Published online Jun 16, 2017. doi: 10.4253/wjge.v9.i6.273
Peer-review started: January 19, 2017
First decision: March 13, 2017
Revised: April 4, 2017
Accepted: May 18, 2017
Article in press: May 19, 2017
Published online: June 16, 2017
To compare high definition white light endoscopy and bright narrow band imaging for colon polyps’ detection rates.
Patients 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.
A 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%.
ADRs 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.
Core tip: Adenoma detection rate (ADR) is one of the most important quality measures in colonoscopy and bright narrow band imaging (bNBI) can theoretically improve imaging and thus reconnaissance of colorectal polyps. In addition, the magnification using bNBI with dual focus (bNBI-DF) allows the prediction of the polyp’s histology. This multicenter randomised controlled trial was conceived to compare the ADR of high definition white light endoscopy (HD-WLE) vs bNBI during withdrawal of screening colonoscopies. No difference was found in ADR between HD-WLE and bNBI. The prediction of diminutive distal polyps with bNBI-DF was satisfactory according to the American Society for Gastrointestinal Endoscopy’s threshold.