Autofluorescence imaging with a transparent hood for detection of colorectal neoplasms: a prospective, randomized trial

BackgroundColonoscopy is one of the most reliable methods for detection of colorectal neoplasms, but conventional colonoscopy can miss some lesions.ObjectiveTo evaluate the efficacy of autofluorescence imaging (AFI) with a transparent hood (TH) for detection of colorectal neoplasms.DesignA 2 × 2 factorial designed, prospective, randomized, controlled trial.SettingThis study was conducted at the Osaka Medical Center for Cancer and Cardiovascular Diseases, a tertiary cancer center.PatientsA total of 561 patients.InterventionsPatients were allocated to 1 of 4 groups: (1) white light imaging (WLI) alone—colonoscopy using WLI without a TH; (2) WLI+TH—colonoscopy using WLI with a TH; (3) AFI alone—colonoscopy using AFI without a TH; and (4) AFI+TH—colonoscopy using AFI with a TH. Eight colonoscopists used each allocated method.Main Outcome MeasurementThe difference in neoplasm detection rate (number of detected neoplasms per patient) between the WLI alone and AFI+TH groups.ResultsNeoplasm detection rate (95% confidence interval) in the AFI+TH group was significantly higher than in the WLI alone group (1.96 [1.50-2.43] vs 1.19 [0.93-1.44]; P = .023, Tukey-Kramer multiple comparison test). Relative detection ratios (95% confidence interval) for polypoid neoplasms based on Poisson regression model were significantly increased by mounting a TH (1.69 [1.34-2.12], P < .001), and relative detection ratios for flat neoplasms were significantly increased by AFI observation (1.83 [1.24-2.71], P = .002).LimitationsOpen trial performed in single cancer referral center.ConclusionAFI colonoscopy with a TH detected significantly more colorectal neoplasms than did conventional WLI colonoscopy without a TH. (Clinical trial registration number: UMIN000001473.)