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Su1704 Linked Color Imaging Improves Visibility of Polyps: A Colonoscopy Video Evaluation Study
Abstracts
Su1701 Development and Validation of a Simple Classification System for In Vivo Diagnosis of Colorectal Polyps Using the Newly Introduced Optical Enhancement (OE) Technology Helmut Neumann*1, Heinz Albrecht1, Silke Löffler1, Michael Vieth2, Timo Rath1, Lucia C. Fry3, Gian Eugenio Tontini4, Claudia Günther1, Klaus Monkemuller3 1 University Hospital Erlangen, Erlangen, Germany; 2Klinikum Bayreuth, Bayreuth, Germany; 3University of Alabama at Birmingham, Birmingham, AL; 4IRCCS Policlinico San Donato, Milano, Italy Introduction: Optical enhancement (OE) will be introduced at DDW 2016 as a novel endoscopic imaging technique that adjusts emitted light to enhance mucosal vascular pattern and surface pattern morphology. This study assessed for the first time the utility of OE to predict colorectal polyp histology. Aims: Primary objective was to develop and validate a simple classification system allowing differentiation of hyperplasic and adenomatous colorectal lesions by using OE. Material & Methods: In the first phase, the capacity of experienced endoscopists to predict the histology of colorectal polyps was assessed. In the second phase, a simplified classification was developed allowing histologic prediction. Thirdly, the validity of the classification was evaluated among inexperienced raters, including medical students, nurses and GI fellows. At least, a pilot clinical evaluation was performed during real-time colonoscopy. Results: A simple classification system for differentiating hyperplasic and adenomatous colorectal lesions by using OE was developed and validated. Diagnosis was made in 85% to 90% of polyps with high-confidence. Sensitivity ranged from 92% to 96% and specificity ranged from 86% to 93%, respectively. During real-time colonoscopy, diagnosis was made with high-confidence in 90% of polyps with sensitivity of 96%, specificity of 92%, and accuracy of 95%. Positive and negative predictive values were 96% and 93%, respectively. Conclusion: We developed and validated for the first time a simple and effective classification system for differentiating hyperplasic and adenomatous colorectal lesions by using the newly introduced OE-technology during real-time colonoscopy. These findings need to be evaluated in future prospective, controlled, and blinded clinical trials.
Su1702 Accuracy of the Full Spectrum Endoscopy System (FUSE) for Prediction of Colorectal Polyp Histology Helmut Neumann*1, Gian Eugenio Tontini2, Heinz Albrecht1, Michael Vieth3, Claudia Günther1, Klaus Monkemuller4 1 University Hospital Erlangen, Erlangen, Germany; 2IRCCS Policlinico San Donato, Milano, Italy; 3Klinikum Bayreuth, Bayreuth, Germany; 4 University of Alabama at Birmingham, Birmingham, AL Introduction: In contrast to other endoscopy systems, FUSE uses LEDs to illuminate the tissue, thereby potentially providing more contrast as xenon lamps which emits over a broad spectrum across the visible range. The ASGE PIVI statement proposed that a new technology should provide a negative predictive value (NPV) >90% for adenomatous polyp histology to leave distal diminutive colorectal polyps in place without resection. To our knowledge no prior study has yet evaluated the feasibility of the recently introduced FUSE system for real-time in vivo prediction of polyp histology. Aims: Prospective assessment of real-time prediction of colorectal polyps by using the FUSE system. Material & Methods: Consecutive patients undergoing screening or surveillance colonoscopy were included. Colorectal lesions were evaluated in real-time by using the FUSE system. Before resection, the endoscopist described each polyp according to size, shape and surface characteristics (pit and vascular pattern, color, depression) and histology was predicted with a level of confidence (high or low). Results: The histology was predicted with high-confidence in 87.6% of polyps. The overall accuracy for prediction of adenomatous polyp histology was 95.6% with sensitivity, specificity, positive and negative predictive value of 97.8%, 87.5%, 96.7%, and 91.3%, respectively. When the prediction was made with high-confidence, the accuracy was 96.9%. Sensitivity, specificity, positive and negative predictive values were 98.8%, 89.5%, 97.5%, and 94.4%, respectively. Conclusion: The FUSE system is accurate enough for in vivo prediction of colorectal polyp histology. These findings need to be evaluated in future prospective, controlled, and blinded clinical trials.
Su1703 Surveillance Colonoscopy Using Magnification Without Removal for Minute Adenoma - Based on the Concept of Semi-Clean Colon Yuki Ninomiya*1, Shinji Tanaka1, Shiro Oka1, Kyoku Sumimoto2, Daiki Hirano2, Yuzuru Tamaru2, Naoki Asayama2, Kenjiro Shigita2, Nana Hayashi1, Taiji Matsuo1, Kazuaki Chayama2 1 Endoscopy, Hiroshima University Hospital, Hiroshima, Japan; 2 Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan Background: According to National Polyp Study, colorectal cancer was prevented by colonoscopic removal of all adenomatous polyps. Magnifying observation (pit pattern classification) makes it possible to diagnose histopathological features of colorectal lesions precisely. The Aim of this study was to evaluate the usefulness of
AB402 GASTROINTESTINAL ENDOSCOPY Volume 83, No. 5S : 2016
surveillance colonoscopy (SC) using magnification without removal for minute (&5 mm) adenomas. Patients and Methods: Seven hundred and six patients who underwent 4,353 total colonoscopies at our institution between January 2005 and December 2014 were enrolled in this study. The patients had colorectal minute polypoid or flat adenomas during an initial total colonoscopy. All colorectal lesions were carried out using chromo (indigo carmine)-magnification. Depressed lesions or lesions with type V pit pattern were resected in all cases regardless of size. The patients were followed-up more than 5 years. We defined an “index lesion” in this study as carcinoma in any size and adenoma S6mm in size. We classified the patients into 2 groups: Group A, patients who had the index lesions during SC; Group B, patients who did not have index lesion in SC. We compared two groups regarding the age, sex, rate of using low dose aspirin (LDA), number of lesions and the existence of cancer in the initial colonoscopy. In addition, we investigate the characteristics of the metachronous cancers during SC. Results: The average observation period was 81 16 months. The number of Group A was 70 (9.9%) and Group B was 636 (90.1%). There was no significant difference in patients’ characteristics between the 2 groups. The number of the lesions (1/2/3&) in initial colonoscopy was 12/18/ 40 in Group A and 255/174/207 in Group B, respectively. The number of the initial polyps was significantly related to the prevalence of the index lesions (P< 0.05). The number of patients who had cancer in initial colonoscopy was 12 in Group A and 43 in Group B. The index lesions occurred more frequently in the patients with cancer than those with adenoma in the initial colonoscopy (P< 0.05). Annual rate of the index lesion prevalence was 1.5 %/year. Regarding to 9 cancers in Group A, average size was 10 7 mm, location (right colon/ left colon/ rectum) was 4/4/1, macroscopic type (protruded/ superficial) was 5/4, histology (Tis/ T1) was 8/1 and average duration until the occurrence was 6130 months. Three metachronous cancers were detected during SC within 5 years after initial colonoscopy. Three of 9 cancers were recognized to be grown up from minute adenomas, and the others were considered as missed lesions during SC. All cancers were resected endoscopically without any complications. Conclusion: Based on our long-term data, minute adenomas, observed using magnification, are not necessarily for removal. Also, SC should be carried out 5 years after an initial colonoscopy.
Su1704 Linked Color Imaging Improves Visibility of Polyps: A Colonoscopy Video Evaluation Study Kiyoshi Ogiso*1, Naohisa Yoshida1, Takaaki Murakami1, Ryohei Hirose1, Osamu Dohi1, Kazuhiro Kamada1, Kazuhiko Uchiyama1, Osamu Handa1, Hideyuki Konishi1, Yuji Naito1, Akio Yanagisawa2, Yoshito Itoh1 1 Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan; 2Pathology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan Background & Purpose: A laser endoscopic system (Fujifilm Co, Tokyo, Japan) enables us to perform blue laser imaging (BLI). We previously proved BLI could improve polyp visibility (Yoshida N et al. Gastrointest Endosc 2015). Linked Color Imaging (LCI) recently has been developed for diagnosis of chronic gastritis with the laser endoscopic system. LCI is a kind of narrow band imaging and brighter than BLI. It can enhance the mucosal structure and vessel of the colorectum. In this study, we aimed to investigate whether LCI can improve the visibility of colorectal polyps compared to white light (WL) using prospectively recorded videos. Material and Method: We recorded videos of consecutive polyps found during colonoscopy (from April 2015 to November 2015) in Kyoto Prefectural University of Medicine. Two videos were captured for each polyp, one with LCI and one with WL. All polyps were positioned at the midpoint of the video (5 cm proximal and 5 cm distal to a polyp). The videos were evaluated in a randomized order by 4 endoscopists (2 experts and 2 non-experts) according to an original polyp visibility score from 4 (excellent visibility) to 1 (poor visibility). The study was approved by the institutional review board and the ethics committees of Kyoto Prefectural University of Medicine. Results: We studied 48 colorectal polyps in total (35 neoplastic and 13 non-neoplastic). There were 28 polyps in the right-sided colon. The mean polyp size was 8.7 mm (range: 230mm) and 20 polyps were protruding. The mean visibility score of LCI was significantly higher than that of WL (3.170.88 vs 2.651.05, PZ0.0003). With regard to endoscopist’s experience, the mean visibility scores of LCI were significantly higher than those of WL in both expert and non-expert (LCI vs WL: expert: 3.22 0.89 vs 2.68 1.08, PZ0.0096, non-expert: 3.12 0.88 vs 2.62 1.03, PZ0.0133). The mean visibility scores in terms of various clinical characteristics including location, size, histopathological diagnosis, and morphology were analyzed. The visibility scores of LCI were significantly higher than those of WL for right-sided colon polyp group (3.050.89 vs 2.480.96, PZ0.0017), <10mm polyp group (3.210.85 vs 2.581.03, PZ0.0004), neoplastic polyp group (3.380.81 vs 2.801.06, PZ0.0004), and any morphology (both protruding and non-protruding polyp groups) (3.300.81 vs 2.801.05, PZ0.0215, 3.080.93 vs 2.551.05, PZ0.0055). On the other hand, there were no significant differences for the left-sided colon and rectum polyp group (3.350.85 vs 2.901.13, PZ0.0514), 10 mm polyp group (3.110.93 vs 2.771.08, PZ0.1727), and non-neoplastic polyp group (2.610.83 vs 2.260.94, PZ0.17). Conclusion: Our study showed that polyps were more visible under LCI compared to WL in experts and non-experts. More studies should be done to determine whether LCI can improve polyp detection rate.
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Su1701 Development and Validation of a Simple Classification System for In Vivo Diagnosis of Colorectal Polyps Using the Newly Introduced Optical Enhancement (OE) Technology Helmut Neumann*1, Heinz Albrecht1, Silke Löffler1, Michael Vieth2, Timo Rath1, Lucia C. Fry3, Gian Eugenio Tontini4, Claudia Günther1, Klaus Monkemuller3 1 University Hospital Erlangen, Erlangen, Germany; 2Klinikum Bayreuth, Bayreuth, Germany; 3University of Alabama at Birmingham, Birmingham, AL; 4IRCCS Policlinico San Donato, Milano, Italy Introduction: Optical enhancement (OE) will be introduced at DDW 2016 as a novel endoscopic imaging technique that adjusts emitted light to enhance mucosal vascular pattern and surface pattern morphology. This study assessed for the first time the utility of OE to predict colorectal polyp histology. Aims: Primary objective was to develop and validate a simple classification system allowing differentiation of hyperplasic and adenomatous colorectal lesions by using OE. Material & Methods: In the first phase, the capacity of experienced endoscopists to predict the histology of colorectal polyps was assessed. In the second phase, a simplified classification was developed allowing histologic prediction. Thirdly, the validity of the classification was evaluated among inexperienced raters, including medical students, nurses and GI fellows. At least, a pilot clinical evaluation was performed during real-time colonoscopy. Results: A simple classification system for differentiating hyperplasic and adenomatous colorectal lesions by using OE was developed and validated. Diagnosis was made in 85% to 90% of polyps with high-confidence. Sensitivity ranged from 92% to 96% and specificity ranged from 86% to 93%, respectively. During real-time colonoscopy, diagnosis was made with high-confidence in 90% of polyps with sensitivity of 96%, specificity of 92%, and accuracy of 95%. Positive and negative predictive values were 96% and 93%, respectively. Conclusion: We developed and validated for the first time a simple and effective classification system for differentiating hyperplasic and adenomatous colorectal lesions by using the newly introduced OE-technology during real-time colonoscopy. These findings need to be evaluated in future prospective, controlled, and blinded clinical trials.
Su1702 Accuracy of the Full Spectrum Endoscopy System (FUSE) for Prediction of Colorectal Polyp Histology Helmut Neumann*1, Gian Eugenio Tontini2, Heinz Albrecht1, Michael Vieth3, Claudia Günther1, Klaus Monkemuller4 1 University Hospital Erlangen, Erlangen, Germany; 2IRCCS Policlinico San Donato, Milano, Italy; 3Klinikum Bayreuth, Bayreuth, Germany; 4 University of Alabama at Birmingham, Birmingham, AL Introduction: In contrast to other endoscopy systems, FUSE uses LEDs to illuminate the tissue, thereby potentially providing more contrast as xenon lamps which emits over a broad spectrum across the visible range. The ASGE PIVI statement proposed that a new technology should provide a negative predictive value (NPV) >90% for adenomatous polyp histology to leave distal diminutive colorectal polyps in place without resection. To our knowledge no prior study has yet evaluated the feasibility of the recently introduced FUSE system for real-time in vivo prediction of polyp histology. Aims: Prospective assessment of real-time prediction of colorectal polyps by using the FUSE system. Material & Methods: Consecutive patients undergoing screening or surveillance colonoscopy were included. Colorectal lesions were evaluated in real-time by using the FUSE system. Before resection, the endoscopist described each polyp according to size, shape and surface characteristics (pit and vascular pattern, color, depression) and histology was predicted with a level of confidence (high or low). Results: The histology was predicted with high-confidence in 87.6% of polyps. The overall accuracy for prediction of adenomatous polyp histology was 95.6% with sensitivity, specificity, positive and negative predictive value of 97.8%, 87.5%, 96.7%, and 91.3%, respectively. When the prediction was made with high-confidence, the accuracy was 96.9%. Sensitivity, specificity, positive and negative predictive values were 98.8%, 89.5%, 97.5%, and 94.4%, respectively. Conclusion: The FUSE system is accurate enough for in vivo prediction of colorectal polyp histology. These findings need to be evaluated in future prospective, controlled, and blinded clinical trials.
Su1703 Surveillance Colonoscopy Using Magnification Without Removal for Minute Adenoma - Based on the Concept of Semi-Clean Colon Yuki Ninomiya*1, Shinji Tanaka1, Shiro Oka1, Kyoku Sumimoto2, Daiki Hirano2, Yuzuru Tamaru2, Naoki Asayama2, Kenjiro Shigita2, Nana Hayashi1, Taiji Matsuo1, Kazuaki Chayama2 1 Endoscopy, Hiroshima University Hospital, Hiroshima, Japan; 2 Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan Background: According to National Polyp Study, colorectal cancer was prevented by colonoscopic removal of all adenomatous polyps. Magnifying observation (pit pattern classification) makes it possible to diagnose histopathological features of colorectal lesions precisely. The Aim of this study was to evaluate the usefulness of
AB402 GASTROINTESTINAL ENDOSCOPY Volume 83, No. 5S : 2016
surveillance colonoscopy (SC) using magnification without removal for minute (&5 mm) adenomas. Patients and Methods: Seven hundred and six patients who underwent 4,353 total colonoscopies at our institution between January 2005 and December 2014 were enrolled in this study. The patients had colorectal minute polypoid or flat adenomas during an initial total colonoscopy. All colorectal lesions were carried out using chromo (indigo carmine)-magnification. Depressed lesions or lesions with type V pit pattern were resected in all cases regardless of size. The patients were followed-up more than 5 years. We defined an “index lesion” in this study as carcinoma in any size and adenoma S6mm in size. We classified the patients into 2 groups: Group A, patients who had the index lesions during SC; Group B, patients who did not have index lesion in SC. We compared two groups regarding the age, sex, rate of using low dose aspirin (LDA), number of lesions and the existence of cancer in the initial colonoscopy. In addition, we investigate the characteristics of the metachronous cancers during SC. Results: The average observation period was 81 16 months. The number of Group A was 70 (9.9%) and Group B was 636 (90.1%). There was no significant difference in patients’ characteristics between the 2 groups. The number of the lesions (1/2/3&) in initial colonoscopy was 12/18/ 40 in Group A and 255/174/207 in Group B, respectively. The number of the initial polyps was significantly related to the prevalence of the index lesions (P< 0.05). The number of patients who had cancer in initial colonoscopy was 12 in Group A and 43 in Group B. The index lesions occurred more frequently in the patients with cancer than those with adenoma in the initial colonoscopy (P< 0.05). Annual rate of the index lesion prevalence was 1.5 %/year. Regarding to 9 cancers in Group A, average size was 10 7 mm, location (right colon/ left colon/ rectum) was 4/4/1, macroscopic type (protruded/ superficial) was 5/4, histology (Tis/ T1) was 8/1 and average duration until the occurrence was 6130 months. Three metachronous cancers were detected during SC within 5 years after initial colonoscopy. Three of 9 cancers were recognized to be grown up from minute adenomas, and the others were considered as missed lesions during SC. All cancers were resected endoscopically without any complications. Conclusion: Based on our long-term data, minute adenomas, observed using magnification, are not necessarily for removal. Also, SC should be carried out 5 years after an initial colonoscopy.
Su1704 Linked Color Imaging Improves Visibility of Polyps: A Colonoscopy Video Evaluation Study Kiyoshi Ogiso*1, Naohisa Yoshida1, Takaaki Murakami1, Ryohei Hirose1, Osamu Dohi1, Kazuhiro Kamada1, Kazuhiko Uchiyama1, Osamu Handa1, Hideyuki Konishi1, Yuji Naito1, Akio Yanagisawa2, Yoshito Itoh1 1 Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan; 2Pathology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan Background & Purpose: A laser endoscopic system (Fujifilm Co, Tokyo, Japan) enables us to perform blue laser imaging (BLI). We previously proved BLI could improve polyp visibility (Yoshida N et al. Gastrointest Endosc 2015). Linked Color Imaging (LCI) recently has been developed for diagnosis of chronic gastritis with the laser endoscopic system. LCI is a kind of narrow band imaging and brighter than BLI. It can enhance the mucosal structure and vessel of the colorectum. In this study, we aimed to investigate whether LCI can improve the visibility of colorectal polyps compared to white light (WL) using prospectively recorded videos. Material and Method: We recorded videos of consecutive polyps found during colonoscopy (from April 2015 to November 2015) in Kyoto Prefectural University of Medicine. Two videos were captured for each polyp, one with LCI and one with WL. All polyps were positioned at the midpoint of the video (5 cm proximal and 5 cm distal to a polyp). The videos were evaluated in a randomized order by 4 endoscopists (2 experts and 2 non-experts) according to an original polyp visibility score from 4 (excellent visibility) to 1 (poor visibility). The study was approved by the institutional review board and the ethics committees of Kyoto Prefectural University of Medicine. Results: We studied 48 colorectal polyps in total (35 neoplastic and 13 non-neoplastic). There were 28 polyps in the right-sided colon. The mean polyp size was 8.7 mm (range: 230mm) and 20 polyps were protruding. The mean visibility score of LCI was significantly higher than that of WL (3.170.88 vs 2.651.05, PZ0.0003). With regard to endoscopist’s experience, the mean visibility scores of LCI were significantly higher than those of WL in both expert and non-expert (LCI vs WL: expert: 3.22 0.89 vs 2.68 1.08, PZ0.0096, non-expert: 3.12 0.88 vs 2.62 1.03, PZ0.0133). The mean visibility scores in terms of various clinical characteristics including location, size, histopathological diagnosis, and morphology were analyzed. The visibility scores of LCI were significantly higher than those of WL for right-sided colon polyp group (3.050.89 vs 2.480.96, PZ0.0017), <10mm polyp group (3.210.85 vs 2.581.03, PZ0.0004), neoplastic polyp group (3.380.81 vs 2.801.06, PZ0.0004), and any morphology (both protruding and non-protruding polyp groups) (3.300.81 vs 2.801.05, PZ0.0215, 3.080.93 vs 2.551.05, PZ0.0055). On the other hand, there were no significant differences for the left-sided colon and rectum polyp group (3.350.85 vs 2.901.13, PZ0.0514), 10 mm polyp group (3.110.93 vs 2.771.08, PZ0.1727), and non-neoplastic polyp group (2.610.83 vs 2.260.94, PZ0.17). Conclusion: Our study showed that polyps were more visible under LCI compared to WL in experts and non-experts. More studies should be done to determine whether LCI can improve polyp detection rate.
www.giejournal.org