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Evaluation of Effect of Colonoscopist Experience and Addition of of Mucosal Enhancement Techniques on Detection of Colonic Polyps When Viewing Videotaped Colonoscopic Withdrawals

18 Years
Open (Enrolling)

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Trial Information

Evaluation of Effect of Colonoscopist Experience and Addition of of Mucosal Enhancement Techniques on Detection of Colonic Polyps When Viewing Videotaped Colonoscopic Withdrawals

Colorectal cancer is the second commonest cause of cancer death. In a majority of cases it
is preceeded by a precancerous lesion called an adenoma (commonly known as polyp). Patients
with colitis are at specially high risk of colorectal cancer which is estimated to be 18% at
30 years of disease. Detection and removal of adenomas at colonoscopy has been shown to
reduce the death rate from colorectal cancer. However, despite meticulous examination there
is a "miss rate" for adenomas at colonoscopy with ranges from 6-15% in back-to-back
colonoscopy studies. The nature of the polyps which as well as being pedunculated (cherry
like) can be flat or depressed making them difficult to see and may also contribute to the
"miss rate".

The factors that affect whether an endoscopist sees a polyp are not well studied. Polyp
detection rates vary widely, even amongst experts. Endoscopist experience is assumed to
improve polyp detection rates; however in one study the least experienced endoscopists found
the most polyps. Techniques that highlight lesions advanced in recent years.
Chromoendoscopy, spraying dye on the bowel lining, has been shown to help pick up more
pre-cancerous polyp in one of three studies in normal patients and seems definitely helpful
in colitis. Autofluorescence endoscopy and narrow band imaging use light filters to produce
a false colour image of the bowel lining where polyps stand out. These techniques have been
used with some success in the oesophagus and stomach but little work is available for the
colon. High definition endoscopy produces very clear images and may also help in polyp

This study aims to collect videos of colonoscopy when the colonoscope is being removed. This
is the main time when polyps are looked for. Some videos will have subtle polyps. The study
will re-examine and re-video these areas using one of the techniques which may make polyps
stand out better. The aim is to get videos of polyps with and without each of the techniques
to highlight the lesions in both normal colon and colitis. These videos will then be shown
to endoscopist of differing experience to test if their ability to spot the lesions depends
on experience and to see if techniques to make lesions stand out help them see lesions more

Inclusion Criteria:

- Patients: over 18 years of age, with clinical indication for colonoscopy who are
considered by the endoscopist to be fit for the procedure

- Endoscopists who have started colonoscopy training on a recognised training rotation.
Consultants who perform colonoscopy regularly

Exclusion Criteria:

- patients under 18 years, patients with previous colorectal surgery or known familial
polyposis, patients unable to give informed consent, pregnant patients, patients for
whom coloscope insertion was difficult or uncomfortable, patients whose colon is not
sufficiently cleared of stool, those unwilling to participate

Type of Study:


Study Design:

Allocation: Non-Randomized, Intervention Model: Crossover Assignment, Masking: Open Label, Primary Purpose: Diagnostic

Outcome Measure:

The difference in adenoma detection rate on video between consultants endoscopist vs. trainee endoscopists who have performed more than 200 endoscopies vs. trainee endospopists who have performed less than 200 endoscopies

Principal Investigator

Brian Saunders, MD, FRCP

Investigator Role:

Principal Investigator

Investigator Affiliation:

North West London Hospitals NHS Trust


United Kingdom: National Health Service

Study ID:




Start Date:

October 2005

Completion Date:

Related Keywords:

  • Polyps
  • colonoscopy, chromoendoscopy, autoflurescence, narrow band imaging, high definition endoscopy, colorectal cancer, colitis, polyp, DALM, adenoma, video
  • Polyps