMed  Google Scholar 

  58. Su MY, Hsu CM, Ho YP, Chen PC, Lin CJ, Chiu CT. Comparative study of conventional colonoscopy, chromoendoscopy, and narrow-band imaging systems in differential diagnosis of neoplastic and nonneoplastic colonic polyps. Am J Gastroenterol. 2006;101:2711–6.

    Article  PubMed  Google Scholar 

  59. East JE, Suzuki N, Bassett P, Stavrinidis M, Thomas HJ, Guenther T, et al. Narrow band imaging­ with magnification for the characterization of small and diminutive colonic polyps: pit pattern and vascular pattern intensity. Endoscopy. 2008;40:811–7.

    Article  PubMed  CAS  Google Scholar 

  60. Chiu HM, Chang CY, Chen CC, Lee YC, Wu MS, Lin JT, et al. A prospective comparative study of narrow-band imaging, chromoendoscopy, and conventional colonoscopy in the diagnosis of colorectal neoplasia. Gut. 2007;56:373–9.

    Article  PubMed  Google Scholar 

  61. Tischendorf JJ, Wasmuth HE, Koch A, Hecker H, Trautwein C, Winograd R. Value of magnifying chromoendoscopy and narrow band imaging (NBI) in classifying colorectal polyps: a prospective controlled study. Endoscopy. 2007;39:1092–6.

    Article  PubMed  CAS  Google Scholar 

  62. Hirata M, Tanaka S, Oka S, Kaneko I, Yoshida S, Yoshihara M, et al. Magnifying endoscopy with narrow band imaging for diagnosis of colorectal tumors. Gastrointest Endosc. 2007;65:988–95.

    Article  PubMed  Google Scholar 

  63. Machida H, Sano Y, Hamamoto Y, Muto M, Kozu T, Tajiri H, et al. Narrow-band imaging in the diagnosis of colorectal mucosal lesions: a pilot study. Endoscopy. 2004;36:1094–8.

    Article  PubMed  CAS  Google Scholar 

  64. Rastogi A, Keighley J, Singh V, Callahan P, Bansal A, Wani S, et al. High accuracy of narrow band imaging without magnification for the real-time characterization of polyp histology and its comparison with high-definition white light colonoscopy: a prospective study. Am J Gastroenterol. 2009;104:2422–30.

    Article  PubMed  Google Scholar 

  65. Rogart JN, Jain D, Siddiqui UD, Oren T, Lim J, Jamidar P, et al. Narrow-band imaging without high magnification to differentiate polyps during real-time colonoscopy: improvement with experience. Gastrointest Endosc. 2008;68:1136–45.

    Article  PubMed  Google Scholar 

  66. Sikka S, Ringold DA, Jonnalagadda S, Banerjee B. Comparison of white light and narrow band high definition images in predicting colon polyp histology, using standard colonoscopes without optical magnification. Endoscopy. 2008;40:818–22.

    Article  PubMed  CAS  Google Scholar 

  67. Rastogi A, Pondugula K, Bansal A, Wani S, Keighley J, Sugar J, et al. Recognition of surface mucosal and vascular patterns of colon polyps by using narrow-band imaging: interobserver and intraobserver agreement and prediction of polyp histology. Gastrointest Endosc. 2009;69:716–22.

    Article  PubMed  Google Scholar 

  68. Rastogi A, Bansal A, Wani S, Callahan P, McGregor DH, Cherian R, et al. Narrow-band imaging colonoscopy – a pilot feasibility study for the detection of polyps and correlation of surface patterns with polyp histologic diagnosis. Gastrointest Endosc. 2008;67:280–6.

    Article  PubMed  Google Scholar 

  69. Pohl J, Nguyen-Tat M, Pech O, May A, Rabenstein T, Ell C. Computed virtual chromoendoscopy for classification of small colorectal lesions: a prospective comparative study. Am J Gastroenterol. 2008;103:562–9.

    Article  PubMed  Google Scholar 

  70. Hoffman A, Kagel C, Goetz M, Tresch A, Mudter J, Biesterfeld S, et al. Recognition and characterization of small colonic neoplasia with high-definition colonoscopy using I-Scan is as precise as chromoendoscopy. Dig Liver Dis. 2010;42:45–50.

    Article  PubMed  CAS  Google Scholar 

  71. Kiesslich R, Burg J, Vieth M, Gnaendiger J, Enders M, Delaney P, et al. Confocal laser endoscopy for diagnosing intraepithelial neoplasias and colorectal cancer in vivo. Gastroenterology. 2004;127:706–13.

    Article  PubMed  Google Scholar 

  72. Hurlstone DP, Baraza W, Brown S, Thomson M, Tiffin N, Cross SS. In vivo real-time confocal laser scanning endomicroscopic colonoscopy for the detection and characterization of colorectal neoplasia. Br J Surg. 2008;95:636–45.

    Article  PubMed  CAS  Google Scholar 

  73. Wang TD, Friedland S, Sahbaie P, Soetikno R, Hsiung PL, Liu JT, et al. Functional imaging of colonic mucosa with a fibered confocal microscope for real-time in vivo pathology. Clin Gastroenterol Hepatol. 2007;5:1300–5.

    Article  PubMed  Google Scholar 

  74. Sasajima K, Kudo SE, Inoue H, Takeuchi T, Kashida H, Hidaka E, et al. Real-time in vivo virtual histology of colorectal lesions when using the endocytoscopy system. Gastrointest Endosc. 2006;63:1010–7.

    Article  PubMed  Google Scholar 

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Rex, D.K. (2011). New Colonoscopic Technologies for Colorectal Cancer Screening. In: Anderson, MD, J., Kahi, MD, C. (eds) Colorectal Cancer Screening. Clinical Gastroenterology. Humana Press. https://doi.org/10.1007/978-1-60761-398-5_7

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