Abstract
Colonoscopic detection and removal of polyps represent the most important prevention method for colorectal cancer. We aimed to investigate the diagnostic yield of narrow band imaging (NBI) colonoscopy for polyp detection compared with standard colonoscopy. In this prospective study, 505 patients that underwent total colonoscopy were randomized into two groups: 226 patients in NBI group and 279 in non-NBI group (standard colonoscopy). The primary endpoints were polyp detection rate (PDR) and adenoma detection rate (ADR) in both groups. Polyps detected with NBI technique were characterized according to the NBI International Colorectal Endoscopic (NICE) classification. The total number of polyps detected in NBI group was significantly higher compared with non-NBI group (325 polyps in 226 patients versus 189 polyps in 279 patients, respectively). PDR in NBI group was 55.3%, versus 43.3% in non-NBI group. ADR in NBI group was significantly higher compared with non-NBI group (35.3% versus 20%, respectively). The proportion of detected adenomas in the left-sided colon was significantly higher in NBI group (72.8% versus 61.06% in non-NBI group), which was related to an increased number of small adenomas detected in NBI group. Also, in NBI group, a significant number of flat adenomas were detected (28 versus 9 in non-NBI group). A total of 147 (45.2%) polyps were classified according to the NICE classification, and showed a good correlation with histological analysis. In conclusion, this study demonstrated increased PDR and ADR for NBI colonoscopy. A good correlation between the NICE classification and histological analysis was also observed.
Highlights
Colonoscopic detection and removal of polyps represent the most important prevention method for colorectal cancer (CRC) [1], with a decrease of 76-90% in CRC incidence, in large cohorts of patients who had adenomas removed [2]
The patients were randomized into two groups: narrow band imaging (NBI) group included 226 patients, and non-NBI group included 279 patients
Because conflicting results have been reported regarding the role of NBI technique in polyp detection [12,14,17,18], this study focused on investigating the diagnostic yield of NBI technique for polyp detection and characterization in daily practice
Summary
Colonoscopic detection and removal of polyps represent the most important prevention method for colorectal cancer (CRC) [1], with a decrease of 76-90% in CRC incidence, in large cohorts of patients who had adenomas removed [2]. Because 17-24% of polyps are missed during colonoscopy [3], new endoscopic techniques have been developed to increase the detection rate of adenomas. These techniques include: high-definition endoscopy, conventional or virtual chromoendoscopy (i.e., narrow band imaging [NBI], i-Scan digital contrast [i-SCAN], and flexible spectral imaging color enhancement [FICE] technologies), and autofluorescence imaging [4]. Due to the ability to differentiate between neoplastic and other types of polyps (i.e. non-neoplastic polyps), these methods. Chromoendoscopy has a sensitivity of 91% and a specificity of 89% in differentiating neoplastic lesions from non-neoplastic polyps according to the Kudo’s classification [8]. The sensitivity and specificity of NBI are similar to those of chromoendoscopy [11]
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