Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Oct 7, 2012; 18(37): 5231-5239
Published online Oct 7, 2012. doi: 10.3748/wjg.v18.i37.5231
High-definition colonoscopy with i-Scan: Better diagnosis for small polyps and flat adenomas
Pier Alberto Testoni, Chiara Notaristefano, Cristian Vailati, Milena Di Leo, Edi Viale
Pier Alberto Testoni, Chiara Notaristefano, Cristian Vailati, Milena Di Leo, Edi Viale, Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, 20132 Milan, Italy
Author contributions: Testoni PA was responsible for the conception and design; Notaristefano C, Di Leo M and Vailati C contributed to the analysis and interpretation of the data; Testoni PA and Notaristefano C drafted the article; Testoni PA and Viale E contributed to critical revision of the article for important intellectual content; Testoni PA and Viale E contributed to final approval of the article.
Correspondence to: Pier Alberto Testoni, MD, Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Via Olgettina 60, 20132 Milan, Italy. testoni.pieralberto@hsr.it
Telephone: +39-2-26432756 Fax: +39-2-26435609
Received: February 27, 2012
Revised: May 2, 2012
Accepted: May 5, 2012
Published online: October 7, 2012
Abstract

AIM: To investigate if high-definition (HD) colonoscope with i-Scan gave a higher detection rate of mucosal lesions vs standard white-light instruments.

METHODS: Data were collected from the computerized database of the endoscopy unit of our tertiary referral center. We retrospectively analyzed 1101 consecutive colonoscopies that were performed over 1 year with standard white-light (n = 849) or HD+ with i-Scan (n = 252) instruments by four endoscopists, in an outpatient setting. Colonoscopy records included patients’ main details and family history for colorectal cancer, indication for colonoscopy (screening, diagnostic or surveillance), type of instrument used (standard white-light or HD+ plus i-Scan), name of endoscopist and bowel preparation. Records for each procedure included whether the cecum was reached or not and the reason for failure, complications during or immediately after the procedure, and number, size, location and characteristics of the lesions. Polyps or protruding lesions were defined as sessile or pedunculated, and nonprotruding lesions were defined according to Paris classification. For each lesion, histological diagnosis was recorded.

RESULTS: Eight hundred and forty-nine colonoscopies were carried with the standard white-light video colonoscope and 252 with the HD+ plus i-Scan video colonoscope. The four endoscopists did 264, 300, 276 and 261 procedures, respectively; 21.6%, 24.0%, 21.7% and 24.1% of them with the HD+ plus i-Scan technique. There were no significant differences between the four endoscopists in either the number of procedures done or the proportions of each imaging technique used. Both techniques detected one or more mucosal lesions in 522/1101 procedures (47.4%). The overall number of lesions recognized was 1266; 645 in the right colon and 621 in the left. A significantly higher number of colonoscopies recognized lesions in the HD+ plus i-Scan mode (171/252 = 67.9%) than with the standard white-light technique (408/849 = 48.1%) (P < 0.0001). HD+ with i-Scan colonoscopies identified more lesions than standard white-light imaging (459/252 and 807/849, P < 0.0001), in the right or left colon (mean ± SD, 1.62 ± 1.36 vs 1.33 ± 0.73, P < 0.003 and 1.55 ± 0.98 vs 1.17 ± 0.93, P = 0.033), more lesions < 10 mm (P < 0.0001) or nonprotruding (P < 0.022), and flat polyps (P = 0.04). The cumulative mean number of lesions per procedure detected by the four endoscopists was significantly higher with HD+ with i-Scan than with standard white-light imaging (1.82 ± 2.89 vs 0.95 ± 1.35, P < 0.0001).

CONCLUSION: HD imaging with i-Scan during the withdrawal phase of colonoscopy significantly increased the detection of colonic mucosal lesions, particularly small and nonprotruding polyps.

Keywords: Colonoscopy; High-definition+ with i-Scan colonoscopy; White-light colonoscopy; Colonic polyps; Nonprotruding lesions; Adenoma detection rate; Withdrawal time; Surface enhancement; Contrast enhancement; Tone enhancement