title: High definition plus colonoscopy combined with i-scan tone enhancement vs. high definition colonoscopy for colorectal neoplasia: A randomized trial.
abstract: BACKGROUND
  High definition endoscopy is the accepted standard in colonoscopy. However, an important problem is missed polyps.
  
  
  OBJECTIVE
  Our objective was to assess the additional adenoma detection rate between high definition colonoscopy with tone enhancement (digital chromoendoscopy) vs. white light high definition colonoscopy.
  
  
  METHODS
  In this prospective randomized trial patients were included to undergo a tandem colonoscopy. The first exam was a white light colonoscopy with removal of all visualized polyps. The second examination was randomly assigned in a 1:1 ratio as either again white light colonoscopy (Group A) or colonoscopy with tone enhancement (Group B). Primary endpoint was the adenoma detection rate during the second withdrawal (sample size calculation - 40 per group).
  
  
  RESULTS
  67 lesions (Group A: n=34 vs. Group B: n=33) in 80 patients (mean age 61 years, male 64%) were identified on the first colonoscopy. The second colonoscopy detected 78 additional lesions: n=60 with tone enhancement vs. n=18 with white light endoscopy (p<0.001). Tone enhancement found more additional adenomas (A n=20 vs. B n=6, p=0.006) and identified significantly more missed adenomas per subject (0.5 vs. 0.15, p=0.006).
  
  
  CONCLUSIONS
  High definition plus colonoscopy with tone enhancement detected more adenomas missed by white light colonoscopy.
authors.affiliation: St. Mary's Hospital, Department of Medicine, Frankfurt, Germany; 1. Medical Department, Johannes Gutenberg University Mainz, Germany. Electronic address: ahoff66286@aol.com.
authors.forename: Arthur
authors.initials: A
authors.lastname: Hoffman
authors.affiliation: St. Mary's Hospital, Department of Medicine, Frankfurt, Germany.
authors.forename: Linn
authors.initials: L
authors.lastname: Loth
authors.affiliation: St. Mary's Hospital, Department of Medicine, Frankfurt, Germany; 1. Medical Department, Johannes Gutenberg University Mainz, Germany.
authors.forename: Johannes Wilhelm
authors.initials: JW
authors.lastname: Rey
authors.affiliation: St. Mary's Hospital, Department of Medicine, Frankfurt, Germany.
authors.forename: Fareed
authors.initials: F
authors.lastname: Rahman
authors.affiliation: 1. Medical Department, Johannes Gutenberg University Mainz, Germany; 1. Medical Department, University of Tübingen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Goetz
authors.affiliation: Institute of Pathology, Johannes Gutenberg University Mainz, Germany; Clinic Lippe, Institute of Pathology, Detmold, Germany.
authors.forename: Torsten
authors.initials: T
authors.lastname: Hansen
authors.affiliation: Max Planck Institute, Cologne, Germany.
authors.forename: Achim
authors.initials: A
authors.lastname: Tresch
authors.affiliation: Gene Zentrum Ludwig-Maximilians-Universität München, Germany.
authors.forename: Theresa
authors.initials: T
authors.lastname: Niederberger
authors.affiliation: 1. Medical Department, Johannes Gutenberg University Mainz, Germany.
authors.forename: Peter Robert
authors.initials: PR
authors.lastname: Galle
authors.affiliation: St. Mary's Hospital, Department of Medicine, Frankfurt, Germany; 1. Medical Department, Johannes Gutenberg University Mainz, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Kiesslich
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000601:surgery; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D005858:Germany; D006785:Hospitals, University; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted; D018709:Statistics, Nonparametric
keywords: Adenoma detection rate; Adenoma miss rate; I-scan technique; Red flag technology