Multicenter randomised controlled trial comparing the high definition white light endoscopy and the bright narrow band imaging for colon polyps

Abstract

AIMTo compare high definition white light endoscopy and bright narrow band imaging for colon polyps’ detection rates.METHODSPatients were randomised to high definition white light endoscopy (HD-WLE) or the bright narrow band imaging (bNBI) during withdrawal of the colonoscope. Polyps identified in either mode were characterised using bNBI with dual focus (bNBI-DF) according to the Sano’s classification. The primary outcome was to compare adenoma detection rates (ADRs) between the two arms. The secondary outcome was to assess the negative predictive value (NPV) in differentiating adenomas from hyperplastic polyps for diminutive rectosigmoid lesions.RESULTSA total of 1006 patients were randomised to HD-WLE (n = 511) or bNBI (n = 495). The mean of adenoma per patient was 1.62 and 1.84, respectively. The ADRs in bNBI and HD-WLE group were 37.4% and 39.3%, respectively. When adjusted for withdrawal time (OR = 1.19, 95%CI: 1.15-1.24, P < 0.001), the use of bNBI was associated with a reduced ADR (OR = 0.69, 95%CI: 0.52-0.92). Nine hundred and thirty three polyps (86%) in both arms were predicted with high confidence. The sensitivity (Sn), specificity (Sp), positive predictive value and NPV in differentiating adenomatous from non-adenomatous polyps of all sizes were 95.9%, 87.2%, 94.0% and 91.1% respectively. The NPV in differentiating an adenoma from hyperplastic polyp using bNBI-DF for diminutive rectal polyps was 91.0%.CONCLUSIONADRs did not differ between bNBI and HD-WLE, however HD-WLE had higher ADR after adjustment of withdrawal time. bNBI surpassed the PIVI threshold for diminutive polyps.

Narrow band imaging versus white light for detecting sessile serrated lesion: A prospective randomized multicenter study

“…Similar results of longer withdrawal time in the NBI arm were noted in previous randomized controlled trials and meta‐analyses. 36 , 42 , 43 It is well‐established that increased withdrawal time leads to improved PDR (as in this study) and ADR. 37 Since the withdrawal time in the NBI group was longer compared to HD‐WL, one would have expected that the NBI arm should have performed better than HD‐WL in terms of ADR and PDR.…”

“…An earlier study found that one operator had a significantly enhanced ADR using NBI while two others did not. 43 Thus, operators could also have had different baseline ADRs, and adapted to using NBI differently over time. Moreover, patients were randomized to each modality in a 1:1 ratio in blocks of 10.…”

“…Second, we also confirmed the association between NBI use and increased withdrawal time. Similar results of longer withdrawal time in the NBI arm were noted in previous randomized controlled trials and meta‐analyses 36,42,43 . It is well‐established that increased withdrawal time leads to improved PDR (as in this study) and ADR 37 .…”

Linked color imaging enhances endoscopic detection of sessile serrated adenoma/polyps

“…The rates of additional detection of HP and adenomas in the WLI-LCI group were also higher than in the LCI-WLI group. Since these polyps are easily detectable due to their protruding morphology, detection by WLI may be sufficient 26 . The value of LCI for the detection of these polyps should be further investigated.…”

Gastrointestinal diagnosis using non-white light imaging capsule endoscopy

“…Disadvantages of the use 11 of exogenous markers include potentially unequal distribution, pooling which can obscure lesions, and lengthening of 12 the duration of the procedure 51 . These imaging modalities have also been integrated into CE [52][53][54][55] but studies have 13 cast doubt on their efficacy compared with standard WLI capsules [56][57][58][59] . Other alternative imaging technologies such 14 as µUS, fluorescent imaging and OCT address some of the limitations associated with WLI technology.…”