Hyperplastic polyposis syndrome: a pilot study for the differentiation of polyps by using high-resolution endoscopy, autofluorescence imaging, and narrow-band imaging

Background: Endoscopic differentiation and removal of potentially premalignant sessile serrated adenomas (SSAs) may be important steps in preventing the development of colorectal cancer in hyperplastic polyposis syndrome (HPS). Objective: To assess the value of high-resolution endoscopy, autofluorescence imaging (AFI), and narrow-band imaging (NBI) for differentiating polyps in HPS, Design: A prospective polyp series. Setting: Single tertiary referral center. Patients and Interventions: Seven patients with HPS underwent colonoscopy with endoscopic trimodal imaging, which incorporates high-resolution endoscopy, AFI, and NBI in I system. All detected polyps were analyzed with AFI for color and with NBI for Kudo pit pattern and vascular pattern intensity. Main Outcome Measurements: The accuracy, sensitivity,, and specificity of AFI and NBI in differentiating detected polyps were determined by using histology as the criterion standard. Results: A total of 19 hyperplastic polyps (HPs), 32 SSAs, and 15 adenomas were detected. For differentiating SSAs from HPs, AFI color, Kudo pit pattern, and vascular pattern intensity resulted in a diagnostic accuracy of 55%, 55%, and 52%, respectively For differentiating adenomas from HPs, the accuracy was 65%, 94%, and 90%, respectively Macroscopically, the combination of a size of 3 mm or larger and a proximal location resulted in the highest accuracy (76%) for differentiating SSAs from HPs. Limitation: Small sample size. Conclusion: Endoscopic differentiation between HPs and SSAs by using endoscopic trimodal imaging proved unsatisfactory Differentiation of adenomas from HPs was possible with NBI but not With AFI. (Gastrointest Endosc 2009;70:947-55.)