The Experts below are selected from a list of 2655 Experts worldwide ranked by ideXlab platform
Xavier Bessa - One of the best experts on this subject based on the ideXlab platform.
-
Narrow-band imaging and high-definition White-Light Endoscopy in patients with serrated lesions not fulfilling criteria for serrated polyposis syndrome: a randomized controlled trial with tandem colonoscopy
BMC gastroenterology, 2020Co-Authors: Fausto Riu Pons, Montserrat Andreu, Marco Antonio Alvarez-gonzalez, Josep Maria Dedeu, Dolores Naranjo, Agustín Seoane, Luis Barranco, Xavier BessaAbstract:It is unknown whether narrow-band imaging (NBI) could be more effective than high-definition White-Light Endoscopy (HD-WLE) in detecting serrated lesions in patients with prior serrated lesions > 5 mm not completely fulfilling serrated polyposis syndrome (SPS) criteria. We conducted a randomized, cross-over trial in consecutive patients with prior detection of at least one serrated polyp ≥10 mm or ≥ 3 serrated polyps larger than 5 mm, both proximal to the sigmoid colon. Five experienced endoscopists performed same-day tandem colonoscopies, with the order being randomized 1:1 to NBI—HD-WLE or HD-WLE—NBI. All tandem colonoscopies were performed by the same endoscopist. We included 41 patients. Baseline characteristics were similar in the two cohorts: NBI—HD-WLE (n = 21) and HD-WLE—NBI (n = 20). No differences were observed in the serrated lesion detection rate of NBI versus HD-WLE: 47.4% versus 51.9% (OR 0.84, 95% CI: 0.37–1.91) for the first and second withdrawal, respectively. Equally, no differences were found in the polyp miss rate of NBI versus HD-WLE: 21.3% versus 26.1% (OR 0.77, 95% CI: 0.43–1.38). Follow-up colonoscopy in nine patients (22%) allowed them to be reclassified as having SPS. In patients with previous serrated lesions, the serrated lesion detection rate was similar with NBI and HD-WLE. A shorter surveillance colonoscopy interval increases the detection of missed serrated polyps and could change the diagnosis of SPS in approximately one in every five patients. ClinicalTrials.gov NCT02406547, registered on April 2, 2015.
-
Narrow band imaging and White Light Endoscopy in the characterization of a polypectomy scar: A single-blind observational study.
World journal of gastroenterology, 2018Co-Authors: Fausto Riu Pons, Montserrat Andreu, Javier Gimeno Beltran, Marco Antonio Alvarez-gonzalez, Agustín Seoane Urgorri, Josep Maria Dedeu, Luis Barranco Priego, Xavier BessaAbstract:Narrow band imaging and White Light Endoscopy in the characterization of a polypectomy scar: A single-blind observational study
Pradeep Bhandari - One of the best experts on this subject based on the ideXlab platform.
-
OC-045 High Definition White Light Endoscopy and I-Scan for small Colonic Polyp Evaluation : Results of the Hiscope Study
Gut, 2013Co-Authors: Peter J. Basford, Gaius Longcroft-wheaton, Bernard Higgins, Pradeep BhandariAbstract:Introduction Standard definition White Light Endoscopy is inadequate for in-vivo characterisation of small colonic polyps. The ASGE has identified prediction of polyp surveillance intervals and negative predictive value for adenomatous histology of diminutive recto-sigmoid polyps as key targets for new technologies. High definition White Light Endoscopy is now available but there is little data on it’s use. Methods We aimed to examine the in-vivo characterisation accuracy of high definition White Light Endoscopy (HDWL) plus a novel electronic imaging modality – i-Scan (Pentax, Japan). Patients undergoing colonoscopy through the UK Bowel Cancer Screening Programme were prospectively recruited. All colonoscopies were performed by a single expert endoscopist with extensive experience in in-vivo diagnosis. Procedures were performed with Pentax EC-3890Li 1.2 Megapixel HD+ colonoscopes and EPKi processor. An initial classification & validation exercise was carried out to determine the optimum i-Scan settings for in-vivo diagnosis, and to develop a novel in-vivo diagnosis assessment tool. All polyps Results 84 patients were recruited, in whom 209 polyps Conclusion Excellent in vivo diagnostic accuracy, in excess of 90% can be achieved with HDWL alone. No significant gains in accuracy over HDWL were noted with i-Scan when used with a 1.2Megapixel HD colonoscope Both HDWL and i-Scan fulfil the ASGE criteria for ‘resect and discard’ and ‘do not resect’ strategies for diminutive polyps Disclosure of Interest None Declared
-
Tu1482 High Definition White Light Endoscopy and I-SCAN for in-Vivo Characterisation of Small Colonic Polyps: No Need to Push the Button
Gastrointestinal Endoscopy, 2013Co-Authors: Peter J. Basford, Gaius Longcroft-wheaton, Pradeep BhandariAbstract:a conventional image, the lesion was each observed by NBI magnification. The diagnosis of NBI magnification was based on Sano’s classification. Also irregular findings of microvessels including “caliber change of microvessel” (CCM), “long irregular vessel” (LIV) and “decline of microvessel density” (DMD) were analyzed. When type V pit pattern was suspected, the lesion was observed after crystal-violet dye-stain. The diagnosis of chromoendoscopic magnification was based on Kudo’s classification. Both capillary pattern and pit pattern were compared with final histological diagnosis. This study was performed retrospectively and consecutively. Histological diagnosis on resected specimen was determined according to Vienna classification. Submucosal massively invasive cancer (SM-M) was defined as an invasive depth greater than 1000 m. Results: As to histological diagnoses, there were 380 intramucosal cancers, 60 submucosal sLightly invasive cancers, and 81 cancers with submucosal massively invasion. The values of the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) and accuracy of type IIIB for the diagnosis of SM-M were 70.4%, 98.6%, 90.5%, 94.8% and 94.3%, respectively. Those of VI highly irregular and VN were 81.5%, 98.4%, 90.4%, 96.7% and 95.8%, respectively. Type IIIB was observed in 19 (73.1%) of 26 protruded type SM-M, 8 (40.0%) of 20 flat type SM-M and 30 (85.7%) of 35 depressed type SM-M. The values of specificity of CCM, LIV and DMD for the diagnosis of SM-M were 99.1%, 99.8% and 99.5%, respectively. CCM was observed in 14 (51.9%) of 26 protruded type SM-M. And DMD were observed in 23 (67.6%) of 35 depressed type SM-M. Conclusion: NBI magnification would have clinical advantage to diagnose the invasion depth of early colorectal cancers. Submucosal massively invasive cancers had characteristic irregular findings that depended on the morphological type. These irregular findings had high specificity for the diagnosis of submucosal massively invasive cancers. Tu1482 High Definition White Light Endoscopy and I-SCAN for in-Vivo Characterisation of Small Colonic Polyps: No Need to Push the Button Peter J. Basford*, Gaius R. Longcroft-Wheaton, Pradeep Bhandari Gastroenterology, Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom Introduction: Standard definition White Light Endoscopy is inadequate for in-vivo characterisation of small colonic polyps. ChromoEndoscopy and electronic imaging techniques are shown to improve accuracy. The ASGE has identified prediction of polyp surveillance intervals and negative predictive value for adenomatous histology of diminutive recto-sigmoid polyps as key targets for new technologies. High definition White Light Endoscopy incorporating charge coupled device chips with resolution in excess of 1 million pixels are now available but there is little data on their use. Aims&Methods: We aimed to examine the in-vivo characterisation accuracy of high definition White Light Endoscopy (HDWL) plus a novel electronic imaging modality i-Scan (Pentax, Japan). Patients undergoing colonoscopy through the UK Bowel Cancer Screening Programme were prospectively recruited. All colonoscopies were performed by a single expert endoscopist with extensive experience in in-vivo diagnosis. Procedures were performed with Pentax EC-3890Li 1.2 Megapixel HD colonoscopes and EPKi processor. An initial classification & validation exercise was carried out to determine the optimum i-Scan settings for in-vivo diagnosis, and to develop a novel in-vivo diagnosis assessment tool. All polyps 10mm in size were assessed sequentially with HDWL and i-Scan. Optical magnification was not used. Predicted histology (non-neoplastic, adenoma, cancer) was recorded for both modalities and compared to the final histopathological diagnosis as reported by an expert gastrointestinal pathologist. Predictions were rated as high or low confidence assessments. Results were analysed for sensitivity and specificity for neoplasia, overall accuracy, and negative predictive value for rectosigmoid polyps 5mm as recommended by the ASGE PIVI statement. Results: 84 patients were recruited, in whom 209 polyps 10mm were included. Mean polyp diameter was 4.3mm, median 4mm. 134 polyps were neoplastic and 75 non-neoplastic. There were no significant differences in sensitivity (95.5% vs 97.0%) and specificity (89.3% vs 90.7%) for neoplasia and overall diagnostic accuracy (93.3% vs 94.7%) between HDWL and i-Scan. Negative predictive value for adenomatous histology of rectosigmoid polyps 5mm was 100% with both modalities. Polyp surveillance intervals using in-vivo assessment of diminutive polyps were correct in 95% and 97% of patients with HDWL and i-Scan respectively. Conclusion: 1) Excellent in vivo diagnostic accuracy, in excess of 90% can be achieved with HDWL alone.2) No significant gains in accuracy over HDWL were noted with i-Scan when used with a 1.2Megapixel HD colonoscope therefore, there is no need to push the button or spray dye to improve accuracy. 3) Both HDWL and i-Scan fulfill the ASGE criteria for ‘resect and discard’ and ‘do not resect’ strategies for diminutive polyps
Christopher J. Hawkey - One of the best experts on this subject based on the ideXlab platform.
-
Comparison of high definition with standard White Light Endoscopy for detection of dysplastic lesions during surveillance colonoscopy in patients with colonic inflammatory bowel disease.
Inflammatory bowel diseases, 2013Co-Authors: Venkataraman Subramanian, Christopher J. Hawkey, Vidyasagar Ramappa, E Telakis, Jayan Mannath, A Jawhari, Krish RagunathAbstract:Introduction Dysplasia in colonic inflammatory bowel disease (IBD) is often multifocal and flat, making it easy for significant lesions to be overlooked. Dye spraying the mucosal surface is believed to enhance visualisation of subtle mucosal abnormalities, but is cumbersome and messy and has poor uptake among endoscopists. High definition (HD) colonoscopy improves adenoma detection rates by improving the ability to detect subtle mucosal changes and is as good as chromoEndoscopy in polyp detection. The utility of high definition colonoscopy in dysplasia detection in patients with IBD has not been reported so far. The authors aimed to compare the yield of dysplastic lesions detected by standard definition White Light Endoscopy (SD) with high definition Endoscopy (HD). Methods Details of consecutive patients with long standing (>7 years) colonic IBD who underwent surveillance colonoscopy at Nottingham University Hospitals between September 2008 and February 2010 were extracted from the Endoscopy database. Details of diagnosis, duration of disease and outcomes of the colonoscopy were then collected from the electronic patient records and patient notes. The colonoscopies were done at 2 sites, of which one had only HD systems and the other SD. SPSS v17 was used for the data analysis. Results 360 colonoscopies were done on 353 patients. There were 162 colonoscopies (102 UC and 60 CD) in the SD group and 208 colonoscopies (146 UC and 62 CD), in the HD group. The groups were well matched for mean age of patients, duration of disease, gender and number of biopsies taken. Table 1 gives information on the number and characterisation of dysplastic lesions detected. Conclusion HD colonoscopy is superior to SD colonoscopy in targeted detection of dysplastic lesions during surveillance colonoscopy of patients with colonic IBD in routine clinical practice. HD colonoscopy could facilitate endoscopic resection in these patients. Randomised controlled studies are required to confirm these findings.
-
Comparison of narrow band imaging with high resolution White Light Endoscopy for the assessment of non-steroidal anti-inflammatory drug induced gastroduodenal injury
Gut, 2011Co-Authors: Venkataraman Subramanian, Krish Ragunath, Vidyasagar Ramappa, E Telakis, Jayan Mannath, M Desai, M Wireko, Christopher J. HawkeyAbstract:Introduction The diagnosis of NSAID induced gastroduodenal injury is often associated with difficulties in determination of the degree of injury. The Lanza score and its many modifications are commonly used in clinical trials, but are considered subjective and susceptible to errors in interpretation. The aim of this study was to determine the inter-observer variability in assessing NSAID induced gastroduodenal injury among endoscopists with and without experience in narrow band imaging (NBI) using both high resolution White Light Endoscopy (HR-WLE) and NBI. Methods Corresponding NBI and HR-WLE images were taken during Endoscopy from healthy volunteers taking different NSAID preparations. Six blinded endoscopists (three experts in NBI imaging) counted the number of ulcers, erosions and haemorrhagic lesions to derive a five point modified Lanza scale and evaluated image quality on a 10 point visual analogue score (VAS). Overall agreement and κ value with bias corrected 95% CIs using bootstrapping techniques were calculated to assess interobserver reliability. Results The inter-observer agreement (κ) with HR-WLE among all six endoscopists was 0.62 (95% CI 0.52 to 0.72), which improved significantly with NBI to 0.76 (95% CI 0.69 to 0.84, p=0.02). The inter-observer agreement among expert endoscopists with HR-WLE was ‘substantial’ (κ=0.75, 95% CI 0.63 to 0.87) and improved with NBI to ‘almost perfect agreement (κ=0.87, 95% CI 0.78 to 0.95, p=0.06) which almost reached statistical significance. The inter-observer agreement among non-expert endoscopists with HR-WLE was ‘moderate’ (κ=0.54, 95% CI 0.42 to 0.67) and significantly improved with NBI to ‘substantial’ (κ=0.72, 95% CI 0.60 to 0.82, p=0.02). Non-expert endoscopists found significantly higher number of mucosal haemorrhages on NBI images (p=0.03). VAS scores for NBI images were higher than HR-WLE for experts while the opposite was true for non-experts. VAS scores for NBI images were however consistently higher than HR-WLE when the paired images were presented side by side. Conclusion Inter-observer reliability between both expert and non-expert endoscopists for assessment of NSAID induced injury is better with NBI than HR-WLE images. NBI imaging improves the visualisation of mucosal haemorrhages especially in non-expert endoscopists.
-
Meta-analysis: the diagnostic yield of chromoEndoscopy for detecting dysplasia in patients with colonic inflammatory bowel disease
Alimentary pharmacology & therapeutics, 2010Co-Authors: Venkataraman Subramanian, Krish Ragunath, Jayan Mannath, Christopher J. HawkeyAbstract:Aliment Pharmacol Ther 2011; 33: 304–312 Summary Background Dysplasia in inflammatory bowel disease (IBD) is often multifocal and flat. Dye spraying is believed to enhance visualisation of subtle mucosal abnormalities. Aim To perform a meta-analysis of the published studies to compare the diagnostic yield of dysplastic lesions in patients with IBD undergoing surveillance colonoscopy between chromoEndoscopy and standard White Light Endoscopy. Methods We searched electronic databases for full journal articles reporting on chromoEndoscopy in patients with IBD. Pooled incremental yield of chromoEndoscopy over White Light Endoscopy for dysplasia detection was determined. A fixed effects model was used unless there was significant heterogeneity. Publication bias was assessed using Funnel plots or Egger’s test. Results Six studies involving 1277 patients provided data on a number of dysplastic lesions detected. The difference in yield of dysplasia between chromoEndoscopy and White Light Endoscopy was 7% (95% CI 3.2–11.3) on a per patient analysis with an NNT of 14.3. The difference in proportion of lesions detected by targeted biopsies was 44% (95% CI 28.6–59.1) and flat lesions was 27% (95% CI 11.2–41.9) in favour of chromoEndoscopy. Conclusions ChromoEndoscopy is significantly better than White Light Endoscopy in detecting dysplasia in patients with colonic IBD. This holds true for all dysplastic lesions, proportion of targeted lesions and proportion of flat lesions detected.
-
White Light Endoscopy, narrow band imaging and chromoEndoscopy with magnification in diagnosing colorectal neoplasia
World journal of gastrointestinal endoscopy, 2009Co-Authors: Rajvinder Singh, Victoria Owen, Anthony Shonde, Philip Kaye, Christopher J. Hawkey, Krish RagunathAbstract:AIM: To evaluate the sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of 3 different techniques: high resolution White Light Endoscopy (WLE), Narrow Band Imaging (NBI) and ChromoEndoscopy (CHR), all with magnification in differentiating adenocarcinomas, adenomatous and hyperplastic colorectal polyps. METHODS: Each polyp was sequentially assessed first by WLE, followed by NBI and finally by CHR. Digital images of each polyp with each modality were taken and stored. Biopsies or polypectomies were then performed followed by blinded histopathological analysis. Each image was blindly graded based on the Kudo’s pit pattern (KPP). In the assessment with NBI, the mesh brown capillary network pattern (MBCN) of each polyp was also described. The Sn, Sp, PPV and NPV of differentiating hyperplastic (Type I & II-KPP, Type I-MBCN) adenomatous (Types III, IV-KPP, Type II-MBCN) and carcinomatous polyps (Type V-KPP, Type III-MCBN) was then compared with reference to the final histopathological diagnosis. RESULTS: A total of 50 colorectal polyps (5 adenocarcinomas, 38 adenomas, 7 hyperplastic) were assessed. CHR and NBI [KPP, MBCN or the combined classification (KPP & MBCN)] were superior to WLE in the prediction of polyp histology (P < 0.001, P = 0.002, P = 0.001 and P < 0.001, respectively). NBI, using the MBCN pattern or the combined classification showed higher numerical accuracies compared to CHR, but this was not statistically significant (P = 0.625, 0.250). CONCLUSION: This feasibility study demonstrated that this combined classification with NBI could potentially be useful in routine clinical practice, allowing the endoscopist to predict histology with higher accuracies using a less cumbersome and technically less challenging method.
-
Comparison of high-resolution magnification narrow-band imaging and White-Light Endoscopy in the prediction of histology in Barrett's oesophagus.
Scandinavian journal of gastroenterology, 2009Co-Authors: Rajvinder Singh, Haris Karageorgiou, Victoria Owen, Klara Garsed, Paul J. Fortun, Edward Fogden, Venkataraman Subramaniam, Anthony Shonde, Philip Kaye, Christopher J. HawkeyAbstract:Objective. To evaluate whether there is any appreciable difference in imaging characteristics between high-resolution magnification White-Light Endoscopy (WLE-Z) and narrow-band imaging (NBI-Z) in Barrett's oesophagus (BE) and if this translates into superior prediction of histology. Material and methods. This was a prospective single-centre study involving 21 patients (75 areas, corresponding NBI-Z and WLE-Z images) with BE. Mucosal patterns (pit pattern and microvascular morphology) were evaluated for their image quality on a visual analogue scale (VAS) of 1–10 by five expert endoscopists. The endoscopists then predicted mucosal morphology based on four subtypes which can be visualized in BE. Type A: round pits, regular microvasculature; type B: villous/ridge pits, regular microvasculature; type C: absent pits, regular microvasculature; type D: distorted pits, irregular microvasculature. The sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and accuracy...
Fausto Riu Pons - One of the best experts on this subject based on the ideXlab platform.
-
Narrow-band imaging and high-definition White-Light Endoscopy in patients with serrated lesions not fulfilling criteria for serrated polyposis syndrome: a randomized controlled trial with tandem colonoscopy
BMC gastroenterology, 2020Co-Authors: Fausto Riu Pons, Montserrat Andreu, Marco Antonio Alvarez-gonzalez, Josep Maria Dedeu, Dolores Naranjo, Agustín Seoane, Luis Barranco, Xavier BessaAbstract:It is unknown whether narrow-band imaging (NBI) could be more effective than high-definition White-Light Endoscopy (HD-WLE) in detecting serrated lesions in patients with prior serrated lesions > 5 mm not completely fulfilling serrated polyposis syndrome (SPS) criteria. We conducted a randomized, cross-over trial in consecutive patients with prior detection of at least one serrated polyp ≥10 mm or ≥ 3 serrated polyps larger than 5 mm, both proximal to the sigmoid colon. Five experienced endoscopists performed same-day tandem colonoscopies, with the order being randomized 1:1 to NBI—HD-WLE or HD-WLE—NBI. All tandem colonoscopies were performed by the same endoscopist. We included 41 patients. Baseline characteristics were similar in the two cohorts: NBI—HD-WLE (n = 21) and HD-WLE—NBI (n = 20). No differences were observed in the serrated lesion detection rate of NBI versus HD-WLE: 47.4% versus 51.9% (OR 0.84, 95% CI: 0.37–1.91) for the first and second withdrawal, respectively. Equally, no differences were found in the polyp miss rate of NBI versus HD-WLE: 21.3% versus 26.1% (OR 0.77, 95% CI: 0.43–1.38). Follow-up colonoscopy in nine patients (22%) allowed them to be reclassified as having SPS. In patients with previous serrated lesions, the serrated lesion detection rate was similar with NBI and HD-WLE. A shorter surveillance colonoscopy interval increases the detection of missed serrated polyps and could change the diagnosis of SPS in approximately one in every five patients. ClinicalTrials.gov NCT02406547, registered on April 2, 2015.
-
Narrow band imaging and White Light Endoscopy in the characterization of a polypectomy scar: A single-blind observational study.
World journal of gastroenterology, 2018Co-Authors: Fausto Riu Pons, Montserrat Andreu, Javier Gimeno Beltran, Marco Antonio Alvarez-gonzalez, Agustín Seoane Urgorri, Josep Maria Dedeu, Luis Barranco Priego, Xavier BessaAbstract:Narrow band imaging and White Light Endoscopy in the characterization of a polypectomy scar: A single-blind observational study
Venkataraman Subramanian - One of the best experts on this subject based on the ideXlab platform.
-
PWE-046 Eye Tracking Assessment Suggests Faster Time To Detection And Greater Attention Span For Dysplastic Lesions With Autofluoresence Compared To White Light Endoscopy
Gut, 2014Co-Authors: J Ariyaratnam, Noor Mohammed, Venkataraman SubramanianAbstract:Introduction Surveillance Endoscopy is crucial to the management of Barrett’s oesophagus to diagnose and treat dysplasia. Recent studies have confirmed that increased time of inspection of the Barrett’s mucosa increases detection rates. However increasing inspection time has both clinical and economic implications. Advanced imaging techniques like autofluoresence imaging (AFI) improves detection of dysplastic lesions, but little on known about the time taken to detect abnormalities with these modalities. Methods We presented a series of endoscopic images of dysplastic lesions within the oesophagus to novice endoscopists on a computer screen. Each of the 10 lesions was presented in White Light Endoscopy (WLE) and AFI modes. The subjects reviewed these images in a random order with 10 seconds for each image. They were tasked with identifying the lesion as fast as possible and fixating on it for the duration of presentation. An eye tracking system (Grinbath eye tracker, College Station Texas) was used to record eye movements of the subjects and we calculated the amount of time it took to fixate on the lesion and the percentage attention time on each lesion. Results A total of 26 novice endoscopists were recruited to the study, resulting in a total of 260 presentations of WLE images and 260 presentations of AFI images. The average time to fixation on the lesion was significantly less (p Conclusion AFI reduces time to detection in novice endoscopists and could be a valuable training tool for trainees to improve their skills in detecting dysplasa in a time efficient manner. Advanced imaging endoscopic techniques may therefore help trainee endoscopists more than experienced endoscopists. Disclosure of Interest None Declared.
-
Comparison of high definition with standard White Light Endoscopy for detection of dysplastic lesions during surveillance colonoscopy in patients with colonic inflammatory bowel disease.
Inflammatory bowel diseases, 2013Co-Authors: Venkataraman Subramanian, Christopher J. Hawkey, Vidyasagar Ramappa, E Telakis, Jayan Mannath, A Jawhari, Krish RagunathAbstract:Introduction Dysplasia in colonic inflammatory bowel disease (IBD) is often multifocal and flat, making it easy for significant lesions to be overlooked. Dye spraying the mucosal surface is believed to enhance visualisation of subtle mucosal abnormalities, but is cumbersome and messy and has poor uptake among endoscopists. High definition (HD) colonoscopy improves adenoma detection rates by improving the ability to detect subtle mucosal changes and is as good as chromoEndoscopy in polyp detection. The utility of high definition colonoscopy in dysplasia detection in patients with IBD has not been reported so far. The authors aimed to compare the yield of dysplastic lesions detected by standard definition White Light Endoscopy (SD) with high definition Endoscopy (HD). Methods Details of consecutive patients with long standing (>7 years) colonic IBD who underwent surveillance colonoscopy at Nottingham University Hospitals between September 2008 and February 2010 were extracted from the Endoscopy database. Details of diagnosis, duration of disease and outcomes of the colonoscopy were then collected from the electronic patient records and patient notes. The colonoscopies were done at 2 sites, of which one had only HD systems and the other SD. SPSS v17 was used for the data analysis. Results 360 colonoscopies were done on 353 patients. There were 162 colonoscopies (102 UC and 60 CD) in the SD group and 208 colonoscopies (146 UC and 62 CD), in the HD group. The groups were well matched for mean age of patients, duration of disease, gender and number of biopsies taken. Table 1 gives information on the number and characterisation of dysplastic lesions detected. Conclusion HD colonoscopy is superior to SD colonoscopy in targeted detection of dysplastic lesions during surveillance colonoscopy of patients with colonic IBD in routine clinical practice. HD colonoscopy could facilitate endoscopic resection in these patients. Randomised controlled studies are required to confirm these findings.
-
Comparison of narrow band imaging with high resolution White Light Endoscopy for the assessment of non-steroidal anti-inflammatory drug induced gastroduodenal injury
Gut, 2011Co-Authors: Venkataraman Subramanian, Krish Ragunath, Vidyasagar Ramappa, E Telakis, Jayan Mannath, M Desai, M Wireko, Christopher J. HawkeyAbstract:Introduction The diagnosis of NSAID induced gastroduodenal injury is often associated with difficulties in determination of the degree of injury. The Lanza score and its many modifications are commonly used in clinical trials, but are considered subjective and susceptible to errors in interpretation. The aim of this study was to determine the inter-observer variability in assessing NSAID induced gastroduodenal injury among endoscopists with and without experience in narrow band imaging (NBI) using both high resolution White Light Endoscopy (HR-WLE) and NBI. Methods Corresponding NBI and HR-WLE images were taken during Endoscopy from healthy volunteers taking different NSAID preparations. Six blinded endoscopists (three experts in NBI imaging) counted the number of ulcers, erosions and haemorrhagic lesions to derive a five point modified Lanza scale and evaluated image quality on a 10 point visual analogue score (VAS). Overall agreement and κ value with bias corrected 95% CIs using bootstrapping techniques were calculated to assess interobserver reliability. Results The inter-observer agreement (κ) with HR-WLE among all six endoscopists was 0.62 (95% CI 0.52 to 0.72), which improved significantly with NBI to 0.76 (95% CI 0.69 to 0.84, p=0.02). The inter-observer agreement among expert endoscopists with HR-WLE was ‘substantial’ (κ=0.75, 95% CI 0.63 to 0.87) and improved with NBI to ‘almost perfect agreement (κ=0.87, 95% CI 0.78 to 0.95, p=0.06) which almost reached statistical significance. The inter-observer agreement among non-expert endoscopists with HR-WLE was ‘moderate’ (κ=0.54, 95% CI 0.42 to 0.67) and significantly improved with NBI to ‘substantial’ (κ=0.72, 95% CI 0.60 to 0.82, p=0.02). Non-expert endoscopists found significantly higher number of mucosal haemorrhages on NBI images (p=0.03). VAS scores for NBI images were higher than HR-WLE for experts while the opposite was true for non-experts. VAS scores for NBI images were however consistently higher than HR-WLE when the paired images were presented side by side. Conclusion Inter-observer reliability between both expert and non-expert endoscopists for assessment of NSAID induced injury is better with NBI than HR-WLE images. NBI imaging improves the visualisation of mucosal haemorrhages especially in non-expert endoscopists.
-
Meta-analysis: the diagnostic yield of chromoEndoscopy for detecting dysplasia in patients with colonic inflammatory bowel disease
Alimentary pharmacology & therapeutics, 2010Co-Authors: Venkataraman Subramanian, Krish Ragunath, Jayan Mannath, Christopher J. HawkeyAbstract:Aliment Pharmacol Ther 2011; 33: 304–312 Summary Background Dysplasia in inflammatory bowel disease (IBD) is often multifocal and flat. Dye spraying is believed to enhance visualisation of subtle mucosal abnormalities. Aim To perform a meta-analysis of the published studies to compare the diagnostic yield of dysplastic lesions in patients with IBD undergoing surveillance colonoscopy between chromoEndoscopy and standard White Light Endoscopy. Methods We searched electronic databases for full journal articles reporting on chromoEndoscopy in patients with IBD. Pooled incremental yield of chromoEndoscopy over White Light Endoscopy for dysplasia detection was determined. A fixed effects model was used unless there was significant heterogeneity. Publication bias was assessed using Funnel plots or Egger’s test. Results Six studies involving 1277 patients provided data on a number of dysplastic lesions detected. The difference in yield of dysplasia between chromoEndoscopy and White Light Endoscopy was 7% (95% CI 3.2–11.3) on a per patient analysis with an NNT of 14.3. The difference in proportion of lesions detected by targeted biopsies was 44% (95% CI 28.6–59.1) and flat lesions was 27% (95% CI 11.2–41.9) in favour of chromoEndoscopy. Conclusions ChromoEndoscopy is significantly better than White Light Endoscopy in detecting dysplasia in patients with colonic IBD. This holds true for all dysplastic lesions, proportion of targeted lesions and proportion of flat lesions detected.
