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Detect InSpect ChAracterise Resect and Discard 2 (DISCARD2)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01603927
Recruitment Status : Unknown
Verified May 2012 by South Tyneside and Sunderland NHS Foundation Trust.
Recruitment status was:  Not yet recruiting
First Posted : May 23, 2012
Last Update Posted : May 23, 2012
University of Durham
Information provided by (Responsible Party):
South Tyneside and Sunderland NHS Foundation Trust

Brief Summary:

Bowel cancer is a common disorder in the UK. Most cancers happen when a type of polyp, called an adenoma, becomes cancerous. Polyps are growths in the large bowel that can be cancerous, non-cancerous, or pre-cancerous (adenoma). Polyps are most commonly detected during colonoscopy (camera test of the lower bowel). The removal of adenomas has been shown to reduce the subsequent risk of bowel cancer. Current practice is that all polyps are removed or biopsied to allow a laboratory diagnosis (histology). This is important as it influences if and when patients require follow-up colonoscopies, known as the surveillance interval. Patients with only non-cancerous polyps do not need surveillance.

A new blue light technology, called narrow band imaging (NBI), used during colonoscopy can help colonoscopists (doctor or nurse performing the procedure)differentiate between polyp types during colonoscopy. NBI is currently available in a large number of UK endoscopy units however is variably used. Studies from 'expert' centres have demonstrated that NBI allows accurate optical diagnosis of colonic polyps. Benefits of optical diagnosis include avoiding removal of non-cancerous polyps and an immediate (on the day) diagnosis for the patient including the surveillance interval.

The primary aim of this study is to evaluate the accuracy with which colonoscopists assess the required surveillance interval using optical diagnosis when compared with histology in non-expert centres. The investigators will invite 2500 patients, who have been referred for colonoscopy, to participate. Patients will undergo a routine colonoscopy the only addition being the use of NBI during the procedure. Colonoscopists will provide an optical diagnosis at the time of colonoscopy in addition to polyp removal or biopsy.

The investigators will compare surveillance intervals provided using optical diagnosis with the diagnosis from histology and thereby the accuracy with which colonoscopists can use the technology. The investigators will also calculate the cost savings to the NHS.

Condition or disease Intervention/treatment
Colonic Polyps Device: Narrow band imaging for 'optical diagnosis' of colonic polyps (Olympus).

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Study Type : Observational
Estimated Enrollment : 2500 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: Detect InSpect ChAracterise Resect and Discard 2
Study Start Date : June 2012
Estimated Primary Completion Date : June 2013
Estimated Study Completion Date : December 2013

Resource links provided by the National Library of Medicine

Group/Cohort Intervention/treatment
Colonoscopy with Narrow band imaging (NBI)
All patients attending for routine colonoscopies performed for the diagnosis of symptoms or asymptomatic screening.
Device: Narrow band imaging for 'optical diagnosis' of colonic polyps (Olympus).
Colonoscopists will narrow band imaging to provide an 'optical diagnosis' for colonic polyps found during routine colonoscopies performed for the diagnosis of symptoms or asymptomatic screening.

Primary Outcome Measures :
  1. The sensitivity NBI optical diagnosis in determining colonoscopy surveillance intervals. [ Time Frame: 12 months ]
    The proportion of individuals requiring surveillance colonoscopy (according to British Society of Gastroenterology Guidelines)that are correctly identified by NBI optical diagnosis (test sensitivity).

Secondary Outcome Measures :
  1. The sensitivity, specificity and accuracy of optical diagnosis on a per polyp basis. [ Time Frame: 12 months ]
    Sensitivity, specificity and accuracy of optical diagnosis on a per-polyp basis

  2. The learning curve and maintenance of accuracy of optical diagnosis. [ Time Frame: 12 months ]
    Learning curve and maintenance of quality of optical diagnosis measured by proportion of polyps/patients diagnosed with high/low confidence.

  3. The economic implications of replacing histological assessment with optical diagnosis. [ Time Frame: 12 months ]
    Potential cost saving of optical diagnosis

  4. Description of the population undergoing routine colonoscopy and prevalence of polyps and polyp type. [ Time Frame: 12 months ]
    Proportion of patients with no polyps, small polyps, large polyps, categorised by age, gender and polyps type.

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
Patients attending for routine diagnostic or screening colonoscopy.

Inclusion Criteria:

Phase 1

  1. Patients able to provide valid informed consent.
  2. Patients over 18 years of age.
  3. Patients attending for routine colonoscopy.

Phase 2

  1. Patient fulfils inclusion criteria for phase 1.
  2. Patients with one or more polyps under 10mm detected at colonoscopy.
  3. Patients undergoing a complete colonoscopy confirmed by photo documentation of caecal landmarks.

Exclusion Criteria:

  1. Patients with known inflammatory bowel disease (ulcerative colitis of Crohns disease) or known polyposis syndromes.
  2. Patients who lack capacity to give informed consent as assessed by the clinical study team member taking consent.
  3. Patients who are known to be pregnant (self-reported).

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01603927

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Contact: Colin J Rees, MBBS, FRCP (0191) 4041000 ext 4028
Contact: Praveen T Rajasekhar, MBChB BMedSci MRCP (0191) 4041000 ext 2899

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United Kingdom
County Durham and Darlington NHS Foundation Trust
Darlington, County Durham, United Kingdom, DL3 6HX
Contact: John G Silcock, MBBS, FRCP   
Principal Investigator: John G Silcock, MBBS, FRCP         
North Cumbria University Hospitals NHS Trust
Carlisle, Cumbria, United Kingdom, CA2 7HY
Contact: Chris E MacDonald, MBBS FRCP    01228 814184   
Principal Investigator: Chris E MacDonald, MBBS FRCP         
Northumbria Healthcare NHS Trust
Ashington, Northumberland, United Kingdom, NE63 9JJ
Contact: Anthoor Jayaprakash   
Principal Investigator: Anthoor Jayaprakash         
South Tees NHS Trust
Middlesbrough, Teeside, United Kingdom, TS4 3BW
Contact: Arvind Ramadas, MBBS, MRCP   
Principal Investigator: Arvind Ramadas, MBBS, MRCP         
North Tees and Hartlepool NHS Foundation Trust
Stockton-on-Tees, Teeside, United Kingdom, TS19 8PE
Contact: Matthew D Rutter, MBChB MD    +44(0)1642 624557   
Principal Investigator: Matthew D Rutter, MBChB MD         
Sponsors and Collaborators
South Tyneside and Sunderland NHS Foundation Trust
University of Durham
National Bowel Cancer Audit 2009 NBOCAP Available at:
Lee TJW, Rutter MD, Blanks, RG et al. Colonoscopy quality measure: experience from the NHS Bowel Cancer Screening Programme. Gut 2011. Available at:
World Health Organisation. World Health Organisation classification of tumours:pathology and genetics of tumours of the digestive system. Lyon: IARC press. 2000.
NHS Bowel Cancer Screening Programme: Quality Assurance Guidelines for Colonoscopy. Andrew Chilton and Matt Rutter. March 2010. Available at:

Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: South Tyneside and Sunderland NHS Foundation Trust Identifier: NCT01603927    
Other Study ID Numbers: DISCARD2
PB-PG-1010-23222 ( Other Grant/Funding Number: NHS National Institute for Health Research )
First Posted: May 23, 2012    Key Record Dates
Last Update Posted: May 23, 2012
Last Verified: May 2012
Additional relevant MeSH terms:
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Colonic Polyps
Intestinal Polyps
Pathological Conditions, Anatomical