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Multicentre randomised controlled trial comparing standard and high resolution optical technologies in colorectal cancer screening
  1. Simona Di Caro1,
  2. Lucia Fini2,
  3. Roser Vega1,
  4. Konstantinos C Fragkos1,
  5. Sunil Dolwani3,
  6. John Green3,
  7. Lesley-Ann Smith4,
  8. Conrad Beckett4,
  9. Ewen Cameron5,
  10. Matthew Banks1
  1. 1 GI Services, University College London Hospitals NHS Foundation Trust, London, UK
  2. 2 Department of Internal Medicine, Gastroenterology and Digestive Endoscopy Unit, Ospedale di Busto Arsizio, Busto Arsizio, Italy
  3. 3 Gastroenterology, Cardiff and Vale NHS Trust, Cardiff, UK
  4. 4 Department of Gastroenterology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
  5. 5 Department of Gastroenterology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  1. Correspondence to Dr Matthew Banks, GI Services, University College London Hospitals NHS Foundation Trust, London NW1 2PG, UK; matthew.banks2{at}


Background and objectives The UK bowel cancer screening programme (BCSP) has been established for the early detection of colorectal cancer offering colonoscopy to patients screened positive by faecal occult blood tests. In this multisite, prospective, randomised controlled trial, we aimed to compare the performance of Standard Definition Olympus Lucera (SD-OL) with Scope Guide and the High Definition Pentax HiLine (HD-PHL).

Patients and methods Subjects undergoing a colonoscopy as part of the UK National BCSP at four UK sites were randomised to an endoscopy list run using either SD-OL or HD-PHL. Primary endpoints were polyp and adenoma detection rate (PDR and ADR, respectively) as well as polyp size, morphology and histology characteristics.

Results 262 subjects (168 males, mean age 66.3±4.3 years) were colonoscoped (133 patients with HD-PHL while 129 with SD-OL). PDR and ADR were comparable within the two optical systems. The HD-PHL group resulted in a PDR 55.6% and ADR 43.6%; the SD-OL group had PDR 56.6% and ADR 45.7%. HD-PHL was significantly superior to SD-OL in detection of flat adenomas (18.6% vs 5.2%, p<0.001), but not detection of pedunculated or sessile polyps. Patient comfort, use of sedation and endoscopist perception of procedural difficulty resulted similar despite the use of Scope Guide with SD-OL.

Conclusion PDR and ADR were not significantly different between devices. The high-resolution colonoscopy system HD-PHL may improve polyp detection as compared with standard resolution technology in detecting flat adenomas. This advantage may have clinically significant implications for missed lesion rates and post-colonoscopy interval colorectal cancer rates.

  • polyp detection rate
  • bowel cancer screening
  • olympus lucera
  • pentax hiline
  • colonoscopy
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  • Contributors SDC designed the study, analysed the data and contributed to writing the manuscript. LF, RV and KCF analysed the data and contributed to writing the manuscript. SD, JG, L-AS, CB and EC helped design the study, provided data and helped writing the manuscript. MB designed and supervised the study, provided data, helped with analysis and wrote the manuscript.

  • Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. University College London sponsors this study.

  • Competing interests Pentax Medical have funded other projects at UCLH but no funding was provided directly for this study.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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