Comparative Study of Conventional Colonoscopy, Chromoendoscopy, and Narrow-Band Imaging Systems in Differential Diagnosis of Neoplastic and Nonneoplastic.

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Presentation transcript:

Comparative Study of Conventional Colonoscopy, Chromoendoscopy, and Narrow-Band Imaging Systems in Differential Diagnosis of Neoplastic and Nonneoplastic Colonic Polyps Ming-Yao Su, M.D., Chen-Ming Hsu, M.D., Yu-Pin Ho, M.D., Pang-Chi Chen, M.D., Chun-Jung Lin, M.D., and Cheng-Tang Chiu, M.D. Department of Gastroenterology and Hepatology, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan Am J Gastroenterol 2006;101:2711-2716 R2 In Ah Choi / Prof Jae Young Jang

INTRODUCTION colorectal polyp neoplastic : adenoma, adenocarcinoma nonneoplastic : hyperplastic, inflammatory, harmatomatous, etc mucosal biopsy : standard approach for histological diagnosis chromoendoscopy : ‘ pit pattern analysis’ via magnified colonoscopy and indigo carmine contrast → requires considerable time for dye spraying and observations narrow-band imaging (NBI) system : light in short and limited wavelengths within the hemoglobin absorption band → blood vessels can be demonstrated with adequate contrast for an unobstructed view

INTRODUCTION * Objectives To analyse NBI system for its ability to differentiate between neoplastic and nonneoplastic colorectal polyps To compared its performance with that of conventional colonoscopy and chromoendoscopy * Objectives

MATERIALS AND METHODS 110 polyps (78 patients) 98 polyps (70 patients) Chang-Gung Memorial Hospital, Linkou Medical Center,Taiwan, between January and February 2006 110 polyps (78 patients) 98 polyps (70 patients) 12 polyps (8 patients) colorectal cancer screening postpolypectomy follow-up bowel habit changes bodyweight loss due to inadequate colonic preparation obtaining biopsy specimens was impossible DVD did not record properly.

MATERIALS AND METHODS Images of each patient’s polyps were recorded on DVD and blindly reviewed by two experienced colonoscopists Neoplastic lesions polyp was found by conventional colonoscopy reddish discolorization or size more than 10 mm by conventional colonoscopy change to the NBI system to examine the vascular network brownish vascular network enhanced by NBI system 0.2% indigo carmine sprayed directly on the mucosa surface for pit pattern analysis type III to V pits were found by chromoendoscopy polypectomized or biopsied for histological analysis

RESULTS Mean 3.5 6.5 8.0 10.5 20.5

RESULTS Hyperplastic polyp 38 Neoplastic polyp Malignant change

RESULTS 34/33 Neoplastic polyp 33/34 Malignant change 5

RESULTS Neoplastic polyp Conventional colonoscopy NBI system Type IIIL pit pattern by Indigo carmine contrast dye

RESULTS Non neoplastic polyp Type II pit pattern by Indigo carmine contrast dye Conventional colonoscopy NBI system

RESULTS

RESULTS

CONCLUSIONS “ The NBI system identified morphlogic details that correlate well with polyp histology by chromoendoscopy”