title: Use of wide-screen, high-definition monitors for improving adenoma detection: A prospective, randomized, controlled trial.
abstract: OBJECTIVE
  Colonoscopy is sensitive at detecting large polyps; however, a significant polyp miss rate is still recognized. Indicators such as the adenoma detection rate (ADR) and, more recently, the adenoma per colonoscopy rate (APC) are increasingly used to ensure quality in colonoscopy. We carried out a prospective, randomized, controlled study evaluating improvement in adenoma detection between wide-screen, high-definition (WSHD) monitors compared to standard monitors (SD).
  
  
  METHODS
  Patients undergoing screening or surveillance colonoscopy were randomized to a WSHD room or SD. Polyp size, location, shape, and histology were recorded. Right-sided polyps were considered to be those proximal to the splenic flexure.
  
  
  RESULTS
  A total of 152 patients were enrolled in the study, with 78 (51.3%) and 74 (48.7%) enrolled in the WSHD and SD groups, respectively. A 10% absolute difference in favor of the WSHD group was noted for the ADR (41% vs 31% patients); however, the difference was statistically not significant. In the WSHD and SD groups, APC of 0.9 ± 1.4 versus 0.7 ± 1.4 (P = 0.49) were noted, respectively. For polyps <5 mm, an ADR of 0.3 ± 0.4 versus 0.2 ± 0.4 (P = 0.34) and APC of 0.5 ± 1.1 versus 0.2 ± 0.5 (P = 0.06) were seen in the WSHD and SD groups.
  
  
  CONCLUSIONS
  This study shows a trend toward improvement in ADR, with an increase in APC for small adenomas that approaches statistical significance. WSHD monitors are a one-time, low-cost intervention for improving the quality of colonoscopy with potentially favorable outcomes.
authors.affiliation: Division of Gastroenterology, Advocate Lutheran General Hospital, Park Ridge, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Mills
authors.affiliation: Department of Medicine, Advocate Lutheran General Hospital, Park Ridge, USA.
authors.forename: Tilemahos
authors.initials: T
authors.lastname: Spyratos
authors.affiliation: Department of Medicine, Advocate Lutheran General Hospital, Park Ridge, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Haider
authors.affiliation: James R. & Helen D. Russell Institute for Research & Innovation, Advocate Health Care, Downers Grove, USA.
authors.forename: Suela
authors.initials: S
authors.lastname: Sulo
authors.affiliation: Division of Gastroenterology, Advocate Lutheran General Hospital, Park Ridge, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Laurie
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000601:surgery*; D000368:Aged; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D003113:Colonoscopy / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D016896:Treatment Outcome