title: A comparison of high definition-image enhanced colonoscopy and standard white-light colonoscopy for colorectal polyp detection.
abstract: OBJECTIVE
  Colonoscopy is widely used to detect and remove precancerous polyps, but fails to detect some polyps. Recent studies evaluating different image-enhanced methods have revealed conflicting results. The efficacy of colonoscopy imaging with simultaneous use of commercially available improvements, including high definition narrow band imaging (HD-NBI), and monochromatic charge-coupled device (CCD) video, was compared with a widely used standard definition white light (SDWL) colonoscopy system for detecting colorectal polyps. The primary aim was to determine whether the combination of image-enhanced colonoscopy systems resulted in fewer missed polyps compared with conventional colonoscopy.
  
  
  METHODS
  In a randomized controlled trial (Clinicaltrials.gov. study number NCT00825292) patients having routine screening and surveillance underwent tandem colonoscopies with SDWL and image-enhanced (HD-NBI) colonoscopy. The main outcome measurement was the per-polyp false-negative ("miss") rate. Secondary outcomes were adenoma miss rate, and per-patient polyp and adenoma miss rates.
  
  
  RESULTS
  100 patients were randomized and 96 were included in the analysis. In total, 177 polyps were detected; of these, 72 (41 %) were adenomatous. Polyp and adenoma miss rates for SDWL colonoscopy were 57 % (60/105) and 49 % (19/39); those for image-enhanced colonoscopy were 31 % (22/72) and 27 % (9/33) (P = 0.005 and P = 0.036 for polyps and adenomas, respectively). Image-enhanced and SDWL approaches had similar per-patient miss rates for polyps (6/35 vs. 9/32, P = 0.27) and adenomas (4/22 vs. 8/20, P = 0.11).
  
  
  CONCLUSIONS
  Utilization of multiple recent improvements in image-enhanced colonoscopy was associated with a reduced miss rate for all polyps and for adenomatous polyps. It is not known which individual feature or combination of image-enhancement features led to the improvement.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida 32224, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Gross
authors.forename: A M
authors.initials: AM
authors.lastname: Buchner
authors.forename: J E
authors.initials: JE
authors.lastname: Crook
authors.forename: J R
authors.initials: JR
authors.lastname: Cangemi
authors.forename: M F
authors.initials: MF
authors.lastname: Picco
authors.forename: H C
authors.initials: HC
authors.lastname: Wolfsen
authors.forename: K R
authors.initials: KR
authors.lastname: DeVault
authors.forename: D S
authors.initials: DS
authors.lastname: Loeb
authors.forename: M
authors.initials: M
authors.lastname: Raimondo
authors.forename: T A
authors.initials: TA
authors.lastname: Woodward
authors.forename: M B
authors.initials: MB
authors.lastname: Wallace
mesh_terms: D000368:Aged; D003111:Colonic Polyps / Q000175:diagnosis*; D003113:Colonoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000175:diagnosis