Gastroenterology

Gastroenterology

Volume 140, Issue 7, June 2011, Pages 1887-1894
Gastroenterology

Imaging and Advanced Technology
Endoscopic Trimodal Imaging Detects Colonic Neoplasia as Well as Standard Video Endoscopy

https://doi.org/10.1053/j.gastro.2011.03.008Get rights and content

Background & Aims

Endoscopic trimodal imaging (ETMI) is a novel endoscopic technique that combines high-resolution endoscopy (HRE), autofluorescence imaging (AFI), and narrow-band imaging (NBI) that has only been studied in academic settings. We performed a randomized, controlled trial in a nonacademic setting to compare ETMI with standard video endoscopy (SVE) in the detection and differentiation of colorectal lesions.

Methods

The study included 234 patients scheduled to receive colonoscopy who were randomly assigned to undergo a colonoscopy in tandem with either ETMI or SVE. In the ETMI group (n = 118), first examination was performed using HRE, followed by AFI. In the other group, both examinations were performed using SVE (n = 116). In the ETMI group, detected lesions were differentiated using AFI and NBI.

Results

In the ETMI group, 87 adenomas were detected in the first examination (with HRE), and then 34 adenomas were detected during second inspection (with AFI). In the SVE group, 79 adenomas were detected during the first inspection, and then 33 adenomas were detected during the second inspection. Adenoma detection rates did not differ significantly between the 2 groups (ETMI: 1.03 vs SVE: 0.97, P = .360). The adenoma miss-rate was 29% for HRE and 28% for SVE. The sensitivity, specificity, and accuracy of NBI in differentiating adenomas from nonadenomatous lesions were 87%, 63%, and 75%, respectively; corresponding values for AFI were 90%, 37%, and 62%, respectively.

Conclusions

In a nonacademic setting, ETMI did not improve the detection rate for adenomas compared with SVE. NBI and AFI each differentiated colonic lesions with high levels of sensitivity but low levels of specificity.

Section snippets

Patients

This study was performed in 6 nonacademic centers in the Amsterdam region, and patients scheduled for colonoscopy in 1 of the centers were screened for participation. Inclusion criteria were as follows: age > 18 years, surveillance because of a history of adenomatous polyps, a history of CRC for which a partial colectomy was performed, hereditary nonpolyposis colorectal cancer, or patients with a positive family history for CRC according to the revised Bethesda criteria.14 Exclusion criteria

Patient Characteristics

Between July 2007 and February 2010, 258 patients gave informed consent and underwent colonoscopy of which 24 were excluded; 15 patients were excluded because of poor bowel preparation, 6 because of technically difficult and painful colonoscopy, 2 because of a mechanical obstruction, and 1 because of bradycardia (Figure 1).

Out of the 234 included patients, 118 underwent colonoscopy in the ETMI group and 116 in the SVE group. The average insertion time was 10.02 minutes (range, 1.19–35.15

Discussion

The current study reports on the potential of ETMI in the detection of adenomas compared with SVE in a nonacademic setting. Many endoscopic studies on advanced imaging of the colon are performed in tertiary centers, and there is a need to ascertain whether these new imaging techniques improve detection and differentiation of colonic lesions in the community and nonspecialized settings.8, 10, 12, 13, 21, 22, 23, 24, 25, 26 Our results demonstrate that ETMI did not improve adenoma detection rate

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    Conflicts of interest The authors disclose the following: Teaco Kuiper: unrestricted grant from Olympus Medical. Frank J.C. van den Broek: unrestricted grant from Olympus Medical. Jacques J.G.H.M. Bergman: unrestricted grants from Astra Zeneca, Olympus Medical, Cook Medical. The remaining authors disclose no conflicts.

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