Sehgal Abhinav, Aggarwal Soorya, Mandaliya Rohan, Loughney Thomas, Mattar Mark C
Department of Gastroenterology, Georgetown University School of Medicine, Washington, DC 20007, United States.
Division of Gastroenterology, MedStar Georgetown University Hospital, Washington, DC 20007, United States.
World J Gastrointest Endosc. 2022 Apr 16;14(4):226-234. doi: 10.4253/wjge.v14.i4.226.
Sessile serrated adenomas (SSAs) are important premalignant lesions that are difficult to detect during colonoscopy due to poor definition, concealment by mucous caps, and flat appearance. High definition (HD) colonoscopy may uniquely aid in the detection of these inconspicuous lesions compared to standard definition (SD) colonoscopes. In the absence of existing clinical guidelines to obligate the use of HD colonoscopy for colorectal cancer screening in average-risk patients, demonstrating the benefit of HD colonoscopy on SSA detection rate (SSADR) may help strengthen the evidence to recommend its use in all settings.
To evaluate the benefit of HD colonoscopy compared to SD colonoscopy on SSADR in average-risk patients undergoing screening colonoscopy.
Data from screening colonoscopies for patients aged 50-76 years two years before and two years after the transition from SD colonoscopy to HD colonoscopy at our large, academic teaching center were collected. Patients with symptoms of colorectal disease, positive occult blood test, history of colon polyps, cancer, polyposis syndrome, inflammatory bowel disease or family history of colon cancer or polyps were excluded. Patients whose endoscopists did not perform colonoscopies both before and after scope definition change were also excluded. Differences in individual endoscopist SSADR, average SSADR, and overall SSADR with SD colonoscopy HD colonoscopy were also evaluated for significance.
A total of 3657 colonoscopies met eligibility criteria with 2012 colonoscopies from the SD colonoscopy period and 1645 colonoscopies from the HD colonoscopy period from a pool of 11 endoscopists. Statistically significant improvements of 2.30% in mean SSADR and 2.53% in overall SSADR were noted with HD colonoscopy ( = 0.00028 and = 0.00849, respectively). On the individual level, three endoscopists experienced statistically significant benefit with HD colonoscopy (+5.74%, = 0.0056; +4.50%, = 0.0278; +4.84%, = 0.03486).
Our study suggests that HD colonoscopy statistically significantly improves sessile serrated adenoma detection rate in the screening of average risk patients during screening colonoscopy. By improving the detection and removal of these lesions, adoption of HD colonoscopy may reduce the significant premalignant burden of sessile serrated adenomas.
无蒂锯齿状腺瘤（SSA）是重要的癌前病变，由于边界不清、被黏液帽遮盖以及外观扁平，在结肠镜检查时难以发现。与标准清晰度（SD）结肠镜相比，高清晰度（HD）结肠镜可能在检测这些不明显病变方面具有独特优势。在缺乏现有临床指南要求在平均风险患者的结直肠癌筛查中使用HD结肠镜的情况下，证明HD结肠镜对SSA检出率（SSADR）的益处可能有助于加强在所有情况下推荐使用它的证据。
评估在接受筛查结肠镜检查的平均风险患者中，与SD结肠镜相比，HD结肠镜对SSADR的益处。
收集了在我们大型学术教学中心从SD结肠镜过渡到HD结肠镜之前两年和之后两年，年龄在50 - 76岁患者的筛查结肠镜检查数据。排除有结直肠疾病症状、潜血试验阳性、结肠息肉病史、癌症、息肉病综合征、炎症性肠病或结肠癌或息肉家族史的患者。还排除内镜医师在结肠镜清晰度改变前后均未进行结肠镜检查的患者。还评估了个体内镜医师的SSADR、平均SSADR以及SD结肠镜与HD结肠镜的总体SSADR差异的显著性。
共有3657例结肠镜检查符合纳入标准，其中来自SD结肠镜检查时期的有2012例，来自HD结肠镜检查时期的有1645例，涉及11位内镜医师。HD结肠镜检查时，平均SSADR有2.30%的统计学显著改善，总体SSADR有2.53%的统计学显著改善（分别为 = 0.00028和 = 0.00849）。在个体层面，三位内镜医师在使用HD结肠镜检查时获得了统计学显著益处（分别提高了5.74%， = 0.0056；4.50%， = 0.0278；4.84%， = 0.03486）。
我们的研究表明，在筛查结肠镜检查中，HD结肠镜在统计学上显著提高了平均风险患者筛查时无蒂锯齿状腺瘤的检出率。通过改善这些病变的检测和切除，采用HD结肠镜可能会减轻无蒂锯齿状腺瘤的重大癌前负担。
