Neoplasms

All Conditions

Digestive System Diseases

Symptoms and General Pathology

Adenoma

Colonic Neoplasms

Polyps

Colorectal Neoplasms

Intestinal Neoplasms

Gastrointestinal Neoplasms

Digestive System Neoplasms

Gastrointestinal Diseases

Colonic Diseases

Intestinal Diseases

Herbal and Botanical

All Drugs and Chemicals

Cola

Narrow band imaging

Wai Keung Leung, MD

Although colonoscopy is considered the gold standard for diagnosis of colonic polyps, the missed rate for colonic adenoma ranged from 15-32%. In particular, missed colonic polyps in the right side colon have been suggested to be the cause for interval cancer that developed after a prior negative colonoscopy.

Different endoscopic image enhanced modules like the narrow band imaging (NBI) have been developed to improve colonic polyp detection. However, it remains controversial whether the previous version of NBI helps to improve colonic polyp detection. The new generation colonoscope is equipped with high definition and improved narrow band imaging (NBI) which gives at least twice the viewable distance and contrast. The images obtained are far brighter with better resolution than the previous version. It however remains to be determined whether this enhanced imaging technique could help to improve colonic polyps detection.

Hypothesis:

The new generation NBI increases the detection rate of proximal serrated polyps and reduces the missed rate of all colorectal polyps.

Aims:

* To determine whether the new generation NBI improve the detection rate of proximal serrated polyps.
* To determine whether the new generation NBI improve the detection rate of all colorectal adenoma and polyps.
* To determine whether the new generation NBI reduce the miss rate of colorectal adenoma and polyps.

Design:

Prospective randomized trial

Inclusion:

• All patients scheduled to have screening or scheduled colonoscopy

Exclusion:

* History of Crohn's or ulcerative colitis
* Surveillance for known polyposis syndrome (FAP or HNPCC)
* Previous colonic resection (except appendectomy)
* Refused consent
* Deranged coagulation profile that preclude polypectomy

Narrow Band Imaging for Diagnosis of Proximal Serrated Polyps

Colonoscopy With Narrow Band Imaging for Diagnosis of Proximal Serrated Polyps

No. of patients with proximal serrated polyps

Missing rate for proximal serrated polyps

The University of Hong Kong

Clinical Professor

Neoplasms, Glandular and Epithelial

Neoplasms by Histologic Type

Participants are randomised to undergo first either with Endocuff or cap assisted colonoscopy during colonoscopy.

It is a randomised back to back study to compare cap and Endocuff to detect adenoma in colonoscopic examination

Endocuff

cap assisted colonoscopy (CAC)

Brian P Saunders, MD

A randomised back to back study comparing cap and Endocuff to detect adenomas during colonoscopy

It is a randomised back to back study to compare the performance of cap assisted colonoscopy (CAC) and Endocuff assisted colonoscopy (EAC)

Detection in Tandem Endocuff Cap Trial

Is Endocuff Vision Assisted Colonoscopy Superior to Cap Assisted Colonoscopy to Detect Adenomas

To compare any surveillance interval difference between CAC and EAC

Comparison of adenoma miss rate between cap ( CAC) and Endocuff assisted colonoscopy(E

Difference in mean adenomas detected per procedure (MAP) between EAC and CAC.

Number of times Cap or Endocuff are removed to complete the procedure

Comparison of caecal intubation and withdrawal time

Comparison of miss rates of advanced adenomas, serrated polyps and proxima polyps between CAC and EAC

Comparison of patient comfort score between CAC and EAC

London North West Healthcare NHS Trust

Rectal Diseases

Participants will be evaluated by same endoscopist, back-to-back tandem colonoscopy. It consists of two withdrawal from the cecum to sigmoid colon using firstly High Definition White Light Endoscopy (WLE) and secondly Narrow Band Imaging (NBI). All detected polyps will be classified macroscopically and resected in each withdrawal.

Participants will be evaluated by same endoscopist, back-to-back tandem colonoscopy. It consists of two withdrawal from the cecum to sigmoid colon using firstly Narrow Band Imaging (NBI) and secondly High Definition White Light Endoscopy (WLE). All detected polyps will be classified macroscopically and resected in each withdrawal.

Withdrawal from cecum to sigmoid colon with Narrow Band Imaging (NBI, Evis Exera III, Olympus)

Withdrawal from cecum to sigmoid colon with High Definition White Light Endoscopy (WLE)

Fausto Riu, MD

This study is designed to evaluate the utility of Narrow Band Imaging (NBI) compared with High Definition White Light colonoscopy (WLE) in subjects with serrated lesions who do not fulfill the diagnostic criteria of Serrated Polyposis Syndrome (SPS).

Colorectal cancer (CRC) is the second leading cause of cancer death in western countries. Conventional polyps were considered the precursor lesions of all cases of sporadic colon cancer. Recently, serrated lesions and especially the Sessile Serrated Adenoma (SSA), are responsible of interval CRC between 20% to 35% of all CRC cases. These polyps are difficult to identify at endoscopy because they are located in the right colon, they are sessile or flat morphology and are pale color with mucus capping.

According to the WHO, SPS is defined with one of the following criteria: (1) at least 5 serrated polyps proximal to the sigmoid colon, 2 of which are greater than 10 mm in diameter; (2) any number of serrated polyps occurring proximal to the sigmoid colon in an individual who has a first-degree relative with serrated polyposis; or (3) more than 20 serrated polyps of any size distributed throughout the colon. Therefore, patients with SPS are considered to be at increased risk of CRC. Considering the substantial risk of polyp recurrence, it is mandatory to follow up an annual surveillance.

Narrow-Band Imaging (NBI, Olympus) selectively uses certain wavelengths of the visible light leading to a shift in the excitation spectrum towards blue light. Blood vessels will appear dark, allowing an improved visibility and identification of the surface and vascular structures. In contrast to conventional chromoendoscopy, it is easily activated by pressing a button on the endoscope. A pilot study in patients with SPS showed significantly lower polyp miss rate with NBI compared with WLE. Furthermore, the European Society of Gastrointestinal Endoscopy (ESGE) has recently published the first Guideline of Advanced Endoscopic Imaging for the detection and differentiation of colorectal neoplasia and recommends conventional chromoendoscopy or NBI in patients with SPS (strong recommendation, low quality evidence).

The hypothesis is that NBI could improve the detection rate of serrated polyps compared with WLE in patients who do not accomplish the SPS criteria.

The investigators will perform a randomised, cross-over trial of tandem colonoscopy using NBI and WLE. The main goal is to compare the rate of detected polyps between both techniques and, if it is necessary, reassessing the diagnosis for an appropriate surveillance interval.

Study of Narrow Band Imaging in the Characterization of Serrated Lesions

Randomised Tandem Colonoscopy of Narrow Band Imaging (NBI) and White Light Endoscopy in Patients With Serrated Lesions

Efficacy of NBI in detecting serrated polyps compared with WLE

Compare the number of missed lesions on the index examination based on the colonoscopy findings (NBI and WLE)

Accuracy in detecting adenomas endoscopically compared with histopathology (gold standard)

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Narrow Band Imaging for Diagnosis of Proximal Serrated Polyps	NCT01725321	Colonic Neoplas...	Narrow band ima...	40 Years -	The University of Hong Kong
Detection in Tandem Endocuff Cap Trial	NCT03254498	Colonic Neoplas... Adenomas Serrat... Colo-rectal Can... Colon Adenoma	Endocuff cap assisted co...	18 Years - 90 Years	London North West Healthcare NHS Trust
Study of Narrow Band Imaging in the Characterization of Serrated Lesions	NCT02406547	Serrated Polyps Sessile Serrate... Colorectal Neop...	NBI WLE	50 Years -	Parc de Salut Mar

Spots Global Cancer Trial Database for serrated polyps