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Original article
Endoscopic versus histological characterisation of polyps during screening colonoscopy
  1. Guido Schachschal1,
  2. Michael Mayr2,
  3. Andras Treszl3,
  4. Klaus Balzer3,
  5. Karl Wegscheider3,
  6. Jens Aschenbeck2,
  7. Alireza Aminalai2,
  8. Rolf Drossel2,
  9. Andreas Schröder2,
  10. Mathias Scheel2,
  11. Carl-Hermann Bothe4,
  12. Jens-Peter Bruhn4,
  13. Wolfgang Burmeister4,
  14. Gabriela Stange1,
  15. Christina Bähr1,
  16. Ralf Kießlich5,
  17. Thomas Rösch1
  1. 1Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
  2. 2Private Gastroenterology Practices, Berlin, Germany
  3. 3Department of Statistics and Epidemiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
  4. 4Private Gastroenterology Practices, Hamburg, Germany
  5. 5Department of Gastroenterology, University Hospital Mainz, Germany
  1. Correspondence to Professor Thomas Rösch, Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany; t.roesch{at}


Background As screening colonoscopy becomes more widespread, the costs for histopathological assessment of resected polyps are rising correspondingly. Reference centres have published highly accurate results for endoscopic polyp classification. Therefore, it has been proposed that, for smaller polyps, the differential diagnosis that guides follow-up recommendations could be based on endoscopy alone.

Objective The aim was to prospectively assess whether the high accuracy for endoscopic polyp diagnosis as reported by reference centres can be reproduced in routine screening colonoscopy.

Design Ten experienced private practice endoscopists had initial training in pit patterns. Then they assessed all polyps detected during 1069 screening colonoscopies. Patients (46% men; mean age 63 years) were randomly assigned to colonoscopy with conventional or latest generation HDTV instruments. The main outcome measure was diagnostic accuracy of in vivo polyp assessment (adenomatous vs hyperplastic). Secondary outcome measures were differences between endoscopes and reliability of image-based follow-up recommendations; a blinded post hoc analysis of polyp photographs was also performed.

Results 675 polyps were assessed (461 adenomatous, 214 hyperplastic). Accuracy, sensitivity and specificity of in vivo diagnoses were 76.6%, 78.1% and 73.4%; size of adenomas and endoscope withdrawal time significantly influenced accuracy. Image-based recommendations for post-polypectomy surveillance were correct in only 69.5% of cases. Post hoc analysis of polyp photographs did not improve accuracy.

Conclusions In everyday practice, endoscopic classification of polyp type is not accurate enough to abandon histopathological assessment and use of latest generation colonoscopes does not improve this. Image-based surveillance recommendations after polypectomy would consequently not meet guideline requirements.

TrialRegNo NCT01297712.

  • Colorectal Adenomas
  • Colonic Polyps
  • Differentiation
  • Screening

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