High-resolution colonoscopy and chromoendoscopy for classifying colonic polyps: A multicenter study

C. Y. Kim, D. E. Fleischer, R. A. Kozarek, D. L. Carr-Locke, T. C M Li, C. J. Gostout, S. J. Heller, E. A. Montgomery, F. H. Al-Kawas, M. I. Avigan, G. M. Eisen, J. H. Lewis, S. B. Benjamin

Research output: Contribution to journalArticle

Abstract

Background: Visual, non-biopsy techniques for predicting histology of diminutive colorectal polyps have not proven reliable. We recently reported using an affordable conventional high-resolution colonoscope (HRC), the Fujinon EC-200LR, in combination with indigo carmine dye (ICD) for the diagnosis of small polyps. The sensitivity of our technique in distinguishing adenomatous from non-adenomatous polyps was 96%, and the negative predictive value was 96%. We now report on preliminary results of our five center trial (4 academic GI units and 1 primary care practice). Methods: Complete colonoscopy or flexible sigmoidoscopy using the Fujinon 200 series scopes (EC-200LR or ES-200ER) was performed in patients with polyps. All polyps <10mm were sprayed with 0.8% ICD. Histologic diagnosis was predicted based on the polyps's surface architecture ("pits" = hyperplastic (HP), "sulci" = adenomatous (AP)). All polyps were removed. Polyps seen and stained on flexible sigmoidoscopy were removed on a followup colonoscopy. Results: 120 polyps w/a mean diameter of 4.6mm were evaluated from 68 pts. 10 polyps were excluded because no prediction could be made. Actual Histology Predicted Histo:AP Predicted Histo:HP Diag Accuracy AP (N=42) 42 1 98% HP (N=39) 7 34 83% OT (N=25)* 4 22 NA * OT (Other) = colonic mucosa or lymphoid aggregate When attempting to separate AP from non-AP (HP+Other), this technique has a sensitivity of 98%, a specificity of 84%, and a negative predictive value of 98% (i.e. if a polyp is predicted to be hyperplastic, there is a 98% (56/57) likelihood that it is not an adenomatous polyp). Conclusions: Using a conventional HRC in combination with ICD, it is possible to separate non-AP from AP without biopsy. Since it is generally agreed that hyperplastic polyps do not require removal and are not markers for neoplastic diseases in the more proximal colon, these findings suggest that important reductions in the cost of colon cancer screening may be possible.

Original languageEnglish (US)
JournalGastrointestinal Endoscopy
Volume45
Issue number4
StatePublished - 1997

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Colonic Polyps
Colonoscopy
Polyps
Multicenter Studies
Indigo Carmine
Colonoscopes
Sigmoidoscopy
Coloring Agents
Histology
Adenomatous Polyps
Early Detection of Cancer
Colonic Neoplasms
Primary Health Care

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Kim, C. Y., Fleischer, D. E., Kozarek, R. A., Carr-Locke, D. L., Li, T. C. M., Gostout, C. J., ... Benjamin, S. B. (1997). High-resolution colonoscopy and chromoendoscopy for classifying colonic polyps: A multicenter study. Gastrointestinal Endoscopy, 45(4).

High-resolution colonoscopy and chromoendoscopy for classifying colonic polyps : A multicenter study. / Kim, C. Y.; Fleischer, D. E.; Kozarek, R. A.; Carr-Locke, D. L.; Li, T. C M; Gostout, C. J.; Heller, S. J.; Montgomery, E. A.; Al-Kawas, F. H.; Avigan, M. I.; Eisen, G. M.; Lewis, J. H.; Benjamin, S. B.

In: Gastrointestinal Endoscopy, Vol. 45, No. 4, 1997.

Research output: Contribution to journalArticle

Kim, CY, Fleischer, DE, Kozarek, RA, Carr-Locke, DL, Li, TCM, Gostout, CJ, Heller, SJ, Montgomery, EA, Al-Kawas, FH, Avigan, MI, Eisen, GM, Lewis, JH & Benjamin, SB 1997, 'High-resolution colonoscopy and chromoendoscopy for classifying colonic polyps: A multicenter study', Gastrointestinal Endoscopy, vol. 45, no. 4.
Kim CY, Fleischer DE, Kozarek RA, Carr-Locke DL, Li TCM, Gostout CJ et al. High-resolution colonoscopy and chromoendoscopy for classifying colonic polyps: A multicenter study. Gastrointestinal Endoscopy. 1997;45(4).
Kim, C. Y. ; Fleischer, D. E. ; Kozarek, R. A. ; Carr-Locke, D. L. ; Li, T. C M ; Gostout, C. J. ; Heller, S. J. ; Montgomery, E. A. ; Al-Kawas, F. H. ; Avigan, M. I. ; Eisen, G. M. ; Lewis, J. H. ; Benjamin, S. B. / High-resolution colonoscopy and chromoendoscopy for classifying colonic polyps : A multicenter study. In: Gastrointestinal Endoscopy. 1997 ; Vol. 45, No. 4.
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abstract = "Background: Visual, non-biopsy techniques for predicting histology of diminutive colorectal polyps have not proven reliable. We recently reported using an affordable conventional high-resolution colonoscope (HRC), the Fujinon EC-200LR, in combination with indigo carmine dye (ICD) for the diagnosis of small polyps. The sensitivity of our technique in distinguishing adenomatous from non-adenomatous polyps was 96{\%}, and the negative predictive value was 96{\%}. We now report on preliminary results of our five center trial (4 academic GI units and 1 primary care practice). Methods: Complete colonoscopy or flexible sigmoidoscopy using the Fujinon 200 series scopes (EC-200LR or ES-200ER) was performed in patients with polyps. All polyps <10mm were sprayed with 0.8{\%} ICD. Histologic diagnosis was predicted based on the polyps's surface architecture ({"}pits{"} = hyperplastic (HP), {"}sulci{"} = adenomatous (AP)). All polyps were removed. Polyps seen and stained on flexible sigmoidoscopy were removed on a followup colonoscopy. Results: 120 polyps w/a mean diameter of 4.6mm were evaluated from 68 pts. 10 polyps were excluded because no prediction could be made. Actual Histology Predicted Histo:AP Predicted Histo:HP Diag Accuracy AP (N=42) 42 1 98{\%} HP (N=39) 7 34 83{\%} OT (N=25)* 4 22 NA * OT (Other) = colonic mucosa or lymphoid aggregate When attempting to separate AP from non-AP (HP+Other), this technique has a sensitivity of 98{\%}, a specificity of 84{\%}, and a negative predictive value of 98{\%} (i.e. if a polyp is predicted to be hyperplastic, there is a 98{\%} (56/57) likelihood that it is not an adenomatous polyp). Conclusions: Using a conventional HRC in combination with ICD, it is possible to separate non-AP from AP without biopsy. Since it is generally agreed that hyperplastic polyps do not require removal and are not markers for neoplastic diseases in the more proximal colon, these findings suggest that important reductions in the cost of colon cancer screening may be possible.",
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T1 - High-resolution colonoscopy and chromoendoscopy for classifying colonic polyps

T2 - A multicenter study

AU - Kim, C. Y.

AU - Fleischer, D. E.

AU - Kozarek, R. A.

AU - Carr-Locke, D. L.

AU - Li, T. C M

AU - Gostout, C. J.

AU - Heller, S. J.

AU - Montgomery, E. A.

AU - Al-Kawas, F. H.

AU - Avigan, M. I.

AU - Eisen, G. M.

AU - Lewis, J. H.

AU - Benjamin, S. B.

PY - 1997

Y1 - 1997

N2 - Background: Visual, non-biopsy techniques for predicting histology of diminutive colorectal polyps have not proven reliable. We recently reported using an affordable conventional high-resolution colonoscope (HRC), the Fujinon EC-200LR, in combination with indigo carmine dye (ICD) for the diagnosis of small polyps. The sensitivity of our technique in distinguishing adenomatous from non-adenomatous polyps was 96%, and the negative predictive value was 96%. We now report on preliminary results of our five center trial (4 academic GI units and 1 primary care practice). Methods: Complete colonoscopy or flexible sigmoidoscopy using the Fujinon 200 series scopes (EC-200LR or ES-200ER) was performed in patients with polyps. All polyps <10mm were sprayed with 0.8% ICD. Histologic diagnosis was predicted based on the polyps's surface architecture ("pits" = hyperplastic (HP), "sulci" = adenomatous (AP)). All polyps were removed. Polyps seen and stained on flexible sigmoidoscopy were removed on a followup colonoscopy. Results: 120 polyps w/a mean diameter of 4.6mm were evaluated from 68 pts. 10 polyps were excluded because no prediction could be made. Actual Histology Predicted Histo:AP Predicted Histo:HP Diag Accuracy AP (N=42) 42 1 98% HP (N=39) 7 34 83% OT (N=25)* 4 22 NA * OT (Other) = colonic mucosa or lymphoid aggregate When attempting to separate AP from non-AP (HP+Other), this technique has a sensitivity of 98%, a specificity of 84%, and a negative predictive value of 98% (i.e. if a polyp is predicted to be hyperplastic, there is a 98% (56/57) likelihood that it is not an adenomatous polyp). Conclusions: Using a conventional HRC in combination with ICD, it is possible to separate non-AP from AP without biopsy. Since it is generally agreed that hyperplastic polyps do not require removal and are not markers for neoplastic diseases in the more proximal colon, these findings suggest that important reductions in the cost of colon cancer screening may be possible.

AB - Background: Visual, non-biopsy techniques for predicting histology of diminutive colorectal polyps have not proven reliable. We recently reported using an affordable conventional high-resolution colonoscope (HRC), the Fujinon EC-200LR, in combination with indigo carmine dye (ICD) for the diagnosis of small polyps. The sensitivity of our technique in distinguishing adenomatous from non-adenomatous polyps was 96%, and the negative predictive value was 96%. We now report on preliminary results of our five center trial (4 academic GI units and 1 primary care practice). Methods: Complete colonoscopy or flexible sigmoidoscopy using the Fujinon 200 series scopes (EC-200LR or ES-200ER) was performed in patients with polyps. All polyps <10mm were sprayed with 0.8% ICD. Histologic diagnosis was predicted based on the polyps's surface architecture ("pits" = hyperplastic (HP), "sulci" = adenomatous (AP)). All polyps were removed. Polyps seen and stained on flexible sigmoidoscopy were removed on a followup colonoscopy. Results: 120 polyps w/a mean diameter of 4.6mm were evaluated from 68 pts. 10 polyps were excluded because no prediction could be made. Actual Histology Predicted Histo:AP Predicted Histo:HP Diag Accuracy AP (N=42) 42 1 98% HP (N=39) 7 34 83% OT (N=25)* 4 22 NA * OT (Other) = colonic mucosa or lymphoid aggregate When attempting to separate AP from non-AP (HP+Other), this technique has a sensitivity of 98%, a specificity of 84%, and a negative predictive value of 98% (i.e. if a polyp is predicted to be hyperplastic, there is a 98% (56/57) likelihood that it is not an adenomatous polyp). Conclusions: Using a conventional HRC in combination with ICD, it is possible to separate non-AP from AP without biopsy. Since it is generally agreed that hyperplastic polyps do not require removal and are not markers for neoplastic diseases in the more proximal colon, these findings suggest that important reductions in the cost of colon cancer screening may be possible.

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