Introduction Electronic imaging technologies such as i-Scan, Narrow Band Imaging (NBI) and Fujinon Intelligence Colour Enhancement (FICE) are increasingly used for polyp detection and characterisation, but to date, their use is limited to expert settings. I-scan is a relatively novel technology. Insufficient literature with i-scan and the lack of RCT’s hinder its implementation in clinical practice. Our goal was to review the current literature on the clinical utility of i-scan and develop evidence-based practical recommendations.
Methods We conducted a systematic review on the role of high definition white-light (HDWL) and i-Scan colonoscopy for polyp detection and characterisation. A series of evidence-based statements were developed and put through anonymous voting along the lines of a modified Delphi process. A one day consensus meeting was held (June 20, 2015, Milan). Each statement was voted until consensus (i.e >80% agreement) was achieved or rejection agreed. GRADE recommendations were assigned to the agreed statements.
Results The Consensus Panel consisted of 11 international experts. In total, 11 statements were proposed, of which 9 achieved consensus:
HDWL is recommended rather than standard definition (SD) for the detection and characterisation of colorectal polyps;
HDWL + i-Scan improves polyp and adenoma detection rates;
HDWL + i-Scan are superior to HDWL alone for the optical diagnosis of colorectal polyps;
HDWL + i-Scan in expert hands meet the ASGE PIVI standards for the optical diagnosis of diminutive polyps;
HDWL+i-Scan in non-expert hands do not meet the ASGE PIVI standards for the optical diagnosis of diminutive polyps;
Optical diagnosis of polyps with i-Scan has a learning curve and needs systematic training;
The performance of i-Scan for real time characterisation of colorectal polyps is similar to NBI & FICE.
Two statements failed to achieve consensus:
HDWL alone can be effective for the in-vivo characterisation of polyps in expert hands;
The adenoma detection rate is comparable when using HDWL + i-scan versus chromoendoscopy.
Conclusion The Consensus Panel proposes evidence-based recommendations for the detection and characterisation of colorectal polyps using high-definition white light endoscopy and i-scan, to facilitate implementation of this technology in clinical practice. Areas of uncertainty, controversy and future research needs are addressed.
Disclosure of Interest None Declared
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