The endoscopists in this study were experts, with many colonoscopies behind them and on their current schedules, and adequate experience with HD+ plus i-Scan imaging in Crenolanib side effects the year leading up to the study. In addition, we compared the numbers of colonic lesions recognized by the same endoscopist using the two techniques, thus applying similar expertise and technique, in a similar clinical setting, and found that the four endoscopists using HD+ plus i-Scan imaging detected cumulatively more lesions. Only one other study comparing the diagnostic yield for colonic polyps using standard white-light and HD+ colonoscopy followed a retrospective design, with an adequate number of unselected patients undergoing colonoscopy in routine practice. The findings confirmed the greater accuracy for detecting polyps of HD imaging compared with white light (42.
2% vs 37.8%)[20]. In our hands, 67.8% and 27.8% of colonoscopies with HD+ plus i-Scan recognized some mucosal lesions and flat small polyps (< 10 mm), respectively, compared to 48.1% and 9.9% for standard white-light imaging. HD+ plus i-Scan thus gave an approximately 30% higher diagnostic yield for mucosal lesions of the colon and increased by three times the diagnostic accuracy for flat polyps smaller than 10 mm. In conclusion, this retrospective study on a large series of consecutive outpatients undergoing colonoscopy in different settings by four expert endoscopists showed that the routine addition of i-Scan to HD imaging during the entire withdrawal phase of colonoscopy, once the cecum had been reached, significantly increased the diagnostic yield for detection of mucosal lesions of the colon, particularly small and nonprotruding ones, without affecting the withdrawal time.
In colon cancer screening, the routine use of HD+ plus i-Scan can recognize more mucosal lesions without the need to prolong the withdrawal time to allow for closer inspection, as suggested in other studies, and could probably enable less-skilled endoscopists to achieve performances comparable to those of experienced ones in detecting colonic polyps. COMMENTS Background Screening colonoscopy is widely considered the gold standard for detection of colonic neoplasia and adenomatous lesions, however, there are several reports of failure to detect small and flat neoplastic lesions, meaning that in these cases, colonoscopy does not provide adequate protection against colorectal cancer.
Besides the operator��s experience, withdrawal time, quality of colon cleansing, presence of blind segments in the colon, and quality of imaging provided by endoscopes play an important role in lesion detection. Standard white-light imaging may be unable to recognize some small or flat lesions, which are particularly frequent in the AV-951 right colon, and it may affect the polyp miss rate during routine colonoscopy.