Using image enhancement in colonoscopy to increase detection of colonic polyps

In this study, we aim to compare the adenoma detection rate with Linked Colour Imaging (LCI) in patients undergoing elective colonoscopy at Gold Coast University Hospital. Our overall objective is to demonstrate whether LCI increases the adenoma detection rate compared with high-definition white light (WL; current standard of care). All procedures will be performed by experienced colonoscopists or fellows already familiar with the Fujifilm colonoscopy system which has LCI in-built (ELUXEO, FUJIFILM Co., Tokyo, Japan) and accessible with the simple push of a button. The endoscopes are currently used for routine practice and procedures in our endoscopy unit (including both high-definition white light and LCI). Prior to enrolment of patients, study endoscopists’ baseline adenoma detection rates will be recorded based on data from 100 prior consecutive colonoscopies. Endoscopists will be classified as baseline expert or non-expert adenoma detectors and adenoma detection assessed both according to group and on an individual basis. Each participant will undergo a single colonoscopy. Participants will be randomised once to examination either under LCI or high-definition WL, with both insertion and withdrawal performed using the same modality. All patients will be sedated by anaesthetist-led propofol sedation as is our current practice. Polyps will be evaluated under Blue Light Imaging (BLI) for characteristic features. They will be removed as they are identified (via standard polypectomy techniques) and submitted for pathological examination. Pathology will be utilised to confirm the presence of polyp tissue.