Introduction There is a small rate of interval cancer after colonoscopy partly due to incomplete lesion detection during the procedure. Some studies have shown superior lesion detection with improved endoscopic image quality and enhancement1 2 with one suggesting a 50% increase in polyp detection with Pentax HiLine (PH) over Olympus Lucera series (OL) colonoscopes. We have compared the performance of these two systems.
Methods All complete bowel cancer screening colonoscopies performed by a single endoscopist between 18 March 2010 and 27 September 2011 in faecal occult blood test positive patients (n=483) were analysed for insertion/withdrawal time, patient comfort/sedation doses and lesion detection (total polyps, adenomas, advanced, right sided). Comparisons were made between OL (white light) and PH (white light high definition on insertion, i-scan 1 on withdrawal). Differences between groups were analysed using either the Mann–Whitney U test or χ2 test.
Results Completion rates were similar (OL 413/425; 97.2% and PH 55/58; 94.9%, p=0.24). The two groups were matched for age and sex. Adenoma detection rates were comparable (49% vs 56%, p=0.38). There was no significant difference in terms of mean insertion time, withdrawal time in normal colonoscopies, total numbers of polyps, adenomas, proximal adenomas or advanced adenomas (>1 cm, villous, with high grade dysplasia or containing cancer). The sample size gave an 88% power to detect the higher polyp detection rate detected previously.2 There was a small statistically significant increase in nurse reported patient discomfort with PH (0.5 vs 1, p<0.0001—none=0, minimal=1, mild=2, moderate=3, severe=4) with higher requirements for Midazolam and similar Fentanyl doses.
Conclusion In this uncontrolled single endoscopist series in a homogenous group of patients, there did not appear to be a significant benefit of one system over the other in terms of procedure duration or lesion recognition. PH colonoscopes did appear to lead to a slight increase in patient discomfort and sedation requirements. A randomised controlled trial is required to establish the relative performances of these systems.
Competing interests None declared.
References 1. Hoffman A, et al. Endoscopy 2010;42:827–33.
2. Banks, et al. World J Gastroenterol 2011;17:4308–13.
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