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PWE-115 Detection and Characterisation of Colorectal Polyps Using High Definition White Light and I-Scan: Evidence and Delphi Process-Based Consensus Recommendations
  1. P Bhandari1,
  2. S Thayalasekaran1,
  3. N Helmut2,
  4. R Kiesslich3,
  5. S Sanduleanu4
  1. 1Endoscopy, Queen Alexandra Hospital, Portsmouth, UK
  2. 2Endoscopy, Erlangen-Nuremberg, Erlangen
  3. 3Endoscopy, Klinikum der Landeshauptstadt Wiesbaden und der HELIOS Kliniken Gruppe, Wiesbaden, Germany
  4. 4Endoscopy, Maastricht University Medical Centre, Maastricht, Netherlands

Abstract

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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