Detection and removal of colonic adenomas is a cornerstone in the prevention of colorectal carcinoma. However, a significant portion of adenomas remain undetected during index colonoscopy, that could lead to interval carcinoma. Many factors play a role, including patient characteristics, bowel preparation, investigator experience, and the technical features of the colonoscopy device. This study aimed to evaluate whether a new introduced advanced endoscopic system featuring ultra–high-resolution imaging fulfils the required adenoma detection rate in a real-world setting at a tertiary care hospital in Germany.

Fifty consecutive patients undergoing screening colonoscopy between May 2025 and October 2025 were examined using the new AOHUA AQ-300 4K UHD Endoscopy System. All examinations were performed with high-definition white-light endoscopy followed by virtual chromoendoscopy. The system was launched in 2022 as one of the first 4K ultra-high-definition imaging system with a 4K display and 4K processor. There are four virtual chromoendoscopy modes, enabled by a 5-LED light source, which significantly improves image brightness. In our study we used only one of the integrated CBI modes.

The patient population was highly heterogeneous, aiming to reproduce a real-world scenario of colorectal carcinoma screening. The reasons for hospital-based screening included incomplete colonoscopy in an ambulatory setting or comorbidities with a high risk of periprocedural complications. The study population included 20 female and 30 male patients, with a mean age of 65 years. Bowel preparation was performed using a standard polyethylene glycol (PEG) formula, and the quality of bowel preparation was documented using standardised scale. Terminal ileum could not be reached in only one of the fifty patients. All colonoscopies were performed by the same experienced investigator.

Out of the 50 patients we screened, adenomas were detected in 20, corresponding to an adenoma detection rate (ADR) of 40% in our study population. In all patients with detected lesions, we used CBI to predict if a lesion is dysplastic or not. We detected altogether 56 lesions. Each lesion was endoscopically removed and histologically examined. Of the 44 lesions predicted as dysplastic, dysplasia was confirmed in 28. Of the 12 lesions predicted as non-dysplastic, 8 lesions were histologically confirmed as non-dysplastic. The virtual chromoendoscopy mode CBI demonstrated a sensitivity of 87 % and the negative predictive value (NPV) in our cohort was 66%.

With these results, the ADR in our study was higher than the average reported in Germany, suggesting a potential improvement in patient outcomes. The diagnostic performance of the evaluated CBI mode in predicting dysplasia was moderate.

The primary focus of this first study using the new AOHUA AQ-300 4K UHD Endoscopy System was the adenoma detection rate (ADR), as current European guidelines recommend only the routine use of high-definition white-light endoscopy systems in this population. Whether the additional application of chromoendoscopy, and moreover the use of all four available chromoendoscopy modes, could further enhance diagnostic accuracy warrants investigation in future studies with a larger cohort.