Efficacy of computed virtual chromoendoscopy on colorectal cancer screening: a prospective, randomized, back-to-back trial of Fuji Intelligent Color Enhancement versus conventional colonoscopy to compare adenoma miss rates

Abstract

Background: Colonoscopy is the criterion standard for screening of colorectal neoplasms. Nonetheless, a substantial miss rate with conventional, white-light colonoscopy (WL) remains a challenge.

Objective: To assess whether Fuji Intelligent Color Enhancement (FICE) can detect more adenomas than WL in screening colonoscopy.

Design: Prospective, randomized trial of tandem colonoscopy adjusted for withdrawal time and lavage effect.

Setting: Seoul National University Hospital Healthcare System Gangnam Center, Korea.

Patients: This study involved 359 average-risk adults undergoing screening colonoscopy.

Intervention: Patients were randomized to the first withdrawal with either FICE (FICE-WL group) or WL (WL-FICE group).

Main outcome measurements: The primary end point measure was the difference in adenoma miss rates, and the secondary outcome measure was the adenoma detection rate.

Results: We enrolled 359 patients (mean age 50.6 years, male 66.9%) and randomly assigned 181 to the WL-FICE group and 178 to the FICE-WL group. The number of adenomas detected by FICE and WL was 123 and 107, respectively. The adenoma miss rate with FICE showed no significant difference compared with that of WL (6.6% vs 8.3%, P = .59). Characteristics of lesions missed by use of FICE were similar to those missed by use of WL; 93% of overall missed polyps were < or =5 mm, and none were > or =1 cm. All missed adenomas were low grade and nonpedunculated. There was no significant difference between FICE and WL in adenoma detection rate (mean 0.64 vs 0.55 per patient, P = .65) nor percentage of patients with > or =1 adenoma (33.7% vs 30.4%, P = .74).

Limitations: Single-center study.

Conclusion: FICE at screening colonoscopy did not improve the adenoma miss rate or detection rate compared with WL.