Post written by Satimai Aniwan, MD, from the Gastrointestinal Endoscopy Excellence Center, Division of Gastroenterology, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Colonoscopy primarily aims to detect and remove colorectal adenomas, which is a precancerous lesion. Most postcolonoscopy colorectal cancer is attributed to the missed lesion at the previous colonoscopy. To overcome the limitation of standard colonoscopy, linked color-imaging (LCI) technology could enhance subtly colored polyp surfaces while mucosal exposure devices (EAC) could detect polyps behind the colonic fold.
This study was the first study to evaluate the impact of a combination of image enhancement and mucosal exposure on improving adenoma detection. A total of 1000 screening colonoscopies were randomized in ratios of 1:1:1:1 to the control arms; LCI+EAC, EAC alone, or LCI alone were performed by endoscopists with a recorded adenoma detection rate (ADR) ≥35%.
The results highlight that the use of 2 different techniques together can provide a synergistic benefit of the 2 mechanisms (image enhancement and mucosal exposure). Compared with the other 3 methods, the combination of LCI and EAC yielded the highest detection rates of adenoma (57.2%) and proximal adenoma (38.4%) and number of adenomas per colonoscopy (1.28). We concluded that the combination of LCI and EAC can significantly improve the detection of proximal adenomas and adenomas per colonoscopy but not ADR by high-ADR performers.
Figure 2. A, Endoscopic imaging of adenoma detected by the combination of linked color imaging (LCI) and Endocuff-assisted colonoscopy (EAC). B, LCI alone. C, EAC alone. D, Standard high-definition colonoscopy.
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