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Endoscopy 2009; 41(4): 316-322
DOI: 10.1055/s-0028-1119628
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Chromocolonoscopy detects more adenomas than white light colonoscopy or narrow band imaging colonoscopy in hereditary nonpolyposis colorectal cancer screening

R.  Hüneburg1 , F.  Lammert1 , 4 , C.  Rabe1 , N.  Rahner2 , P.  Kahl3 , R.  Büttner3 , P.  Propping2 , T.  Sauerbruch1 , C.  Lamberti1 , 5
  • 1Department of Internal Medicine I, University of Bonn, Bonn, Germany
  • 2Institute of Human Genetics, University of Bonn, Bonn, Germany
  • 3Institute of Pathology, University of Bonn, Bonn, Germany
  • 4Department of Internal Medicine II, University of Homburg, Homburg, Germany
  • 5Department of Internal Medicine, Klinikum Coburg, Coburg, Germany
Further Information

Publication History

submitted4 July 2008

accepted after revision3 December 2008

Publication Date:
01 April 2009 (online)

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Background and study aims: Individuals carrying germline mutations in one of the genes responsible for hereditary nonpolyposis colon cancer (HNPCC) have a lifetime risk of up to 80 % of developing colorectal cancer. As there is evidence for a higher incidence of flat adenomatous precursors and because an accelerated adenoma–carcinoma sequence has been postulated for these patients, early detection of these lesions is essential. It was the aim of the present study to assess the detection rate of polypoid lesions by comparing chromocolonoscopy with standard white light colonoscopy and narrow-band imaging (NBI) colonoscopy.

Patients and methods: 109 patients were included (98 with a functionally relevant mutation in a mismatch repair gene, 11 fulfilling the strict Amsterdam criteria). In 47 patients, standard colonoscopy was followed by chromocolonoscopy with indigo carmine. In 62 patients, NBI was performed first followed by chromocolonoscopy.

Results: A total of 128 hyperplastic and 52 adenomatous lesions were detected. In the first series, 0.5 lesions/patient were identified by standard colonoscopy and 1.5 lesions/patient by chromocolonoscopy (P < 0.001). In the second series, 0.7 lesions/patient were detected by NBI colonoscopy and 1.8 lesions/patient by chromocolonoscopy (P = 0.01). At least one adenoma was detected in 15 % of patients by both standard and NBI colonoscopy compared with 28 % of patients by chromocolonoscopy.

Conclusion: According to this study, chromocolonoscopy detects significantly more hyperplastic and, in particular, adenomatous lesions than standard white light colonoscopy or NBI.

References

  • 1 de la Chapelle A. The incidence of Lynch syndrome.  Fam Cancer. 2005;  4 233-237
    CrossrefPubMedGoogle Scholar
  • 2 Vogelstein B, Fearon E R, Hamilton S R. et al . Genetic alterations during colorectal-tumor development.  N Engl J Med. 1988;  319 525-532
    CrossrefPubMedGoogle Scholar
  • 3 Burke W, Petersen G, Lynch P. et al . Recommendations for follow-up care of individuals with an inherited predisposition to cancer. I. Hereditary nonpolyposis colon cancer. Cancer Genetics Studies Consortium.  JAMA. 1997;  277 915-919
    CrossrefPubMedGoogle Scholar
  • 4 Bradshaw N, Holloway S, Penman I. et al . Colonoscopy surveillance of individuals at risk of familial colorectal cancer.  Gut. 2003;  52 1748-1751
    CrossrefPubMedGoogle Scholar
  • 5 Jarvinen H J, Aarnio M, Mustonen H. et al . Controlled 15-year trial on screening for colorectal cancer in families with hereditary nonpolyposis colorectal cancer.  Gastroenterology. 2000;  118 829-834
    CrossrefPubMedGoogle Scholar
  • 6 Mecklin J, Jarvinen H. Treatment and follow-up strategies in hereditary nonpolyposis colorectal carcinoma.  Dis Colon Rectum. 1993;  36 927-929
    CrossrefPubMedGoogle Scholar
  • 7 Winawer S, Fletcher R, Rex D. et al . Colorectal cancer screening and surveillance: clinical guidelines and rationale-Update based on new evidence.  Gastroenterology. 2003;  124 544-560
    CrossrefPubMedGoogle Scholar
  • 8 Lindor N M, Petersen G M, Hadley D W. et al . Recommendations for the care of individuals with an inherited predisposition to Lynch Syndrome: a systematic review.  JAMA. 2006;  296 1507-1517
    CrossrefPubMedGoogle Scholar
  • 9 Rex D, Cutler C, Lemmel G. et al . Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies.  Gastroenterology. 1997;  112 24-28
    CrossrefPubMedGoogle Scholar
  • 10 Hixson L, Fennerty M, Sampliner R. et al . Prospective study of the frequency and size distribution of polyps missed by colonoscopy.  J Natl Cancer Inst. 1990;  82 1769-1772
    CrossrefPubMedGoogle Scholar
  • 11 Hixson L, Fennerty M, Sampliner R, Garewal H. Prospective blinded trial of the colonoscopic miss-rate of large colorectal polyps.  Gastrointest Endosc. 1991;  37 125-127
    CrossrefPubMedGoogle Scholar
  • 12 Waye J, Lewis B, Frankel A, Geller S. Small colon polyps.  Am J Gastroenterol. 1988;  83 120-122
    PubMedGoogle Scholar
  • 13 van Rijn J C, Reitsma J B, Stoker J. et al . Polyp miss rate determined by tandem colonoscopy: a systematic review.  Am J Gastroenterol. 2006;  101 343-350
    CrossrefPubMedGoogle Scholar
  • 14 DeFrancisco J, Grady W. Diagnosis and management of hereditary non-polyposis colon cancer.  Gastrointest Endosc. 2003;  58 390-408
    CrossrefPubMedGoogle Scholar
  • 15 Trecca A, Fujii T, Kato S. et al . Small advanced colorectal adenocarcinomas: report on three cases.  Endoscopy. 1998;  30 493-495
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Rijcken F, Hollema H, Kleibeuker J. Proximal adenomas in hereditary non-polyposis colorectal cancer are prone to rapid malignant transformation.  Gut. 2002;  50 382-386
    CrossrefPubMedGoogle Scholar
  • 17 Watanabe T, Muto T, Sawada T, Miyaki M. Flat adenoma as a precursor of colorectal carcinoma in hereditary nonpolyposis colorectal carcinoma.  Cancer. 1996;  77 627-634
    CrossrefPubMedGoogle Scholar
  • 18 Jass J. Hyperplastic polyps and colorectal cancer: is there a link?.  Clin Gastroenterol Hepatol. 2004;  2 1-8
    CrossrefPubMedGoogle Scholar
  • 19 Vasen H F, Nagengast F M, Khan P M. Interval cancers in hereditary non-polyposis colorectal cancer (Lynch syndrome).  Lancet. 1995;  345 1183-1184
    CrossrefPubMedGoogle Scholar
  • 20 Brooker J, Saunders B, Shah S. et al . Total colonic dye-spray increases the detection of diminutive adenomas during routine colonoscopy: a randomized controlled trial.  Gastrointest Endosc. 2002;  56 333-338
    CrossrefPubMedGoogle Scholar
  • 21 Hurlstone D, Cross S, Adam I. et al . Efficacy of high magnification chromoscopic colonoscopy for the diagnosis of neoplasia in flat and depressed lesions of the colorectum: a prospective analysis.  Gut. 2004;  53 284-290
    CrossrefPubMedGoogle Scholar
  • 22 Hurlstone D, Cross S, Adam I. et al . A prospective clinicopathological and endoscopic evaluation of flat and depressed colorectal lesions in the United Kingdom.  Am J Gastroenterol. 2003;  98 2543-2549
    CrossrefPubMedGoogle Scholar
  • 23 Kiesslich R, von Bergh M, Hahn M. et al . Chromoendoscopy with indigocarmine improves the detection of adenomatous and nonadenomatous lesions in the colon.  Endoscopy. 2001;  33 1001-1006
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Rembacken B, Fujii T, Cairns A. et al . Flat and depressed colonic neoplasms: a prospective study of 1000 colonoscopies in the UK.  Lancet. 2000;  355 1211-1214
    CrossrefPubMedGoogle Scholar
  • 25 Tsuda S, Veress B, Toth E, Fork F. Flat and depressed colorectal tumours in a southern Swedish population: a prospective chromoendoscopic and histopathological study.  Gut. 2002;  51 550-555
    CrossrefPubMedGoogle Scholar
  • 26 Saitoh Y, Waxman I, West A. et al . Prevalence and distinctive biologic features of flat colorectal adenomas in a North American population.  Gastroenterology. 2001;  120 1657-1665
    CrossrefPubMedGoogle Scholar
  • 27 Hurlstone D, Karajeh M, Cross S. et al . The role of high-magnification-chromoscopic colonoscopy in hereditary nonpolyposis colorectal cancer screening: a prospective “back-to-back” endoscopic study.  Am J Gastroenterol. 2005;  100 2167-2173
    CrossrefPubMedGoogle Scholar
  • 28 Lecomte T, Cellier C, Meatchi T. et al . Chromoendoscopic colonoscopy for detecting preneoplastic lesions in hereditary nonpolyposis colorectal cancer syndrome.  Clin Gastroenterol Hepatol. 2005;  3 897-902
    CrossrefPubMedGoogle Scholar
  • 29 Gono K, Obi T, Yamaguchi M. et al . Appearance of enhanced tissue features in narrow-band endoscopic imaging.  J Biomed Opt. 2004;  9 568-577
    CrossrefPubMedGoogle Scholar
  • 30 Su M, Hsu C, Ho Y. et al . Comparative study of conventional colonoscopy, chromoendoscopy, and narrow-band imaging systems in differential diagnosis of neoplastic and nonneoplastic colonic polyps.  Am J Gastroenterol. 2006;  101 2711-2716
    CrossrefPubMedGoogle Scholar
  • 31 Chiu H, Chang C, Chen C. et al . A prospective comparative study of narrow-band imaging, chromoendoscopy, and conventional colonoscopy in the diagnosis of colorectal neoplasia.  Gut. 2007;  56 373-379
    CrossrefPubMedGoogle Scholar
  • 32 Hirata M, Tanaka S, Oka S. et al . Evaluation of microvessels in colorectal tumors by narrow band imaging magnification.  Gastrointest Endosc. 2007;  66 945-952
    CrossrefPubMedGoogle Scholar
  • 33 Machida H, Sano Y, Hamamoto Y. et al . Narrow-band imaging in the diagnosis of colorectal mucosal lesions: a pilot study.  Endoscopy. 2004;  36 1094-1098
    Google Scholar
  • 34 Matsumoto T, Kudo T, Jo Y. et al . Magnifying colonoscopy with narrow band imaging system for the diagnosis of dysplasia in ulcerative colitis: a pilot study.  Gastrointest Endosc. 2007;  66 957-965
    CrossrefPubMedGoogle Scholar
  • 35 East J E, Suzuki N, Stavrinidis M. et al . Narrow band imaging for colonoscopic surveillance in hereditary non-polyposis colorectal cancer.  Gut. 2008;  57 65-70
    CrossrefPubMedGoogle Scholar
  • 36 Tischendorf J, Wasmuth H, Koch A. et al . Value of magnifying chromoendoscopy and narrow band imaging (NBI) in classifying colorectal polyps: a prospective controlled study.  Endoscopy. 2007;  39 1092-1096
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Kudo S. Endoscopic mucosal resection of flat and depressed types of early colorectal cancer.  Endoscopy. 1993;  25 455-461
    Article in Thieme ConnectPubMedGoogle Scholar
  • 38 Hurlstone D, Fujii T, Lobo A. Early detection of colorectal cancer using high-magnification chromoscopic colonoscopy.  Br J Surg. 2002;  89 272-282
    CrossrefPubMedGoogle Scholar
  • 39 Schlemper R, Riddell R, Kato Y. et al . The Vienna classification of gastrointestinal epithelial neoplasia.  Gut. 2000;  47 251-255
    CrossrefPubMedGoogle Scholar
  • 40 Dekker E, van den Broek F, Reitsma J. et al . Narrow-band imaging compared with conventional colonoscopy for the detection of dysplasia in patients with longstanding ulcerative colitis.  Endoscopy. 2007;  39 216-221
    Article in Thieme ConnectPubMedGoogle Scholar
  • 41 Adler A, Pohl H, Papanikolaou I. et al . A prospective randomized study on narrow-band imaging versus conventional colonoscopy for adenoma detection: does NBI induce a learning effect?.  Gut. 2008;  57 59-64
    CrossrefPubMedGoogle Scholar
  • 42 Rex D, Helbig C. High yields of small and flat adenomas with high-definition colonoscopes using either white light or narrow band imaging.  Gastroenterology. 2007;  133 42-47
    CrossrefPubMedGoogle Scholar
  • 43 Kaltenbach T, Friedland S, Soetikno R. A randomized tandem colonoscopy trial of narrow band imaging versus white light examination to compare neoplasia miss rates.  Gut. 2008;  57 1406-1412
    CrossrefPubMedGoogle Scholar
  • 44 Goecke T, Schulmann K, Engel C. et al . Genotype-phenotype comparison of German MLH1 and MSH2 mutation carriers clinically affected with Lynch syndrome: a report by the German HNPCC Consortium.  J Clin Oncol. 2006;  24 4285-4292
    CrossrefPubMedGoogle Scholar
  • 45 Pellisé M, Fernández-Esparrach G, Cárdenas A. et al . Impact of wide-angle, high-definition endoscopy in the diagnosis of colorectal neoplasia: a randomized controlled trial.  Gastroenterology. 2008;  135 1062-1068
    CrossrefPubMedGoogle Scholar

T. SauerbruchMD 

Department of Internal Medicine I
University of Bonn

Sigmund-Freud Straße 25
D-53115 Bonn
Germany

Fax: +49-228-28714322

Email: tilman.sauerbruch@ukb.uni-bonn.de

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