Abstract
Background: Colonoscopy has an appreciable miss rate for adenomas and cancer. The goal of advanced endoscopic imaging is to improve lesion detection. Compared to standard definition (SD), high definition (HD) colonoscopes have the advantage of increased field of visualization and higher resolution; NBI utilizes narrow band filters for enhanced visualization of surface architecture and capillary pattern. Aim: To compare the yield and miss-rates of NBI and WLE for the detection of colon polyps using meta-analysis. Methods: A recursive literature search of randomized trials (RCT) comparing the yield of NBI and WLE for detection of colon polyps in patients undergoing screening/surveillance colonoscopy. Authors contacted for missing data. In RCT with tandem colonoscopy (RCT-t), findings from the first-pass examinations were used in our yield analysis and from the tandem pass for our miss rate analysis. Data on the yield of polyps were extracted, pooled and analyzed using RevMan 4.2.9 software. Odds Ratio (OR) and 95% confidence intervals (CI) for the pooled data for the yield and miss rates of NBI and WLE, were calculated. A fixed effect model (FEM) was used for analyses without, and a random effect model (REM) for analyses with heterogeneity. Results: Ten studies (2 duplicate publications) compared NBI with HD-WLE and 1 study compared NBI with SD-WLE. Nine [6 manuscripts (3 RCT and 3 RCT-t), and 3 abstracts (2 RCT and 1 RCT-t)] with a total of 2897 participants were included. The yield analysis revealed no significant difference in NBI and WLE for the detection of patients with polyps [9 studies; n=2897; OR 1.12; CI 0.84-1.49; REM], patients with adenomas [6 studies; n= 2477; OR 0.99; CI 0.83-1.18; FEM], detection of polyps < 10 mm, [6 studies; N=1361; OR 1.23; CI 0.84-1.80; FEM], or polyps > 10 mm [OR 0.96; CI 0.64-1.43; FEM]. There was a significantly higher yield for flat/sessile polyps per patient on NBI [5 studies; n= 1209; OR 2.02; CI 1.51-2.72; FEM]. Miss rate analysis from 4 tandem studies (3 HD-WLE, 3 manuscripts) revealed no difference in polyp miss rate (OR = 1.28; CI=0.88-1.87; FEM), adenoma miss rate (OR = 1.02; CI=0.41-2.51; REM) or large (>10 mm) adenoma miss rate (OR = 2; CI = 0.36-11; FEM). Conclusions: Compared to WLE, NBI does not increase the yield of colon polyps or adenomas in a patient, number of patients with colon polyps or adenomas, or decrease the miss-rate of colon polyps or adenomas in a patient undergoing screening or surveillance colonoscopy. There is a significantly higher detection of flat/sessile polyps with NBI; however, due to lack of data on their size and histology their clinical significance is unclear.
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