A back-to-back comparison of white light video endoscopy with autofluorescence endoscopy for adenoma detection in high-risk subjects
- Dewkoemar Ramsoekh1,
- Jelle Haringsma1,
- Jan Werner Poley1,
- Paul van Putten1,
- Herman van Dekken2,
- Ewout W Steyerberg3,
- Monique E van Leerdam1,
- Ernst J Kuipers1
- 1Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- 2Department of Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- 3Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Correspondence to Dr J Haringsma, Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, 's Gravendijkwal 230, CE Rotterdam 3015, The Netherlands;
- Revised 24 January 2010
- Accepted 9 February 2010
Objective To compare the sensitivity of autofluorescence endoscopy (AFE) and white light video endoscopy (WLE) for the detection of colorectal adenomas in high-risk patients belonging to Lynch syndrome (LS) or familial colorectal cancer (CRC) families.
Methods This was a prospective single-centre study carried out in a tertiary referral centre. The subjects were 75 asymptomatic patients originating from LS or familial CRC families. Patients were examined with either WLE followed by AFE or AFE followed by WLE. Back-to-back colonoscopy was performed by two blinded endoscopists. All lesions were removed during the second endoscopic procedure. Lesions missed during the second procedure were identified and removed on third pass. The sensitivity calculations for colorectal adenomas were based on histology results. The main outcome measures were the difference in sensitivity between WLE and AFE for the detection of adenomas in patients with LS or familial CRC.
Results At least one adenoma was detected in 41 (55%) patients. WLE identified adenomas in 28/41 patients and AFE in 37/41 patients, corresponding to a 32% increase. In total 95 adenomas were detected, 65 by WLE and 87 by AFE, resulting in a significantly higher sensitivity of AFE compared with WLE (92% vs 68%; p=0.001). The additionally detected adenomas with AFE were significantly smaller than the adenomas detected by WLE (mean 3.0 mm vs 4.9 mm, p<0.01).
Conclusions AFE improves the detection of colorectal adenomas in patients with LS or familial CRC. The results of this study suggest that AFE may be preferable for surveillance of these high-risk patients.
- Autofluorescence endoscopy
- cancer syndromes
- familial colorectal cancer
- Lynch syndrome
- surveillance colonoscopy
- white light video endoscopy
Competing interests None.
Ethics approval This study was conducted with the approval of the institutional review board of the Erasmus MC University Medical Center.
Provenance and peer review Not commissioned; externally peer reviewed.