A comparative study of standard vs. high definition colonoscopy for adenoma and hyperplastic polyp detection with optimized withdrawal technique


Dr J. E. East, Wolfson Unit for Endoscopy, St Mark’s Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, UK.
E-mail: jameseast6@yahoo.com


Background  Colonoscopy has a known miss rate for polyps and adenomas. High definition (HD) colonoscopes may allow detection of subtle mucosal change, potentially aiding detection of adenomas and hyperplastic polyps.

Aim  To compare detection rates between HD and standard definition (SD) colonoscopy.

Methods  Prospective, cohort study with optimized withdrawal technique (withdrawal time >6 min, antispasmodic, position changes, re-examining flexures and folds). One hundred and thirty patients attending for routine colonoscopy were examined with either SD (n = 72) or HD (n = 58) colonoscopes.

Results  Groups were well matched. Sixty per cent of patients had at least one adenoma detected with SD vs. 71% with HD, P = 0.20, relative risk (benefit) 1.32 (95% CI 0.85–2.04). Eighty-eight adenomas (mean ± standard deviation 1.2 ± 1.4) were detected using SD vs. 93 (1.6 ± 1.5) with HD, P = 0.12; however more nonflat, diminutive (<6 mm) adenomas were detected with HD, P = 0.03. Twenty-three proximal hyperplastic polyps (0.32 ± 0.58) were detected with SD vs. 31 (0.53 ± 0.86) with HD, P = 0.35. Overall prevalence of proximal large (>9 mm) hyperplastic polyps was 7% (0.09 ± 0.36).

Conclusions  High definition did not lead to a significant increase in adenoma or hyperplastic polyp detection, but may help where comprehensive lesion detection is paramount. High detection rates appear possible with either SD or HD, when using an optimized withdrawal technique.