Skip to main content
SpringerLink
Log in

Trimodal endoscopic imaging for the detection and differentiation of colorectal adenomas: a prospective single-centre clinical evaluation

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study is to evaluate an endoscopic trimodal imaging (ETMI) system (high resolution, autofluorescence, and NBI) in the detection and differentiation of colorectal adenomas.

Methods

A prospective randomised trial of tandem colonoscopies was carried out using the Olympus XCF-FH260AZI system. Each colonic segment was examined twice for lesions, once with HRE and once with AFI, in random order per patient. All detected lesions were assessed with NBI for pit pattern and with AFI for colour. All lesions were removed and sent for histology. Any lesion identified on the second examination was considered as missed by the first examination. Outcome measures are adenoma miss rates of AFI and HRE, and diagnostic accuracy of NBI and AFI for differentiating neoplastic from non-neoplastic lesions.

Results

Ninety-four patients underwent colonoscopy with ETMI (47 in each group). Among 47 patients examined with AFI first, 31 adenomas in 15 patients were detected initially [detection rate 0.66 (0.52–0.75)]. Subsequent HRE inspection identified six additional adenomas. Among 47 patients examined with HRE first, 29 adenomas in 14 patients were detected initially [detection rate 0.62 (0.53–0.79)]. Successive AFI yielded seven additional adenomas. Adenoma miss rates of AFI and HRE were 14% and 16.2%, respectively (p = 0.29). Accuracy of AFI alone for differentiation was lower than NBI (63% vs. 80%, p < 0.001). Combined use of AFI and NBI achieved improved accuracy for differentiation (84%), showing a trend for superiority compared with NBI alone (p = 0.064).

Conclusions

AFI did not significantly reduce the adenoma miss rate compared with HRE. AFI alone had a disappointing accuracy for adenoma differentiation, which could be improved by combination of AFI and NBI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Jemal A, Siegel R, Ward E et al (2008) Cancer statistics, 2008. CA Cancer J Clin 58:71–96

    Article  PubMed  Google Scholar 

  2. Ferlay J, Parkin DM, Steliarova-Foucher E (2010) Estimates of cancer incidence and mortality in Europe in 2008. Eur J Cancer 46:765–781

    Article  PubMed  CAS  Google Scholar 

  3. Baxter NN, Goldwasser MA, Paszat LF et al (2009) Association of colonoscopy and death from colorectal cancer. Ann Intern Med 150:1–8

    PubMed  Google Scholar 

  4. Heresbach D, Barrioz T, Lapalus MG et al (2008) Miss rate for colorectal neoplastic polyps: a prospective multicenter study of back-to-back video colonoscopies. Endoscopy 40:284–290

    Article  PubMed  CAS  Google Scholar 

  5. Le Rhun M, Coron E, Parlier D et al (2006) High resolution colonoscopy with chromoscopy versus standard colonoscopy for the detection of colonic neoplasia: a randomized study. Clin Gastroenterol Hepatol 4:349–354

    Article  PubMed  Google Scholar 

  6. Rex DK, Helbig CC (2007) High yields of small and flat adenomas with high definition colonoscopes using either white light or narrow band imaging. Gastroenterology 133:42–47

    Article  PubMed  Google Scholar 

  7. Kaltenbach T, Friedland S, Soetikno R (2008) A randomised tandem colonoscopy trial of narrow band imaging versus white light examination to compare neoplasia miss rates. Gut 57:1406–1412

    Article  PubMed  CAS  Google Scholar 

  8. Adler A, Aschenbeck J, Yenerim T et al (2009) Narrow-band versus white-light high definition television endoscopic imaging for screening colonoscopy: a prospective randomized trial. Gastroenterology 136:410–416

    Article  PubMed  Google Scholar 

  9. Kahi CJ, Anderson JC, Waxman I et al (2010) High-definition chromocolonoscopy vs. high-definition white light colonoscopy for average-risk colorectal cancer screening. Am J Gastroenterol 105:1301–1307

    Article  PubMed  Google Scholar 

  10. Bianco MA, Rotondano G, Marmo R et al (2006) Predictive value of magnification chromoendoscopy for diagnosing invasive neoplasia in nonpolypoid colorectal lesions and stratifying patients for endoscopic resection or surgery. Endoscopy 38:470–476

    Article  PubMed  CAS  Google Scholar 

  11. Rex DK (2009) Narrow-band imaging without optical magnification for histologic analysis of colorectal polyps. Gastroenterology 136:1174–1181

    Article  PubMed  Google Scholar 

  12. Paggi S, Radaelli F, Amato A et al (2009) The impact of narrow band imaging in screening colonoscopy: a randomized controlled trial. Clin Gastroenterol Hepatol 7:1049–1054

    Article  PubMed  Google Scholar 

  13. Falk GW (2009) Autofluorescence endoscopy. Gastrointest Endosc Clin N Am 19:209–220

    Article  PubMed  Google Scholar 

  14. Endoscopic Classification Review Group (2005) Update on the Paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy 37:570–578

    Article  Google Scholar 

  15. Kudo S, Rubio CA, Teixeira CR et al (2001) Pit pattern in colorectal neoplasia: endoscopic magnifying view. Endoscopy 33:367–373

    PubMed  CAS  Google Scholar 

  16. Dixon MF (2002) Gastrointestinal epithelial neoplasia: Vienna revisited. Gut 51:130–131

    Article  PubMed  CAS  Google Scholar 

  17. Brown SR, Baraza W (2010) Chromoscopy versus conventional endoscopy for the detection of polyps in the colon and rectum. Cochrane Database Syst Rev 10:CD006439

    PubMed  Google Scholar 

  18. ASGE Report on Emerging Technology (2011) Autofluorescence imaging. Gastrointest Endosc 73:647–650

    Article  Google Scholar 

  19. van den Broek FJ, Fockens P, van Eeden S et al (2008) Endoscopic tri-modal imaging for surveillance in ulcerative colitis: randomised comparison of high-resolution endoscopy and autofluorescence imaging for neoplasia detection; and evaluation of narrow-band imaging for classification of lesions. Gut 57:1083–1089

    Article  PubMed  Google Scholar 

  20. Boparai KS, van den Broek FJ, van Eeden S et al (2009) Hyperplastic polyposis syndrome: a pilot study for the differentiation of polyps by using high-resolution endoscopy, autofluorescence imaging, and narrow-band imaging. Gastrointest Endosc 70:947–955

    Article  PubMed  Google Scholar 

  21. Matsumoto T, Esaki M, Fujisawa R et al (2009) Chromoendoscopy, narrow-band imaging colonoscopy, and autofluorescence colonoscopy for detection of diminutive colorectal neoplasia in familial adenomatous polyposis. Dis Colon Rectum 52:1160–1165

    Article  PubMed  Google Scholar 

  22. Ramsoekh D, Haringsma J, Poley JW et al (2010) A back-to-back comparison of white light video endoscopy with autofluorescence endoscopy for adenoma detection in high-risk subjects. Gut 59:785–793

    Article  PubMed  Google Scholar 

  23. Matsuda T, Saito Y, Fu KI et al (2008) Does autofluorescence imaging videoendoscopy system improve the colonoscopic polyp detection rate? A pilot study. Am J Gastroenterol 103:1926–1932

    Article  PubMed  Google Scholar 

  24. Takeuchi Y, Inoue T, Hanaoka N et al (2010) Autofluorescence imaging with a transparent hood for detection of colorectal neoplasms: a prospective, randomized trial. Gastrointest Endosc 72:1006–1013

    Article  PubMed  Google Scholar 

  25. Inoue K, Wakabayashi N, Morimoto Y et al (2010) Evaluation of autofluorescence colonoscopy for diagnosis of superficial colorectal neoplastic lesions. Int J Colorectal Dis 25:811–816

    Article  PubMed  Google Scholar 

  26. van den Broek FJ, Fockens P, Van Eeden S et al (2009) Clinical evaluation of endoscopic trimodal imaging for the detection and differentiation of colonic polyps. Clin Gastroenterol Hepatol 7:288–295

    Article  PubMed  Google Scholar 

  27. van den Broek FJ, van Soest EJ, Naber AH et al (2009) Combining autofluorescence imaging and narrow-band imaging for the differentiation of adenomas from non-neoplastic colonic polyps among experienced and non-experienced endoscopists. Am J Gastroenterol 104:1498–1507

    Article  PubMed  Google Scholar 

  28. Kuiper T, van Den Broek FJ, Naber AH et al (2011) Endoscopic trimodal imaging detects colonic neoplasia as well as standard video endoscopy. Gastroenterology 140:1887–1894

    Article  PubMed  Google Scholar 

  29. Ignjatovic A, East JE, Suzuki N et al (2009) Optical diagnosis of small colorectal polyps at routine colonoscopy (Detect InSpect ChAracterise Resect and Discard; DISCARD trial): a prospective cohort study. Lancet Oncol 10:1171–1178

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Division of Gastroenterology, ASL NA3sud—Ospedale Maresca, Torre del Greco, Italy

    Gianluca Rotondano, Maria Antonia Bianco, Stefano Sansone, Antonio Prisco, Costantino Meucci, Maria Lucia Garofano & Livio Cipolletta

  2. Via Cappella Vecchia 8, 80121, Naples, Italy

    Gianluca Rotondano

Authors
  1. Gianluca Rotondano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maria Antonia Bianco
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stefano Sansone
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Antonio Prisco
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Costantino Meucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maria Lucia Garofano
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Livio Cipolletta
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gianluca Rotondano.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rotondano, G., Bianco, M.A., Sansone, S. et al. Trimodal endoscopic imaging for the detection and differentiation of colorectal adenomas: a prospective single-centre clinical evaluation. Int J Colorectal Dis 27, 331–336 (2012). https://doi.org/10.1007/s00384-011-1312-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-011-1312-7

Keywords

Search

Navigation