Colonoscopy, the preferred procedure for colon cancer screening, has welldocumented limitations. To improve colonoscopy's effectiveness, augmented endoscopy techniques, such as chromoendoscopy and narrow band imaging (NBI) have been evaluated. Both techniques are inexpensive, safe, and relatively easy to perform. Chromoendoscopy has an increasingly important role in surveillance of IBD, but significant work is needed to determine the optimal staining techniques and mucosal surface pattern analysis before this technique can be incorporated into routine clinical practice. NBI is a much newer technology with far less data. Well-designed prospective randomized controlled trials have failed to identify a benefit of NBI in screening colonoscopy, in surveillance for high-risk populations or as an adjunct for therapeutic procedures.
KEYWORDS: Chromoendoscopy, narrow band imaging, colonoscopy, endoscopyObjectives: On completion of this article, the reader should be able to discuss the techniques of chromoendoscopy and narrow band imaging in colonoscopy.In the United States, colorectal cancer is currently the fifth leading cancer, with an estimated 146,970 new cases annually. It is the second largest cause of cancer death: Approximately 49,920 died of the disease in 2009. 1 As dedicated colonoscopists, we must focus on our ability to meticulously detect and remove colorectal neoplasia with the ultimate goal being colorectal cancer prevention.The practice of removing neoplastic colonic lesions during colonoscopy to reduce the incidence of colorectal cancer has been justified by the results of the National Polyp Study Workgroup cohort study, which showed that colonoscopy with removal of identified polyps reduced the incidence of colorectal cancer 76 to 90%. 2 Currently, white light colonoscopy (colonoscopy), albeit imperfect, is the preferred colorectal cancer screening test. 3 It is the best screening test to both detect and remove colonic neoplasms. However, substantial miss rates for adenoma and cancers have been reported with colonoscopy. The colonoscopy-miss rate for adenomas is not completely understood, but has been well documented by several studies showing a significant discordance in adenoma detection rate (ADR) during screening colonoscopy among practicing colonoscopists.
ADENOMA DETECTION RATEPublished ADRs during colonoscopy have ranged from 7% to 44%, whereas the mean number of adenomas detected per subject screen has ranged from 0.09 to 1.05. [4][5][6][7][8] To study more closely the missed adenoma rate of colonoscopy, same-day tandem (back-to-back) colonoscopies have shown an overall adenoma-miss