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High Definition Is Still the Only Way to Go

Douglas K. Rex, MD, FASGE, reviewing Tziatzios G, et al. Gastrointest Endosc 2020 Jan 15.

Previous meta-analyses have suggested that the use of high-definition (HD) colonoscopy produces small gains in the adenoma detection rate (ADR). In an updated meta-analysis that identified 6 randomized controlled trials involving 4594 individuals with a mixture of indications, the ADR was 40% with HD colonoscopy versus 35% with standard-definition colonoscopy. The advanced adenoma detection rate had a relative risk of 1.33, the sessile serrated lesion (SSL) detection rate had a relative risk of 1.55, and both reached significance. Mean numbers of adenomas, advanced adenomas, and SSLs per colonoscopy did not reach significance. The quality of the evidence was low.

HD is important not only for detection, but it also helps with differentiation of serrated lesions versus adenomas, identification of endoscopic signs of cancer, delineation of lesion margins, and completeness of resection during initial resection and in assessing resection sites at follow-up. Although the effect on ADR here is modest, and actually slightly lower than the effect observed with devices such as Endocuff Vision, there currently seems to be no rationale for purchasing endoscopes that are not HD.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Douglas K. Rex, MD, FASGE


Tziatzios G, Gkolfakis P, Lazaridis LD, et al. High-definition colonoscopy for improving adenoma detection: a systematic review and meta-analysis of randomized controlled studies. Gastrointest Endosc 2020 Jan 15. (Epub ahead of print) (

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