Second‐generation narrow‐band imaging to detect colorectal adenomas: A prospective study including community hospitals

Abstract

Background and Aim It is unclear whether second‐generation narrow‐band imaging (NBI) improves colorectal adenoma detection in clinical practice. We aimed to evaluate the ability of NBI to detect adenomas in academic and community hospitals. Methods This observational, multicenter study was conducted in four academic and four community hospitals between July 2018 and April 2019. We enrolled patients aged ≥ 20 years who underwent colonoscopy for screening, polyp surveillance, or diagnostic workup. The primary endpoint was the adenoma detection rate (ADR) between NBI (NBI group) and white‐light imaging colonoscopies (WLI group) after propensity score (PS) matching. Results Of 1831 patients analyzed before PS matching, the NBI and WLI groups included 742 and 1089 patients, respectively. After PS matching, 711 pairs from both groups were analyzed. ADR and the mean number of adenomas per patient did not differ significantly between the NBI and WLI groups (43.5% vs 44.4%, P = 0.71; 0.90 ± 1.38 vs 0.91 ± 1.40, P = 0.95, respectively). Academic hospitals showed higher ADR in the NBI group (60.5% vs 53.8%), whereas community hospitals showed higher ADR in the WLI group (35.8% vs 40.5%). In the NBI group, ADR was significantly higher among NBI‐screening‐experienced endoscopists than among NBI‐screening‐inexperienced endoscopists (63.2% vs 39.2%, P < 0.001). The mean number of flat and depressed lesions detected per patient was significantly higher with NBI than with WLI (0.62 ± 1.34 vs 0.44 ± 1.01, P = 0.035). Conclusions Second‐generation NBI could not surpass WLI in terms of ADR based on patient recruitment from both academic and community hospitals but improved the detection of easily overlooked flat and depressed lesions.

Mucosal imaging in colon polyps: New advances and what the future may hold

“…In addition, the colour spectrum of NBI is different to WLI and therefore may require experience and familiarity with the technology in order to be effective. This was demonstrated by Minamide et al [ 63 ] who retrospectively reviewed 1831 patients that underwent colonoscopy using second-generation bright NBI or WLI and found a higher polyp detection rate (PDR) with NBI (80.9% vs 71.4%, P = 0.02) in academic centres familiar with its use, while in community centres, there was actually a trend towards a higher PDR with WLI (51.1% vs 47.7%). Additionally, in the NBI group, the ADR for NBI-experienced proceduralists was 63.2% vs 39.2% for NBI-inexperienced proceduralists ( P < 0.001).…”

“…Earlier-generation NBI resulted in a reduction in overall brightness due to the narrow bandwidths, which may limit overall visualisation in the wide colorectal lumen. The second-generation bright NBI has been developed to counter this, although recent studies have again demonstrated no difference in overall adenoma detection[ 58 , 63 ]. NBI also appears to be disproportionately affected by poor bowel preparation (which may also be in part due to reduced brightness), with a 2019 meta-analysis finding superior adenoma detection with second-generation NBI only in patients with maximal bowel preparation scores[ 64 ].…”

Colorectal sessile serrated lesion detection using linked-color imaging versus narrow-band imaging: a parallel randomized controlled trial

“…Therefore, 14 these results should be properly interpreted with attentions paid to potential differences from studies with only screening colonoscopies. Fourth, since we have previously reported the comparison between LCI and WLI in detecting colorectal SSLs [11], and the effectiveness of NBI vs WLI in colorectal SSLs detection have also been reported previously [21,[27][28][29], 18,[24][25][26] we didn't include another WLI arm in the present study. It is more practical to conduct a direct comparison between different modalities rather than comparing them with WLI again.…”

Anesthesia Assistance in Colonoscopy: Impact on Quality Indicators

“…Irina Ioana Vi?ovan found that ADR in NBI group was significantly higher than non-NBI group (35.3% vs. 20%) ( 42 ), consistent with our study. On the contrary, Tatsunori Minamide revealed that second-generation NBI could not surpass WLI in terms of ADR but improved the detection of easily overlooked flat and depressed lesions ( 43 ). The reason may be that patients enrolled in this study are over 20 years old, which is different from our study, which included patients over 40 years.…”