Detecting diminutive colorectal lesions at colonoscopy: a randomised controlled trial of pan-colonic versus targeted chromoscopy
Background: Diminutive and flat colorectal lesions can be difficult to detect using conventional colonoscopic techniques. Previous data have suggested that pan-chromoscopy may improve detection rates. No randomised control trial has been performed examining detection rates of such lesions while cont...
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| Veröffentlicht in: | Gut 2004-03, Vol.53 (3), p.376-380 |
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| description | Background: Diminutive and flat colorectal lesions can be difficult to detect using conventional colonoscopic techniques. Previous data have suggested that pan-chromoscopy may improve detection rates. No randomised control trial has been performed examining detection rates of such lesions while controlling for extubation time and lavage effect. Aim: We conducted a randomised controlled trial of pan-colonic chromoscopic colonoscopy for the detection of diminutive and flat colorectal lesions while controlling for extubation time and lavage effect. Methods: Consecutive patients attending for routine colonoscopy were randomised to either pan-chromoscopy using 0.5% indigo carmine (IC) or targeted chromoscopy (control group). A minimum diagnostic extubation time was set at eight minutes with controls undergoing a matched volume of saline wash. Results: A total of 260 patients were randomised; 132 controls and 128 to pan-colonic chromoscopy. Extubation times did not differ significantly between the control (median 15 minutes (range 8–41)) and chromoscopy (median 17 minutes (range 8–39)) groups. The volume of IC used in the pan-chromoscopy group (median 68 ml (range 65–90)) and normal saline used in the control group (69 ml (range 60–93)) did not differ significantly. There was a statistically significant difference between the groups regarding the total number of adenomas detected (p |
| doi_str_mv | 10.1136/gut.2003.029868 |
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Previous data have suggested that pan-chromoscopy may improve detection rates. No randomised control trial has been performed examining detection rates of such lesions while controlling for extubation time and lavage effect. Aim: We conducted a randomised controlled trial of pan-colonic chromoscopic colonoscopy for the detection of diminutive and flat colorectal lesions while controlling for extubation time and lavage effect. Methods: Consecutive patients attending for routine colonoscopy were randomised to either pan-chromoscopy using 0.5% indigo carmine (IC) or targeted chromoscopy (control group). A minimum diagnostic extubation time was set at eight minutes with controls undergoing a matched volume of saline wash. Results: A total of 260 patients were randomised; 132 controls and 128 to pan-colonic chromoscopy. Extubation times did not differ significantly between the control (median 15 minutes (range 8–41)) and chromoscopy (median 17 minutes (range 8–39)) groups. The volume of IC used in the pan-chromoscopy group (median 68 ml (range 65–90)) and normal saline used in the control group (69 ml (range 60–93)) did not differ significantly. There was a statistically significant difference between the groups regarding the total number of adenomas detected (p<0.05) with significantly more diminutive (<4 mm) adenomas detected in the pan-chromoscopy group (p = 0.03). Pan-chromoscopy diagnosed more diminutive and flat lesions in the right colon compared with controls (p<0.05), with more patients with multiple adenomas (>3) detected using pan-chromoscopy (p<0.01). Hyperplastic lesions were more commonly detected in the pan-chromoscopy group compared with controls (p<0.001). More hyperplastic polyps were detected in the left colon (86% rectosigmoid) using chromoscopy compared with controls. Conclusion: Chromoscopy improves the total number of adenomas detected and enhances the detection of diminutive and flat lesions. Importantly, eight diminutive lesions had foci of high grade dysplasia. Chromoscopy may benefit patients, assuming a high risk of colorectal cancer, and help in risk stratification and planning follow up colonoscopy intervals.</description><identifier>ISSN: 0017-5749</identifier><identifier>EISSN: 1468-3288</identifier><identifier>EISSN: 1458-3288</identifier><identifier>DOI: 10.1136/gut.2003.029868</identifier><identifier>PMID: 14960519</identifier><identifier>CODEN: GUTTAK</identifier><language>eng</language><publisher>London: BMJ Publishing Group Ltd and British Society of Gastroenterology</publisher><subject>adenoma ; Adenoma - diagnosis ; Adenoma - pathology ; Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Biopsy ; cancer ; Catheters ; chromoscopy ; Colon - pathology ; Colon Cancer ; colonoscopy ; Colonoscopy - methods ; Colorectal cancer ; Colorectal Neoplasms - diagnosis ; Colorectal Neoplasms - pathology ; Coloring Agents ; CRC ; Digestive system. Abdomen ; Disease Progression ; dysplasia ; EMR ; endoscopic mucosal resection ; Endoscopy ; Female ; Gastroenterology. Liver. Pancreas. Abdomen ; HGD ; high grade dysplasia ; Humans ; Hyperplasia - diagnosis ; Indigo Carmine ; Intubation ; Investigative techniques, diagnostic techniques (general aspects) ; LGD ; low grade dysplasia ; Male ; Medical sciences ; Medical screening ; Middle Aged ; Neoplasm Invasiveness ; Precancerous Conditions - diagnosis ; Precancerous Conditions - pathology ; Studies ; Tumors</subject><ispartof>Gut, 2004-03, Vol.53 (3), p.376-380</ispartof><rights>Copyright 2004 by Gut</rights><rights>2004 INIST-CNRS</rights><rights>COPYRIGHT 2004 BMJ Publishing Group Ltd.</rights><rights>Copyright: 2004 Copyright 2004 by Gut</rights><rights>Copyright © Copyright 2004 by Gut 2004</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b597t-65a2551a22525cb641051686e6d20775fd59ca70cf0a3a6888f9dd4983f24d763</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1773964/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1773964/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15546625$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/14960519$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hurlstone, D P</creatorcontrib><creatorcontrib>Cross, S S</creatorcontrib><creatorcontrib>Slater, R</creatorcontrib><creatorcontrib>Sanders, D S</creatorcontrib><creatorcontrib>Brown, S</creatorcontrib><title>Detecting diminutive colorectal lesions at colonoscopy: a randomised controlled trial of pan-colonic versus targeted chromoscopy</title><title>Gut</title><addtitle>Gut</addtitle><description>Background: Diminutive and flat colorectal lesions can be difficult to detect using conventional colonoscopic techniques. Previous data have suggested that pan-chromoscopy may improve detection rates. No randomised control trial has been performed examining detection rates of such lesions while controlling for extubation time and lavage effect. Aim: We conducted a randomised controlled trial of pan-colonic chromoscopic colonoscopy for the detection of diminutive and flat colorectal lesions while controlling for extubation time and lavage effect. Methods: Consecutive patients attending for routine colonoscopy were randomised to either pan-chromoscopy using 0.5% indigo carmine (IC) or targeted chromoscopy (control group). A minimum diagnostic extubation time was set at eight minutes with controls undergoing a matched volume of saline wash. Results: A total of 260 patients were randomised; 132 controls and 128 to pan-colonic chromoscopy. Extubation times did not differ significantly between the control (median 15 minutes (range 8–41)) and chromoscopy (median 17 minutes (range 8–39)) groups. The volume of IC used in the pan-chromoscopy group (median 68 ml (range 65–90)) and normal saline used in the control group (69 ml (range 60–93)) did not differ significantly. There was a statistically significant difference between the groups regarding the total number of adenomas detected (p<0.05) with significantly more diminutive (<4 mm) adenomas detected in the pan-chromoscopy group (p = 0.03). Pan-chromoscopy diagnosed more diminutive and flat lesions in the right colon compared with controls (p<0.05), with more patients with multiple adenomas (>3) detected using pan-chromoscopy (p<0.01). Hyperplastic lesions were more commonly detected in the pan-chromoscopy group compared with controls (p<0.001). More hyperplastic polyps were detected in the left colon (86% rectosigmoid) using chromoscopy compared with controls. Conclusion: Chromoscopy improves the total number of adenomas detected and enhances the detection of diminutive and flat lesions. Importantly, eight diminutive lesions had foci of high grade dysplasia. Chromoscopy may benefit patients, assuming a high risk of colorectal cancer, and help in risk stratification and planning follow up colonoscopy intervals.</description><subject>adenoma</subject><subject>Adenoma - diagnosis</subject><subject>Adenoma - pathology</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Biopsy</subject><subject>cancer</subject><subject>Catheters</subject><subject>chromoscopy</subject><subject>Colon - pathology</subject><subject>Colon Cancer</subject><subject>colonoscopy</subject><subject>Colonoscopy - methods</subject><subject>Colorectal cancer</subject><subject>Colorectal Neoplasms - diagnosis</subject><subject>Colorectal Neoplasms - pathology</subject><subject>Coloring Agents</subject><subject>CRC</subject><subject>Digestive system. Abdomen</subject><subject>Disease Progression</subject><subject>dysplasia</subject><subject>EMR</subject><subject>endoscopic mucosal resection</subject><subject>Endoscopy</subject><subject>Female</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>HGD</subject><subject>high grade dysplasia</subject><subject>Humans</subject><subject>Hyperplasia - diagnosis</subject><subject>Indigo Carmine</subject><subject>Intubation</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>LGD</subject><subject>low grade dysplasia</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medical screening</subject><subject>Middle Aged</subject><subject>Neoplasm Invasiveness</subject><subject>Precancerous Conditions - diagnosis</subject><subject>Precancerous Conditions - pathology</subject><subject>Studies</subject><subject>Tumors</subject><issn>0017-5749</issn><issn>1468-3288</issn><issn>1458-3288</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqFks1v1DAQxSMEotvCmRuKhOCAlK3txF89IFVbviu4QMXN8jpO6sWxF9tZ0Rt_Ot7NqguoEsoh0czvvZmJXlE8gWAOYU1O-zHNEQD1HCDOCLtXzGBDWFUjxu4XMwAgrTBt-FFxHOMKAMAYhw-LI9hwAjDks-LXhU5aJeP6sjWDcWMyG10qb33IZWlLq6PxLpYy7arOR-XXN2elLIN0rR9M1G3uuBS8tfkzBZNVvivX0lU7hVHlRoc4xjLJ0Odxmb8OfpicHhUPOmmjfrx_nxRf37z-snhXXX5--35xflktMaepIlgijKFECCOslqSBeX_CiCYtApTirsVcSQpUB2QtCWOs423bcFZ3qGkpqU-KV5PvelwOulU6byytWAczyHAjvDTi744z16L3GwEprTlpssGLvUHwP0Ydk8i3K22tdNqPUTAAMcMYZ_DZP-DKj8Hl47ZevEYN3-1TTVQvrRbGdT5PVb12Og_3Tncml88hbAAGpGGZn9_B56fVg1F3Ck4ngQo-xqC721shENvwiBwesQ2PmMKTFU___EUHfp-WDDzfAzIqabucAGXigcO4IQThw20mJv3zti_Dd0FoTbH4dLUQ_OrDtwX6SEWd-ZcTvxxW_93yN11c63E</recordid><startdate>20040301</startdate><enddate>20040301</enddate><creator>Hurlstone, D P</creator><creator>Cross, S S</creator><creator>Slater, R</creator><creator>Sanders, D S</creator><creator>Brown, S</creator><general>BMJ Publishing Group Ltd and British Society of Gastroenterology</general><general>BMJ</general><general>BMJ Publishing Group Ltd</general><general>BMJ Publishing Group LTD</general><general>Copyright 2004 by Gut</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>M7P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20040301</creationdate><title>Detecting diminutive colorectal lesions at colonoscopy: a randomised controlled trial of pan-colonic versus targeted chromoscopy</title><author>Hurlstone, D P ; Cross, S S ; Slater, R ; Sanders, D S ; Brown, S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b597t-65a2551a22525cb641051686e6d20775fd59ca70cf0a3a6888f9dd4983f24d763</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>adenoma</topic><topic>Adenoma - diagnosis</topic><topic>Adenoma - pathology</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Biopsy</topic><topic>cancer</topic><topic>Catheters</topic><topic>chromoscopy</topic><topic>Colon - pathology</topic><topic>Colon Cancer</topic><topic>colonoscopy</topic><topic>Colonoscopy - methods</topic><topic>Colorectal cancer</topic><topic>Colorectal Neoplasms - diagnosis</topic><topic>Colorectal Neoplasms - pathology</topic><topic>Coloring Agents</topic><topic>CRC</topic><topic>Digestive system. Abdomen</topic><topic>Disease Progression</topic><topic>dysplasia</topic><topic>EMR</topic><topic>endoscopic mucosal resection</topic><topic>Endoscopy</topic><topic>Female</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>HGD</topic><topic>high grade dysplasia</topic><topic>Humans</topic><topic>Hyperplasia - diagnosis</topic><topic>Indigo Carmine</topic><topic>Intubation</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>LGD</topic><topic>low grade dysplasia</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medical screening</topic><topic>Middle Aged</topic><topic>Neoplasm Invasiveness</topic><topic>Precancerous Conditions - diagnosis</topic><topic>Precancerous Conditions - pathology</topic><topic>Studies</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hurlstone, D P</creatorcontrib><creatorcontrib>Cross, S S</creatorcontrib><creatorcontrib>Slater, R</creatorcontrib><creatorcontrib>Sanders, D S</creatorcontrib><creatorcontrib>Brown, S</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>Biological Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Gut</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hurlstone, D P</au><au>Cross, S S</au><au>Slater, R</au><au>Sanders, D S</au><au>Brown, S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Detecting diminutive colorectal lesions at colonoscopy: a randomised controlled trial of pan-colonic versus targeted chromoscopy</atitle><jtitle>Gut</jtitle><addtitle>Gut</addtitle><date>2004-03-01</date><risdate>2004</risdate><volume>53</volume><issue>3</issue><spage>376</spage><epage>380</epage><pages>376-380</pages><issn>0017-5749</issn><eissn>1468-3288</eissn><eissn>1458-3288</eissn><coden>GUTTAK</coden><abstract>Background: Diminutive and flat colorectal lesions can be difficult to detect using conventional colonoscopic techniques. Previous data have suggested that pan-chromoscopy may improve detection rates. No randomised control trial has been performed examining detection rates of such lesions while controlling for extubation time and lavage effect. Aim: We conducted a randomised controlled trial of pan-colonic chromoscopic colonoscopy for the detection of diminutive and flat colorectal lesions while controlling for extubation time and lavage effect. Methods: Consecutive patients attending for routine colonoscopy were randomised to either pan-chromoscopy using 0.5% indigo carmine (IC) or targeted chromoscopy (control group). A minimum diagnostic extubation time was set at eight minutes with controls undergoing a matched volume of saline wash. Results: A total of 260 patients were randomised; 132 controls and 128 to pan-colonic chromoscopy. Extubation times did not differ significantly between the control (median 15 minutes (range 8–41)) and chromoscopy (median 17 minutes (range 8–39)) groups. The volume of IC used in the pan-chromoscopy group (median 68 ml (range 65–90)) and normal saline used in the control group (69 ml (range 60–93)) did not differ significantly. There was a statistically significant difference between the groups regarding the total number of adenomas detected (p<0.05) with significantly more diminutive (<4 mm) adenomas detected in the pan-chromoscopy group (p = 0.03). Pan-chromoscopy diagnosed more diminutive and flat lesions in the right colon compared with controls (p<0.05), with more patients with multiple adenomas (>3) detected using pan-chromoscopy (p<0.01). Hyperplastic lesions were more commonly detected in the pan-chromoscopy group compared with controls (p<0.001). More hyperplastic polyps were detected in the left colon (86% rectosigmoid) using chromoscopy compared with controls. Conclusion: Chromoscopy improves the total number of adenomas detected and enhances the detection of diminutive and flat lesions. Importantly, eight diminutive lesions had foci of high grade dysplasia. Chromoscopy may benefit patients, assuming a high risk of colorectal cancer, and help in risk stratification and planning follow up colonoscopy intervals.</abstract><cop>London</cop><pub>BMJ Publishing Group Ltd and British Society of Gastroenterology</pub><pmid>14960519</pmid><doi>10.1136/gut.2003.029868</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | adenoma Adenoma - diagnosis Adenoma - pathology Adult Aged Aged, 80 and over Biological and medical sciences Biopsy cancer Catheters chromoscopy Colon - pathology Colon Cancer colonoscopy Colonoscopy - methods Colorectal cancer Colorectal Neoplasms - diagnosis Colorectal Neoplasms - pathology Coloring Agents CRC Digestive system. Abdomen Disease Progression dysplasia EMR endoscopic mucosal resection Endoscopy Female Gastroenterology. Liver. Pancreas. Abdomen HGD high grade dysplasia Humans Hyperplasia - diagnosis Indigo Carmine Intubation Investigative techniques, diagnostic techniques (general aspects) LGD low grade dysplasia Male Medical sciences Medical screening Middle Aged Neoplasm Invasiveness Precancerous Conditions - diagnosis Precancerous Conditions - pathology Studies Tumors |
| title | Detecting diminutive colorectal lesions at colonoscopy: a randomised controlled trial of pan-colonic versus targeted chromoscopy |
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