Autofluorescence imaging with a transparent hood for detection of colorectal neoplasms: a prospective, randomized trial.

BACKGROUND

Colonoscopy is one of the most reliable methods for detection of colorectal neoplasms, but conventional colonoscopy can miss some lesions.

OBJECTIVE

To evaluate the efficacy of autofluorescence imaging (AFI) with a transparent hood (TH) for detection of colorectal neoplasms.

DESIGN

A 2 × 2 factorial designed, prospective, randomized, controlled trial.

SETTING

This study was conducted at the Osaka Medical Center for Cancer and Cardiovascular Diseases, a tertiary cancer center.

PATIENTS

A total of 561 patients.

INTERVENTIONS

Patients were allocated to 1 of 4 groups: (1) white light imaging (WLI) alone--colonoscopy using WLI without a TH; (2) WLI+TH--colonoscopy using WLI with a TH; (3) AFI alone--colonoscopy using AFI without a TH; and (4) AFI+TH--colonoscopy using AFI with a TH. Eight colonoscopists used each allocated method.

MAIN OUTCOME MEASUREMENT

The difference in neoplasm detection rate (number of detected neoplasms per patient) between the WLI alone and AFI+TH groups.

RESULTS

Neoplasm detection rate (95% confidence interval) in the AFI+TH group was significantly higher than in the WLI alone group (1.96 [1.50-2.43] vs 1.19 [0.93-1.44]; P = .023, Tukey-Kramer multiple comparison test). Relative detection ratios (95% confidence interval) for polypoid neoplasms based on Poisson regression model were significantly increased by mounting a TH (1.69 [1.34-2.12], P < .001), and relative detection ratios for flat neoplasms were significantly increased by AFI observation (1.83 [1.24-2.71], P = .002).

LIMITATIONS

Open trial performed in single cancer referral center.

CONCLUSION

AFI colonoscopy with a TH detected significantly more colorectal neoplasms than did conventional WLI colonoscopy without a TH.