Accuracy of narrow-band imaging in predicting colonoscopy surveillance intervals and histology of distal diminutive polyps: results from a multicenter, prospective trial

Repici, Alessandro; Hassan, Cesare; Radaelli, Franco; Occhipinti, Pietro; Angelis, Claudio De; Romeo, Fabio; Paggi, Silvia; Saettone, Silvia; Cisarò, Fabio; Spaander, Manon; Sharma, Prateek; Kuipers, Ernst J.

doi:10.1016/j.gie.2013.01.035

Cited by 55 publications

(48 citation statements)

References 21 publications

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“…Accordingly, the variability in performance could be attributed to the lack of rigorous training, performance measurement, and periodic performance feedback, suggesting that exhaustive training programs with feedback should be widely implemented and validated among community gastroenterologists in order to achieve PIVI thresholds. This fascinating hypothesis has been indirectly confirmed by the Small Hyperplastic and Adenomatous Reliability Protocol (SHARP) trial [7], which also included endoscopists from the community setting. All endoscopists were required to undergo formal training with a post-training examination before participating in the study; the study produced excellent results in terms of both NBI accuracy and correctness of surveillance.…”

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confidence: 89%

Predictive Narrow-Band Imaging of Colonic Polyps: The Optics Are Good

2018

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In order to assure safe, technically successful examinations and to achieve clinically relevant outcomes, ensuring endoscopic competence is a priority for GI professional societies. When a paradigm shift occurs, as was the case with the Resect and Discard (R&D) strategy for diminutive polyps, a strategy aimed at avoiding the time and expense of recovering and histologically examining diminutive polyps that have little or no malignant potential, enforcing standards is of the utmost importance. Despite the endorsement of both the American and the European Societies for Gastrointestinal Endoscopy (ASGE and ESGE) for real-time endoscopic prediction of histology of diminutive colorectal polyps, the basis for these endorsements are the high-quality standards that need be achieved, including adequate training and monitoring of the involved endoscopists.In this issue of Digestive Diseases and Sciences, GarciaAlonso et al. [1] address the fundamental issues involved with training in the field of optical diagnosis for the histological prediction in diminutive colonic polyps. The authors evaluated whether an ex vivo image-based single session followed by self-education training on 100 lesions, with feedback received after each diagnosis, was able to reach the performance thresholds recommended by the ASGE for < 7 mm polyps. The study involved medical students, untrained in either endoscopy or narrow-band imaging (NBI), whose progress was evaluated by the learning curve cumulative summation (LC-CUSUM) in order to identify their level of competency. Diagnostic accuracy was subsequently evaluated during a 9-month period using 180 images of diminutive polyps captured during routine colonoscopies. The study demonstrated that none of the thresholds recommended in the Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) statement by the ASGE [2] was reached by most evaluators. Nevertheless, an improvement over time in prediction accuracy was observed for all of the raters.Although numerous training modalities have been explored, uncertainty still exists with regard to the best teaching method for optical diagnosis and how best to certify the acquisition of competency. Indeed, even though the NBI International Colorectal Endoscopic (NICE) criteria have been validated through a systematic process to differentiate adenomatous from hyperplastic polyps, optimal teaching methods for predicting colorectal polyp histology with NBI using these criteria have not been developed.A consistent methodology was used in the first reports on NBI characterization of diminutive polyps, which suggested that optical diagnosis could be effectively taught by simple computer-based training modules consisting of still polyp images, without active feedback [3], or short didactic teaching sessions, mainly on trainees. The authors tested the efficacy of a teaching model on an unbiased and naïve population, namely medical students, who were assumed to have little knowledge of optical diagnosis of diminutive polyps via analysis of endoscopi...

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Predictive Narrow-Band Imaging of Colonic Polyps: The Optics Are Good

2018

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“…They have obtained a good diagnostic accuracy for real time assessment of colonic polyps. Repici et al have recently reported a high confidence prediction of histology in diminutive polyps (92% NPV), when NBI colonoscopies have been performed by experienced endoscopists [21].…”

Section: Characterization Of Colonic Lesionsmentioning

confidence: 99%

“…The thresholds for an accurate assessment of a polyp's histology are: the technology should provide ≥90% negative predictive value (when used with high confidence) for adenomatous histology in diminutive rectosigmoid polyps; optical diagnosis for diminutive polyps combined with pathologic assessment of polyps larger than 5 mm should provide ≥90% agreement in assignment of post-polipectomy surveillance intervals when compared with decisions based on histopathological assessment of all identified polyps [19]. Recent reports have tested the clinical applicability of optical diagnosis by NBI endoscopy and have investigated the ability of the method to reach the PIVI criteria [20,21].…”

Section: Characterization Of Colonic Lesionsmentioning

confidence: 99%

The Usefulness Of Narrow Band Imaging Endoscopy For The Real Time Characterization Of Colonic Lesions

Boeriu

Pascarenco

Brusnic

et al. 2016

Acta Medica Marisiensis

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Narrow band imaging represents a promising endoscopic technique which allows real time characterization of colonic lesions by assessment of mucosal and vascular patterns. Due to the ability to make an optical biopsy, NBI could become a useful tool in clinical decisions regarding therapy and surveillance. The aim of this paper is to review the current knowledge on the optical diagnosis of colonic lesions by using NBI endoscopy. We reviewed research articles, reviews and meta-analyses from the PubMed and MEDLINE containing relevant data in this field. The validity of endoscopic criteria for the differentiation of adenoma and hyperplastic polyps, as well as of invasive cancer, has been evaluated in recent studies. Based on the prediction of polyp histology, new potential cost saving strategies have been proposed. Many reports are focused on the accuracy of optical biopsy by using NBI for predicting colonoscopy surveillance intervals and adenomatous histology in diminutive polyps, according to the Preservation and Incorporation of Valuable Endoscopic Innovations statement. Optical diagnosis is still under evaluation, and cannot yet be endorsed in routine practice. The high level of performance achieved by expert endoscopists needs to be replicated in the community utilizing reliable and standardized endoscopic criteria. IntroductionThe development of advanced endoscopic techniques such as narrow band imaging endoscopy, with or without magnification, represents an important step in the improvement of characterization of colonic lesions by predicting underlying histology. This creates the possibility to adopt new strategies regarding therapy and surveillance in clinical practice. The potential benefits of the real time estimation of a polyp's histology during NBI endoscopy, so called "optical biopsy", are related to potentially decreasing total costs of colonoscopy by eliminating unnecessary biopsies and polypectomies. Recent reports have shown promising results in this field, but controversies remain. Concerns center upon a lack of standardization among different classification systems, variable inter-observer agreement, and lagging clinical acceptance.The aim of this paper is to assess the current knowledge on the optical diagnosis of colonic lesions by using NBI endoscopy. We reviewed research articles, reviews and meta-analyses published in the last eight years in the PubMed and MEDLINE databases for the following search terms: narrow band imaging endoscopy, colonic polyps, and colorectal neoplasia.

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“…Repici et.al [47] conducted a prospective multicenter study to assess the ability of 5 experienced endoscopists in predicting the histology of diminutive polyps and the future colonoscopy surveillance intervals. All had some previous experience with NBI.…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%