Rastogi A, Early DS, Gupta N, Bansal A, Singh V, Ansstas M, Jonnalagadda SS, Hovis CE, Gaddam S, Wani SB, Edmundowicz SA, Sharma P. Randomized, controlled trial of standard-definition white-light, high-definition white-light, and narrow-band imaging colonoscopy for the detection of colon polyps and prediction of polyp histology.
Gastrointest Endosc 2011;
74:593-602. [PMID:
21802078 DOI:
10.1016/j.gie.2011.04.050]
[Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 04/30/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND
Missing adenomas and the inability to accurately differentiate between polyp histology remain the main limitations of standard-definition white-light (SD-WL) colonoscopy.
OBJECTIVE
To compare the adenoma detection rates of SD-WL with those of high-definition white-light (HD-WL) and narrow-band imaging (NBI) as well as the accuracy of predicting polyp histology.
DESIGN
Multicenter, prospective, randomized, controlled trial.
SETTING
Two academic medical centers in the United States.
PATIENTS
Subjects undergoing screening or surveillance colonoscopy.
INTERVENTION
Subjects were randomized to undergo colonoscopy with one of the following: SD-WL, HD-WL, or NBI.
MAIN OUTCOME MEASUREMENTS
The proportion of subjects detected with adenomas, adenomas detected per subject, and the accuracy of predicting polyp histology real time.
RESULTS
A total of 630 subjects were included. The proportion of subjects with adenomas was 38.6% with SD-WL compared with 45.7% with HD-WL and 46.2% with NBI (P = .17 and P = .14, respectively). Adenomas detected per subject were 0.69 with SD-WL compared with 1.12 with HD-WL and 1.13 with NBI (P = .016 and P = .014, respectively). HD-WL and NBI detected more subjects with flat and right-sided adenomas compared with SD-WL (all P values <.005). NBI had a superior sensitivity (90%) and accuracy (82%) to predict adenomas compared with SD-WL and HD-WL (all P values <.005).
LIMITATIONS
Academic medical centers with experienced endoscopists.
CONCLUSIONS
There was no difference in the proportion of subjects with adenomas detected with SD-WL, HD-WL, and NBI. However, HD-WL and NBI detected significantly more adenomas per subject (>60%) compared with SD-WL. NBI had the highest accuracy in predicting adenomas in real time during colonoscopy. (
CLINICAL TRIAL REGISTRATION NUMBER
NCT 00614770.).
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