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Prospective, randomized, back-to-back trial evaluating the usefulness of i-SCAN in screening colonoscopy
Sung Noh Hong1, Won Hyeok Choe, Jung Hyun Lee
1Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
Background:
The newly developed i-SCAN application can theoretically maximize the effectiveness of colonoscopy. However, the practical usefulness of the i-SCAN application during screening colonoscopy has not been assessed.
Objective:
To assess the efficacy of the i-SCAN application during screening colonoscopy.
Design:
A prospective, randomized trial that used a modified, back-to-back colonoscopy.
Setting:
Academic hospital.
Patients:
This study involved 389 asymptomatic, consecutive, average-risk patients who underwent screening colonoscopy.
Intervention:
The patients were randomized to the first withdrawal with either conventional high-definition white light (HDWL group; n = 119), i-SCAN contrast/surface enhancement (CE/SE) mode (i-SCAN1 group; n = 115), or i-SCAN CE/SE/tone enhancement-colorectal mode (i-SCAN2 group; n = 118). All patients underwent a second examination with HDWL as the criterion standard.
Main Outcome Measurements:
The primary outcome measurement was the adenoma detection rate and adenoma miss rate. The secondary outcome measurement was the accuracy of the histologic prediction of neoplastic and nonneoplastic polyps.
Results:
The adenoma detection rates during the first withdrawal of HDWL, i-SCAN1, and i-SCAN2 were 31.9%, 36.5%, and 33.1%, respectively (P = .742), and the adenoma miss rates of each group were 22.9%, 19.3%, and 15.9%, respectively (P = .513). Based on the multivariate analysis, the application of i-SCAN was not associated with an improvement in adenoma detection and the prevention of missed polyps. However, the prediction of neoplastic and nonneoplastic colorectal lesions was more precise in the i-SCAN2 group compared with the HDWL group (accuracy 79.3% vs 75.5%, P = .029; sensitivity 86.5% vs 72.6%, P = .020; and specificity 91.4% vs 80.6%, P = .040).
Limitations:
Single-center trial.
Conclusion:
i-SCAN during the screening colonoscopy may fail to improve adenoma detection and the prevention of missed polyps, but i-SCAN appears to be effective for real-time histologic prediction of polyps compared with conventional HDWL colonoscopy. (
Clinical Trial Registration Number:
NCT01417611.).
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