الفهرس 
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Abstract
I-Scan (Pentax, Tokyo, Japan) is a digital contrast system that uses post-processing computer algorithms combined with a standard high-definition (HD) processor to enhance visualization of the mucosal epithelial surface pattern and vascular pattern that forms the basis for in vivo diagnosis of lesions. It is a type of image enhancement technology that can assist the in vivo distinction between hyperplastic and adenomatous polyps. Colorectal polyp is any tissue mass arise from intestinal wall and protruding into the lumen. It is mainly benign growths but malignant transformation remains a major concern so, polypectomy can interrupt process from adenoma to carcinoma and it is the effective treatment to prevent colorectal cancer. The aim of this work was to detect the accuracy of i-scan as virtual (electronic) chromo endoscopy versus conventional colonoscopy for early detection of dysplastic changes in colorectal polyps among Egyptian patients. This was a hospital based Cross sectional study that was conducted at Hepato-Gastroenterology Unit (Endoscopy Unit), Specialized Medical Hospital, Mansoura University after approval of the Medical Ethics and Research Committee at Mansoura University. Out of 260 patients attended to the Endoscopy Unit for colonoscopy during the period from January 2018- January 2019 only 100 adult patients full filled the inclusion criteria but polyps were detected in only 40 case. The present study concluded that there were many risk factors for development of colorectal polyps like: aging (mean age /years was 55.1 and SD 14.18) gender, diabetes mellitus. There was statistically significant higher frequency of DM among cases with I-scan KUDO III-IV-V. There was statistically significant higher frequency of diabetes among cases diagnosed with dysplasia (64% versus 13.3 % for cases without dysplasia). Patients with colorectal polyps may complain of abdominal pain, weight loss, fatigue, constipation and rectal bleeding, iron deficiency anemia, distension and chronic diarrhea. There was statistically significance between bleeding per rectum (p value o.003), pallor (p value 0.013), fatigue (p value 0.013), and dyschasia (p value 0.014), as clinical presentation of colorectal polyp, so if there is any of these symptoms, rapid assessment, accurate diagnosis is essential. No statistically significant difference between I-scan KUDO classification regarding their clinical presentation among studied cases. There was no statistically significant difference between studied cases with & without dysplasia and their clinical presentation. In the present study there was change in distribution of colon polyps as ascending colon was the main site in the present study. In the present study median WBCS count was 6650, mean hemoglobin level was 10.99 gm/dl, the mean MCV was 76.44, means MCH 24.71 and median platelet count was 304000.Median ESR at first hour and second hour were 30.0& 52.5 respectively. Median CEA was 1.1 ranging from 1 to 1.8, 50% were CRP positive, 27.5%were positive occult blood in stool and only 10% were HCV +ve, none of the studied cases were positive for HBV or HIV infections, 22.5% were positive for bilharziasis, There was statistically significant higher values among Kudo III-IV-V than Kudo I-II as regard WBCs, ESR-1st h, ESR-2nd h and CEA. In the present study there was statistically significant higher mean & median values among cases with dysplasia regarding median platelet count mean ESR-1st h& 2nd h and median CEA and positive CRP. In the present study the highest sensitivity detected for the studied laboratory results in predicting dysplasia was for CEA (88.0%) and the highest specificity was detected for ESR 1st h, 2nd h &CEA (66.7%). In the present study the highest sensitivity detected for the studied laboratory results in differentiating kudo III-IV-V from kudo I-II was detected for ESR 2nd hour and the highest specificity was detected for platelet count. In the present study main histopathological types detected were tubulo-villous adenoma and hyperplastic polyp. The present study revealed that in protruded lesions 61.2% of cases had adenoma (19.4% were tubular adenoma, 19.4% were tubulo villous adenoma, 16.1% were villous adenoma &6.5%were sessile serrated adenoma). It also showed that in flattened lesions 71.4% of cases had adenoma (28.6% were tubulo villous, 28.6% were sessile serrated adenoma& 14.3% were tubular adenoma, and in flattened elevated lesions 50% of cases had tubulo villous adenoma. In the present study there was statistically significant association between dysplasia and histopathological types a percent of dysplasia was 100% in villous, tubulovillous, tubular& sessile serrated adenoma and 0% in hyperplastic, inflammatory, bilharizial & retension. In the present study there was no statistically significant association between polyp site, number, Paris and histopathological types among cases, but there was statistically significant association between polyp size, kudo pit pattern I-scan and histopathological types among studied cases. In the present study there was statistically significant difference between KUDO classification and polyp size. The present study showed that polyps without dysplasia were mainly kudo I-II (86.7%), while polyps with dysplasia were kudo III-IV-V (100%). The present study revealed that there is no statistically significant difference between cases with & without dysplasia regarding Paris classification, but there was statistically significant difference between cases with &without dysplasia as regard size. In cases with dysplasia 80% had polyp size> 5<10mm&93.3% of polyps with size 1-5mm have no dysplasia. The present study showed that in protruded lesions the main kudo pattern distribution was kudo IV in 10 cases (32%), in flattened lesions the main kudo pattern distribution was kudo III in 4 cases (57.1%), and in flattened elevated lesions the main kudo pattern distribution was kudo I in 1 case (50%) and kudo V in 1 case (50%). The present study illustrated that I-scan provide 95.0% accuracy, 100% sensitivity, 86.7% specificity, 92.6% PPV and 100% NPV in differentiating dysplasia. In the present study there was an excellent agreement between kudo pit pattern and dysplasia detection as kappa agreement =0.890.