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Prospective, randomized, back-to-back trial evaluating the usefulness of i-SCAN in screening colonoscopy.

Abstract：

BACKGROUND:The newly developed i-SCAN application can theoretically maximize the effectiveness of colonoscopy. However, the practical usefulness of the i-SCAN application during screening colonoscopy has not been assessed. OBJECTIVE:To assess the efficacy of the i-SCAN application during screening colonoscopy. DESIGN:A prospective, randomized trial that used a modified, back-to-back colonoscopy. SETTING:Academic hospital. PATIENTS:This study involved 389 asymptomatic, consecutive, average-risk patients who underwent screening colonoscopy. INTERVENTION:The patients were randomized to the first withdrawal with either conventional high-definition white light (HDWL group; n = 119), i-SCAN contrast/surface enhancement (CE/SE) mode (i-SCAN1 group; n = 115), or i-SCAN CE/SE/tone enhancement-colorectal mode (i-SCAN2 group; n = 118). All patients underwent a second examination with HDWL as the criterion standard. MAIN OUTCOME MEASUREMENTS:The primary outcome measurement was the adenoma detection rate and adenoma miss rate. The secondary outcome measurement was the accuracy of the histologic prediction of neoplastic and nonneoplastic polyps. RESULTS:The adenoma detection rates during the first withdrawal of HDWL, i-SCAN1, and i-SCAN2 were 31.9%, 36.5%, and 33.1%, respectively (P = .742), and the adenoma miss rates of each group were 22.9%, 19.3%, and 15.9%, respectively (P = .513). Based on the multivariate analysis, the application of i-SCAN was not associated with an improvement in adenoma detection and the prevention of missed polyps. However, the prediction of neoplastic and nonneoplastic colorectal lesions was more precise in the i-SCAN2 group compared with the HDWL group (accuracy 79.3% vs 75.5%, P = .029; sensitivity 86.5% vs 72.6%, P = .020; and specificity 91.4% vs 80.6%, P = .040). LIMITATIONS:Single-center trial. CONCLUSION:i-SCAN during the screening colonoscopy may fail to improve adenoma detection and the prevention of missed polyps, but i-SCAN appears to be effective for real-time histologic prediction of polyps compared with conventional HDWL colonoscopy. ( CLINICAL TRIAL REGISTRATION NUMBER:NCT01417611.).

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Hong SN,Choe WH,Lee JH,Kim SI,Kim JH,Lee TY,Kim JH,Lee SY,Cheon YK,Sung IK,Park HS,Shim CS

doi

10.1016/j.gie.2011.11.040

subject

Has Abstract

pub_date

2012-05-01 00:00:00

pages

1011-1021.e2

issue

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(11)02499-0

journal_volume

pub_type

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Prospective, randomized, back-to-back trial evaluating the usefulness of i-SCAN in screening colonoscopy.