Elsevier

Gastrointestinal Endoscopy

Volume 70, Issue 5, November 2009, Pages 947-955
Gastrointestinal Endoscopy

Original article
Clinical endoscopy
Hyperplastic polyposis syndrome: a pilot study for the differentiation of polyps by using high-resolution endoscopy, autofluorescence imaging, and narrow-band imaging

https://doi.org/10.1016/j.gie.2009.03.1172Get rights and content

Background

Endoscopic differentiation and removal of potentially premalignant sessile serrated adenomas (SSAs) may be important steps in preventing the development of colorectal cancer in hyperplastic polyposis syndrome (HPS).

Objective

To assess the value of high-resolution endoscopy, autofluorescence imaging (AFI), and narrow-band imaging (NBI) for differentiating polyps in HPS.

Design

A prospective polyp series.

Setting

Single tertiary referral center.

Patients and Interventions

Seven patients with HPS underwent colonoscopy with endoscopic trimodal imaging, which incorporates high-resolution endoscopy, AFI, and NBI in 1 system. All detected polyps were analyzed with AFI for color and with NBI for Kudo pit pattern and vascular pattern intensity.

Main Outcome Measurements

The accuracy, sensitivity, and specificity of AFI and NBI in differentiating detected polyps were determined by using histology as the criterion standard.

Results

A total of 19 hyperplastic polyps (HPs), 32 SSAs, and 15 adenomas were detected. For differentiating SSAs from HPs, AFI color, Kudo pit pattern, and vascular pattern intensity resulted in a diagnostic accuracy of 55%, 55%, and 52%, respectively. For differentiating adenomas from HPs, the accuracy was 65%, 94%, and 90%, respectively. Macroscopically, the combination of a size of 3 mm or larger and a proximal location resulted in the highest accuracy (76%) for differentiating SSAs from HPs.

Limitation

Small sample size.

Conclusion

Endoscopic differentiation between HPs and SSAs by using endoscopic trimodal imaging proved unsatisfactory. Differentiation of adenomas from HPs was possible with NBI but not with AFI.

Section snippets

Study population

This study was conducted at the Academic Medical Center Amsterdam and was approved by the local medical ethics committee. Consecutive patients with HPS were invited to participate when fulfilling the criteria for HPS in accordance with the World Health Organization: (1) at least 5 histologically confirmed HPs proximal to the sigmoid colon, of which 2 are greater than 10 mm in diameter, or (2) more than 30 HPs distributed throughout the colon.35 Patients younger than 18 years of age or patients

Results

From January 2005 to July 2006, 7 patients (5 men, 2 women) who met the criteria for HPS underwent colonoscopy with ETMI. The median age of all patients was 55.8 years (range 54-71 years). At colonoscopy, all patients had good to moderate bowel preparation. A total of 66 polyps (19 HPs, 32 SSAs, and 15 tubular adenomas) were detected as well as 10 additional lesions displaying normal mucosa on histology (excluded from the analysis). Macroscopic polyp characteristics are summarized in Table 1.

Discussion

In this study, SSAs were significantly larger and more often proximally located than HPs, but the latter finding has its nominal significance removed by Bonferroni correction for multiple testing of data. This is in concordance with recent comparative studies in which sporadic SSAs were also found to be larger than sporadic HPs and preferentially located in the right colon, whereas HPs were more often found distally.12, 18, 42 Interestingly, in our study, the combination of a size of 3 mm or

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    DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: F.J.C. van den Broek is supported by an unrestricted educational grant from Olympus Medical Systems, Hamburg, Germany. P. Fockens has received a research grant from Olympus Inc, Tokyo, Japan. Olympus Medical Systems provided the Department of Gastroenterology at our institution with endoscopic equipment for this study. All other authors disclosed no financial relationships relevant to this publication.

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