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]
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