Development and validation of a simple classification system for in vivo diagnosis of colorectal polyps using the newly introduced Optical Enhancement (OE) technology

Introduction: Most recently, Optical enhancement (OE) has been introduced as a novel endoscopic imaging technique that adjusts emitted light to enhance mucosal vascular pattern and surface pattern morphology. This study assessed for the first time the utility of OE to predict colorectal polyp histology.

Aims: Primary objective was the development and validation of a simple classification system allowing differentiation of hyperplasic and adenomatous colorectal lesions by using OE.

Material and methods: In the first phase, the capacity of experienced endoscopists to predict the histology of colorectal polyps was assessed. In the second phase, a simplified classification system was developed allowing histologic prediction of colorectal polyps. Thirdly, the validity of the classification was evaluated among inexperienced raters, including medical students, nurses and GI fellows. At least, a pilot clinical evaluation was performed during real-time colonoscopy.

Results: A simple classification system for differentiation of hyperplasic and adenomatous colorectal lesions by using OE was developed and validated. Diagnosis was made in 85% of hyperplastic and 90% of adenomatous polyps with high-confidence. Sensitivity ranged from 92% to 96% and specificity ranged from 86% to 93%, respectively. During real-time colonoscopy, diagnosis was made with high-confidence in 90% of polyps with sensitivity of 96%, specificity of 92%, and accuracy of 95%. Positive and negative predictive values were 96% and 93%, respectively.

Conclusion: For the first time a simple and effective classification system for differentiation of hyperplasic and adenomatous colorectal lesions by using the newly introduced OE-technology was developed and validated. These findings now need to be evaluated in future prospective, controlled, and blinded clinical trials.