Source: DGNews  |  Posted 2 years ago

By Bruce Sylvester

SAN DIEGO -- October 28, 2009 -- High-definition colonoscopy helps clinicians
detect significantly more adenomas than standard white-light colonoscopy,
researchers stated here October 26 at the American College of Gastroenterology
(ACG) 74th Annual Scientific Meeting.

“We had the opportunity to perform a ‘natural experiment’ as our facility
changed over from standard to high-definition equipment,” said Kenneth DeVault,
MD, Mayo Clinic, Jacksonville, Florida.

He noted that while the clinic decided to upgrade its equipment, the facility
didn’t have the funding to do a complete upgrade, leaving 3 colonoscopy suites
with standard equipment and another 3 with the new equipment.

Dr. DeVault said this provided the opportunity to see if the new equipment
actually improved detection rates because the clinicians had no controls of
whether they were assigned the new devices or the older devices.

The study involved 2,011 patients, 823 of whom were assigned to high-definition
colonoscopy. Dr. DeVault said that the adenoma detection rate among the
patients who were treated with high-definition equipment was 29% compared with
24% of the people who underwent colonoscopy with standard white-light group
(P = .018).

“Improving adenoma detection rates during colonoscopy is one of the important
measures of quality of colonoscopy,” he said. “We want to provide the best
detection with the best equipment the healthcare system will allow.”

Doctors using the Olympus 180 high-definition device detected small polyps (0-5
mm) in 20% of the patients while doctors using the standard white-light Olympus
140-160 series equipment found these small lesions in about 17% of patients
(P = .048).

Lesions 6 to 9 mm in size were also detected more often with the
high-definition devices -- 7% of the time -- compared with 5% detection of
these lesions with standard equipment (P < .05). Both devices
detected larger lesions (>= 10 mm) with the same frequency, about 7% of the
time.

The retrospective study reviewed outcomes among patients who underwent
screening, surveillance and diagnostic colonoscopies between September 2006 and
August 2007, Dr. DeVault said.

He said that the analysis of the detection rates appears to rule out learning
effects. “Over the course of the study, adenoma detection rates for standard
detection equipment have not changed after exposure to high-definition
equipment, suggesting no learning effect.” Dr. DeVault said.

Presentation title: Does the High Definition Imaging Induce a Learning
Effect in Clinical Practice? A Comparison of High Definition White Light
Colonoscopy and Standard Definition Colonoscopy for Adenoma Detection in 2011
Patients. Abstract 60