High-definition endoscopy with digital chromoendoscopy for histologic prediction of distal colorectal polyps.
BACKGROUND
Distal diminutive colorectal polyps are common and accurate endoscopic prediction of hyperplastic or adenomatous polyp histology could reduce procedural time, costs and potential risks associated with the resection. Within this study we assessed whether digital chromoendoscopy can accurately predict the histology of distal diminutive colorectal polyps according to the ASGE PIVI statement.


METHODS
In this prospective cohort study, 224 consecutive patients undergoing screening or surveillance colonoscopy were included. Real time histology of 121 diminutive distal colorectal polyps was evaluated using high-definition endoscopy with digital chromoendoscopy and the accuracy of predicting histology with digital chromoendoscopy was assessed.


RESULTS
The overall accuracy of digital chromoendoscopy for prediction of adenomatous polyp histology was 90.1 %. Sensitivity, specificity, positive and negative predictive values were 93.3, 88.7, 88.7, and 93.2 %, respectively. In high-confidence predictions, the accuracy increased to 96.3 % while sensitivity, specificity, positive and negative predictive values were calculated as 98.1, 94.4, 94.5, and 98.1 %, respectively. Surveillance intervals with digital chromoendoscopy were correctly predicted with >90 % accuracy.


CONCLUSIONS
High-definition endoscopy in combination with digital chromoendoscopy allowed real-time in vivo prediction of distal colorectal polyp histology and is accurate enough to leave distal colorectal polyps in place without resection or to resect and discard them without pathologic assessment. This approach has the potential to reduce costs and risks associated with the redundant removal of diminutive colorectal polyps.


BACKGROUND
ClinicalTrials NCT02217449.
Interdisciplinary Endoscopy, Department of Medicine I, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
Timo
T
Rath
Interdisciplinary Endoscopy, Department of Medicine I, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
Gian E
GE
Tontini
Interdisciplinary Endoscopy, Department of Medicine I, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
Andreas
A
Nägel
Institute of Pathology, Klinikum Bayreuth, Bayreuth, Germany.
Michael
M
Vieth
Interdisciplinary Endoscopy, Department of Medicine I, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
Steffen
S
Zopf
Interdisciplinary Endoscopy, Department of Medicine I, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
Claudia
C
Günther
Department of Medicine II, HSK Wiesbaden, Wiesbaden, Germany.
Arthur
A
Hoffman
Interdisciplinary Endoscopy, Department of Medicine I, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
Markus F
MF
Neurath
Interdisciplinary Endoscopy, Department of Medicine I, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany. helmut.neumann@uk-erlangen.de.
Helmut
H
Neumann
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000473:pathology; D003113:Colonoscopy / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000175:diagnosis; D007089:Image Enhancement / Q000379:methods*; D007417:Intestinal Polyps / Q000191:economics / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D061848:Optical Imaging / Q000379:methods* / Q000706:statistics & numerical data; D011159:Population Surveillance / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult