I-scan for Adenoma Detection

This is a randomized controlled trial comparing the use of i-scan (digital surface and
contrast enhancement of the mucosa) versus standard high-definition white light for the
detection of conventional adenomas and sessile serrated adenomas/polyps. Recent studies have
indicated that colonoscopy is more effective in preventing cancer in the left side of the
colon than the right side of the colon. The reasons for this difference may be partly
biologic, in that a special group of polyps known as sessile serrated adenomas/polyps (SSA)
are located primarily proximal to the splenic flexure. Sessile serrated adenomas/polyps share
molecular features with a group of cancers that occur primarily in the proximal colon. These
molecular features include CpG island methylator phenotype (CIMP) and microsatellite
instability. These lesions are endoscopically subtle in that they are often flat, have the
same color as the surrounding mucosa, and are hard to differentiate from normal mucosa.
Recent studies have shown that image enhanced endoscopy can highlight the appearance of these
lesions. This study will test whether i-scan increases the detection of conventional adenomas
and sessile serrated adenomas/polyps in a randomized controlled trial.

Inclusion Criteria:

- Age 50-75

- Intact colon and rectum

- Willing to sign an informed consent form

Exclusion Criteria:

- Subjects less than 50 years of age or greater than 75 years of age

- Subjects who are in the inpatient unit

- Subjects with diverticulitis,

- Subjects with inflammatory bowel disease

- Subjects with polyposis syndromes

- Subjects with previous surgical resection of any portion of the colon or rectum

- Subjects referred for endoscopic resection of previously diagnosed colorectal polyp