Abstract
BackgroundIt is unknown whether narrow-band imaging (NBI) could be more effective than high-definition white-light endoscopy (HD-WLE) in detecting serrated lesions in patients with prior serrated lesions > 5 mm not completely fulfilling serrated polyposis syndrome (SPS) criteria.MethodsWe conducted a randomized, cross-over trial in consecutive patients with prior detection of at least one serrated polyp ≥10 mm or ≥ 3 serrated polyps larger than 5 mm, both proximal to the sigmoid colon. Five experienced endoscopists performed same-day tandem colonoscopies, with the order being randomized 1:1 to NBI—HD-WLE or HD-WLE—NBI. All tandem colonoscopies were performed by the same endoscopist.ResultsWe included 41 patients. Baseline characteristics were similar in the two cohorts: NBI—HD-WLE (n = 21) and HD-WLE—NBI (n = 20). No differences were observed in the serrated lesion detection rate of NBI versus HD-WLE: 47.4% versus 51.9% (OR 0.84, 95% CI: 0.37–1.91) for the first and second withdrawal, respectively. Equally, no differences were found in the polyp miss rate of NBI versus HD-WLE: 21.3% versus 26.1% (OR 0.77, 95% CI: 0.43–1.38). Follow-up colonoscopy in nine patients (22%) allowed them to be reclassified as having SPS.ConclusionsIn patients with previous serrated lesions, the serrated lesion detection rate was similar with NBI and HD-WLE. A shorter surveillance colonoscopy interval increases the detection of missed serrated polyps and could change the diagnosis of SPS in approximately one in every five patients.Trial registrationClinicalTrials.gov NCT02406547, registered on April 2, 2015.
Highlights
It is unknown whether narrow-band imaging (NBI) could be more effective than high-definition white-light endoscopy (HD-WLE) in detecting serrated lesions in patients with prior serrated lesions > 5 mm not completely fulfilling serrated polyposis syndrome (SPS) criteria
According to the World Health Organization (WHO) of 2010, serrated polyposis syndrome (SPS) was defined by the presence of one out of the following criteria: [5] 1) at least five serrated polyps proximal to the sigmoid colon, with two or more of these larger than 10 mm in diameter; 2) any number of serrated polyps occurring proximal to the sigmoid colon in an individual with a first-degree relative with SPS; and 3) more than 20 serrated polyps of any size distributed throughout the colon
Secondary outcomes were the number of missed lesions from the first technique used for each group (NBI or HD-WLE), defined as the proportion of polyps detected on the second withdrawal relative to the number of polyps found during the two examinations, and to assess the number of patients reclassified as having SPS after the scheduled colonoscopy
Summary
Study design and population We performed a randomized, cross-over trial of tandem colonoscopy to compare NBI versus HD-WLE in the detection of serrated lesions in patients with previously resected serrated lesions not fulfilling SPS criteria between March 2015 and April 2016 at Hospital del Mar, Barcelona (Spain). Procedure and randomization Patients were evaluated by the same endoscopist with tandem (“back-to-back”) colonoscopy In this procedure, two withdrawals from the cecum to sigmoid colon were performed using the two techniques consecutively. Secondary outcomes were the number of missed lesions from the first technique used for each group (NBI or HD-WLE), defined as the proportion of polyps detected on the second withdrawal relative to the number of polyps found during the two examinations, and to assess the number of patients reclassified as having SPS after the scheduled colonoscopy. We assumed that at least two polyps would be found in these patients and 41 patients (81/2) were required for the study
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