Impact of Wide-Angle, High-Definition Endoscopy in the Diagnosis of Colorectal Neoplasia: A Randomized Controlled Trial

Background & Aims: It is essential to optimize standard colonoscopy technique to be able to increase polyp detection. We sought to compare the performance of colonoscopy using a high-definition, wide-angle endoscope (HDE) versus a standard colonoscope (SC) for the detection of colorectal neoplasia. Patients and Methods: All consecutive consenting adult patients referred from primary care centers were included and randomly assigned at a 1:1 ratio to undergo HDE or SC. Times to reach and withdraw from the cecum were measured. Morphology, size, location, and pathologic diagnosis of each polyp were recorded. Sample size calculation resulted in a total of 682 patients needed. Results: A total of 693 consecutive patients fulfilled all inclusion criteria (73 excluded owing to insufficient bowel preparation). Each arm included 310 patients with no baseline characteristic differences. Time to reach the cecum was slightly superior for SC (8.9 ± 4.8 minutes vs 8.2 ± 4.5 minutes; P = .055). Pathology examination was feasible in 418 lesions (272 adenomas, 109 hyperplastic polyps, and 37 inflammatory lesions). Both techniques detected a similar number and type of lesions, and there were no differences in the distribution along the colon, in the degree of dysplasia, or morphology of adenomas. The per-patient basis analyses demonstrated that there were no differences between the 2 arms of the study in the detection rates of polyps (SC, 0.84 ± 1.59; HDE, 0.83 ± 1.30), adenomas (0.45 ± 1.07 vs 0.43 ± 0.87), small adenomas (0.22 ± 0.71 vs 0.28 ± 0.78), flat adenomas (0.30 ± 0.91 vs 0.21 ± 0.63), or hyperplastic polyps (0.16 ± 0.50 vs 0.18 ± 0.54). Conclusion: HDE did not detect significantly more colorectal neoplasia than SC.

Abbreviations used in this paper: CRC, colorectal cancer, HDE, high-definition endoscope, NBI, narrow-band imaging, SC, standard colonoscopy