Narrow band imaging versus conventional white light colonoscopy for the detection of colorectal polyps.

BACKGROUND It has been suggested that narrow band imaging colonoscopy (NBI) might be better for detection of colorectal polyps than white light colonoscopy (WLC). OBJECTIVES To compare standard or high definition white light colonoscopy with narrow band imaging colonoscopy for detection of colorectal polyps. SEARCH METHODS We searched The Cochrane Library, MEDLINE, and EMBASE to August 2011. We scanned bibliographies of relevant publications and wrote to experts for additional trials. SELECTION CRITERIA Two authors (NA and GB) independently applied the inclusion criteria and extracted the data to all potential studies without blinding. DATA COLLECTION AND ANALYSIS Authors extracted data independently. Trials with adequate randomisation, allocation concealment, and complete outcome data reporting, as well as without selective outcome reporting or other bias were classified as having a lowest risk of bias. Random-effects and fixed-effect meta-analyses were conducted. MAIN RESULTS We identified 11 randomised trials comparing WLC with NBI for detection of colorectal polyps. In total eight randomised trials with 3673 participants provided data for our analyses. There was no statistically significant difference between WLC (standard definition and high definition pooled) and NBI for the detection of patients with colorectal polyps (6 trials, n = 2832, RR 0.97, 95% CI 0.91 to 1.04), patients with colorectal adenomas (8 trials, n = 3673, RR 0.94, 95% CI 0.87 to 1.02), or patients with colorectal hyperplastic polyps (2 trials, n = 645, RR 0.87, 95% CI 0.76 to 1.00). Number of patients with at least one colorectal adenoma was not significantly different between WLC and NBI group irrespective of adenoma size (< 5 mm:RR 0.95, 95% CI 0.84 to 1.08, I(2) = 56%; 6 to 9 mm: RR 1.06, 95% CI 0.81 to 1.39, I(2) = 0%; ≥ 10 mm: RR 1.06, 95% CI 0.77 to 1.45, I(2) = 0%). Number of patients with at least one colorectal polyp, or colorectal adenoma was significantly lower in the standard definition WLC group compared to NBI group in fixed-effect meta-analysis (RR 0.87, 95% CI 0.78 to 0.97, I(2) = 78%; RR 0.87, 95% CI 0.77 to 0.99, I(2) = 0%, respectively), but not significantly different in random-effects meta-analysis (RR 0.86, 95% CI 0.68 to 1.10, I(2) = 78%). There was no statistically significant difference between high definition WLC and NBI in the number of patiens with at least one colorectal polyp or colorectal adenoma (RR 1.10, 95% CI 0.95 to 1.28; RR 0.87, 95% CI 0.77 to 0.99, I(2) = 0%, respectively). AUTHORS' CONCLUSIONS We could not find convincing evidence that NBI is significantly better than high definition WLC for the detection of patients with colorectal polyps, or colorectal adenomas. We found evidence that NBI might be better than standard definition WLC and equal to high definition WLC for detection the patients with colorectal polyps, or colorectal adenomas.

[1]  Ludovic Reveiz,et al.  Narrow-band imaging does not improve detection of colorectal polyps when compared to conventional colonoscopy: a randomized controlled trial and meta-analysis of published studies , 2011, BMC gastroenterology.

[2]  Ananya Das,et al.  W1169 Narrow Band Imaging (NBI) and White Light Endoscopy (WLE) Have a Comparable Yield for Detection of Colon Polyps in Patients Undergoing Screening or Surveillance Colonoscopy:an Updated Meta-Analysis , 2010 .

[3]  A. Rastogi,et al.  S1544: Comparison of Standard Definition White Light (SD-WL), High Definition White Light (HD-WL), and Narrow Band Imaging (NBI) Colonoscopy: Impact on Surveillance Interval Recommendations , 2010 .

[4]  N. Suzuki,et al.  1080b: Narrow Band Imaging (NBI) for Adenoma Detection in High Risk Patients: A Randomised, Controlled Trial , 2010 .

[5]  A. Rastogi,et al.  1080c: A Multicenter, Prospective, Randomized Controlled Trial Comparing Standard Definition White Light (SDWL), High Definition White Light (HDWL) and Narrow Band Imaging (NBI) Colonoscopy for the Detection of Colon Polyps and Real Time Prediction of Histology , 2010 .

[6]  A. Rastogi,et al.  High Accuracy of Narrow Band Imaging Without Magnification for the Real-Time Characterization of Polyp Histology and Its Comparison With High-Definition White Light Colonoscopy: A Prospective Study , 2009, The American Journal of Gastroenterology.

[7]  A. Amato,et al.  The impact of narrow band imaging in screening colonoscopy: a randomized controlled trial. , 2009, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[8]  Chia-Lang Fang,et al.  Comparative study of conventional colonoscopy, magnifying chromoendoscopy, and magnifying narrow-band imaging systems in the differential diagnosis of small colonic polyps between trainee and experienced endoscopist , 2009, International Journal of Colorectal Disease.

[9]  Paul Fockens,et al.  Combining Autofluorescence Imaging and Narrow-Band Imaging for the Differentiation of Adenomas from Non-Neoplastic Colonic Polyps Among Experienced and Non-Experienced Endoscopists , 2009, The American Journal of Gastroenterology.

[10]  David F Ransohoff,et al.  Variation in polyp detection rates at screening colonoscopy. , 2009, Gastrointestinal endoscopy.

[11]  F. Lammert,et al.  Chromocolonoscopy detects more adenomas than white light colonoscopy or narrow band imaging colonoscopy in hereditary nonpolyposis colorectal cancer screening. , 2009, Endoscopy.

[12]  E. Dekker,et al.  Narrow-Band Imaging Improves the Detection of Polyps in Patients with Hyperplastic Polyposis Syndrome: A Prospective Randomized Study Comparing Narrow-Band Imaging vs High-Resolution White Light Imaging , 2009 .

[13]  A. Hernández-Guerrero,et al.  Narrow Band Imaging Versus Conventional Colonoscopy for Detection of Diminutive Polyps: A Randomized Cross-Over Study with Histopathological Confirmation , 2009 .

[14]  Ananya Das,et al.  Narrow Band Imaging (NBI) and White Light Endoscopy (WLE) Have a Comparable Yield for Detection of Colon Polyps in Patients Undergoing Screening or Surveillance Colonoscopy: A Meta-Analysis , 2009 .

[15]  Prateek Sharma,et al.  Recognition of surface mucosal and vascular patterns of colon polyps by using narrow-band imaging: interobserver and intraobserver agreement and prediction of polyp histology. , 2009, Gastrointestinal endoscopy.

[16]  A. Amato,et al.  THE IMPACT OF NARROW BAND IMAGING IN SCREENING COLONOSCOPY: A RANDOMISED CONTROLLED TRIAL , 2009 .

[17]  Shinji Tanaka,et al.  Narrow-band imaging magnification predicts the histology and invasion depth of colorectal tumors. , 2009, Gastrointestinal endoscopy.

[18]  Thomas Rösch,et al.  Narrow-band versus white-light high definition television endoscopic imaging for screening colonoscopy: a prospective randomized trial. , 2009, Gastroenterology.

[19]  D. Jain,et al.  Narrow-band imaging without high magnification to differentiate polyps during real-time colonoscopy: improvement with experience. , 2008, Gastrointestinal endoscopy.

[20]  J. Bergman,et al.  Meta‐analysis: narrow band imaging for lesion characterization in the colon, oesophagus, duodenal ampulla and lung , 2008, Alimentary pharmacology & therapeutics.

[21]  N. Suzuki,et al.  Narrow band imaging with magnification for the characterization of small and diminutive colonic polyps: pit pattern and vascular pattern intensity. , 2008, Endoscopy.

[22]  S. Jonnalagadda,et al.  Comparison of white light and narrow band high definition images in predicting colon polyp histology, using standard colonoscopes without optical magnification , 2008, Endoscopy.

[23]  S. Friedland,et al.  A randomised tandem colonoscopy trial of narrow band imaging versus white light examination to compare neoplasia miss rates , 2008, Gut.

[24]  Y. Sano,et al.  Narrow band imaging with magnifying colonoscopy as diagnostic tool for predicting histology of early colorectal neoplasia , 2008, Alimentary pharmacology & therapeutics.

[25]  Shigeaki Yoshida.  Narrowband Imaging: Historical Background and Basis for its Development , 2008 .

[26]  Y. Sano,et al.  Optical Chromoendoscopy Using NBI During Screening Colonoscopy: Its Usefulness and Application , 2008 .

[27]  D. Rex.  Detection of neoplasia at colonoscopy: What next? , 2008, Endoscopy.

[28]  N. Sasaki,et al.  Clinical Usefulness of NBI Magnification in Routine Colonoscopic Examination , 2008 .

[29]  B. Wiedenmann,et al.  Narrow Band Imaging Versus Conventional Colonoscopy for Screening Colonoscopy in a Private Practice Setting - A Large Prospective Randomized Trial , 2008 .

[30]  D. Chang,et al.  NARROW BAND IMAGING IN THE DETECTION OF COLORECTAL POLYP: KOREAN EXPERIENCE , 2008 .

[31]  D. Heresbach,et al.  Miss rate for colorectal neoplastic polyps: a prospective multicenter study of back-to-back video colonoscopies , 2008, Endoscopy.

[32]  F. Ramirez,et al.  The Clinical Utility of High Definition Magnification Endoscopy with and Without Narrow Band Imaging for Detection of Colonic Neoplasia , 2008 .

[33]  Douglas G Altman,et al.  Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: meta-epidemiological study , 2008, BMJ : British Medical Journal.

[34]  Takuya Inoue,et al.  Comparative study of conventional colonoscopy and pan-colonic narrow-band imaging system in the detection of neoplastic colonic polyps: a randomized, controlled trial , 2008, Journal of Gastroenterology.

[35]  Prateek Sharma,et al.  Narrow-band imaging colonoscopy--a pilot feasibility study for the detection of polyps and correlation of surface patterns with polyp histologic diagnosis. , 2008, Gastrointestinal endoscopy.

[36]  G. Costamagna,et al.  High-resolution narrow band imaging endoscopy , 2008, Gut.

[37]  C. Trautwein,et al.  Value of magnifying chromoendoscopy and narrow band imaging (NBI) in classifying colorectal polyps: a prospective controlled study. , 2007, Endoscopy.

[38]  Shinji Tanaka,et al.  Evaluation of microvessels in colorectal tumors by narrow band imaging magnification. , 2007, Gastrointestinal endoscopy.

[39]  H. Pohl,et al.  A prospective randomised study on narrow-band imaging versus conventional colonoscopy for adenoma detection: does narrow-band imaging induce a learning effect? , 2007, Gut.

[40]  N. Suzuki,et al.  Narrow band imaging for colonoscopic surveillance in hereditary non-polyposis colorectal cancer , 2007, Gut.

[41]  Noriko Suzuki,et al.  Comparison of magnified pit pattern interpretation with narrow band imaging versus chromoendoscopy for diminutive colonic polyps: a pilot study. , 2007, Gastrointestinal endoscopy.

[42]  Y. Hirooka,et al.  ENDOSCOPIC APPROACH TO THE PANCREATOBILIARY TRACT USING NARROW BAND IMAGING , 2007 .

[43]  Douglas K Rex,et al.  High yields of small and flat adenomas with high-definition colonoscopes using either white light or narrow band imaging. , 2007, Gastroenterology.

[44]  H. Ikeda,et al.  NEW APPLICATION OF NARROW BAND IMAGING FOR CHOLANGIOPANCREATOSCOPY , 2007 .

[45]  Shinji Tanaka,et al.  Magnifying endoscopy with narrow band imaging for diagnosis of colorectal tumors. , 2007, Gastrointestinal endoscopy.

[46]  S. Friedland,et al.  A New Benchmark in the Colorectal Neoplasm Miss Rate During Colonoscopy: Results of a Randomized Controlled Trial of Wide Angle View (170°) Colonoscopy Comparing Narrow Band Imaging and White Light , 2007 .

[47]  F. Ramirez,et al.  The Role of High Definition Narrow Band Imaging Endoscopy in the Screening of Colorectal Neoplasia: Initial Experience with 100 Consecutive Patients , 2007 .

[48]  Wang Yongjun,et al.  Detecting Colorectal Lesions At Colonoscopy: A Randomized Controlled Comparison Trial Between Conventional Imaging, Narrow Band Imaging and Pancolonic Indigo Carmine and Acetic Acid Dye , 2007 .

[49]  N. Suzuki,et al.  Narrow Band Imaging Improves Adenoma Detection in Patients At High Risk for Adenomas: A Randomised Trial , 2007 .

[50]  S. Danese,et al.  A prospective study comparison of narrow band imaging (NBI) versus chromoendoscopy with indigo carmine (IC) versus white light (WL) colonoscopy in the detection of adenomatous colonic lesions , 2007 .

[51]  H. Pohl,et al.  Narrow Band Imaging (NBI) Influences the Learning Curve for Conventional Endoscopy - Final Results of a Prospective Randomized Study in the Detection of Colorectal Adenomas , 2007 .

[52]  Chen-Ming Hsu,et al.  Comparative Study of Conventional Colonoscopy, Chromoendoscopy, and Narrow-Band Imaging Systems in Differential Diagnosis of Neoplastic and Nonneoplastic Colonic Polyps , 2006, The American Journal of Gastroenterology.

[53]  J. Ferlay,et al.  Estimates of the cancer incidence and mortality in Europe in 2006. , 2006, Annals of oncology : official journal of the European Society for Medical Oncology.

[54]  J. Bond,et al.  Colorectal cancers found after a complete colonoscopy. , 2006, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[55]  Hsiu‐Po Wang,et al.  A prospective comparative study of narrow-band imaging, chromoendoscopy, and conventional colonoscopy in the diagnosis of colorectal neoplasia , 2006, Gut.

[56]  Shinji Tanaka,et al.  PIT PATTERN DIAGNOSIS FOR COLORECTAL NEOPLASIA USING NARROW BAND IMAGING MAGNIFICATION , 2006 .

[57]  Yasushi Sano,et al.  MAGNIFYING OBSERVATION OF MICROVASCULAR ARCHITECTURE OF COLORECTAL LESIONS USING A NARROW‐BAND IMAGING SYSTEM , 2006 .

[58]  D. Rex,et al.  Narrow Band Imaging (NBI) Versus White-Light (WL) for Colon Polyp Detection Using High Definition (HD) Colonoscopes , 2006 .

[59]  H. Pohl,et al.  A Prospective Randomized Study Between Narrow Band Imaging and Conventional Wide-Angle Colonoscopy in the Detection of Colorectal Adenomas , 2006 .

[60]  J. Rey,et al.  Narrow-Band Imaging: Potential and Limitations , 2006, Endoscopy.

[61]  Paul Fockens,et al.  New imaging techniques at colonoscopy: tissue spectroscopy and narrow band imaging. , 2005, Gastrointestinal endoscopy clinics of North America.

[62]  T. Byers,et al.  Colorectal cancer in patients under close colonoscopic surveillance. , 2005, Gastroenterology.

[63]  Hisao Tajiri,et al.  OPTICAL/DIGITAL CHROMOENDOSCOPY DURING COLONOSCOPY USING NARROW‐BAND IMAGING SYSTEM , 2005 .

[64]  Y. Sano,et al.  NARROW‐BAND IMAGING COMBINED WITH MAGNIFIED ENDOSCOPY FOR CANCER AT THE HEAD AND NECK REGION , 2005 .

[65]  H. Tajiri,et al.  Narrow-band imaging in the diagnosis of colorectal mucosal lesions: a pilot study. , 2004, Endoscopy.

[66]  Yasushi Sano,et al.  Squamous cell carcinoma in situ at oropharyngeal and hypopharyngeal mucosal sites , 2004, Cancer.

[67]  Perry Pickhardt,et al.  Location of Adenomas Missed by Optical Colonoscopy , 2004, Annals of Internal Medicine.

[68]  Kazuki Sumiyama,et al.  Combined use of a magnifying endoscope with a narrow band imaging system and a multibending endoscope for en bloc EMR of early stage gastric cancer. , 2004, Gastrointestinal endoscopy.

[69]  B. Rembacken.  Missing Colorectal Cancer , 2004, Endoscopy.

[70]  Masahiro Yamaguchi,et al.  Appearance of enhanced tissue features in narrow-band endoscopic imaging. , 2004, Journal of biomedical optics.

[71]  Peter Lance,et al.  Analysis of colorectal cancer occurrence during surveillance colonoscopy in the dietary Polyp Prevention Trial. , 2004, Gastrointestinal endoscopy.

[72]  S. Kudo,et al.  Narrow-band imaging system with magnifying endoscopy for superficial esophageal lesions. , 2004, Gastrointestinal endoscopy.

[73]  L. Aabakken.  Endoscopic Tumor Diagnosis and Treatment , 2003, Endoscopy.

[74]  S. Thompson,et al.  Quantifying heterogeneity in a meta‐analysis , 2002, Statistics in medicine.

[75]  Christian Gluud,et al.  Reported Methodologic Quality and Discrepancies between Large and Small Randomized Trials in Meta-Analyses , 2001, Annals of Internal Medicine.

[76]  D. Cook,et al.  Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? , 1998, The Lancet.

[77]  G. Smith,et al.  Bias in meta-analysis detected by a simple, graphical test , 1997, BMJ.

[78]  J. Carethers.  The cellular and molecular pathogenesis of colorectal cancer. , 1996, Gastroenterology clinics of North America.

[79]  John I. Allen,et al.  Molecular biology of colon polyps and colon cancer. , 1995, Seminars in surgical oncology.

[80]  R. J. Hayes,et al.  Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. , 1995, JAMA.

[81]  C. Begg,et al.  Operating characteristics of a rank correlation test for publication bias. , 1994, Biometrics.

[82]  A. Zauber,et al.  Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. , 1993 .

[83]  D. McGee,et al.  Prospective study of the frequency and size distribution of polyps missed by colonoscopy. , 1990, Journal of the National Cancer Institute.

[84]  D L Demets,et al.  Methods for combining randomized clinical trials: strengths and limitations. , 1987, Statistics in medicine.

[85]  N. Laird,et al.  Meta-analysis in clinical trials. , 1986, Controlled clinical trials.

[86]  A. Jemal,et al.  Global Cancer Statistics , 2011 .

[87]  Paul Fockens,et al.  Systematic review of narrow-band imaging for the detection and differentiation of neoplastic and nonneoplastic lesions in the colon (with videos). , 2009, Gastrointestinal endoscopy.

[88]  Kohzoh Imai,et al.  Usefulness of narrow-band imaging endoscopy for diagnosis of Barrett’s esophagus , 2003, Journal of Gastroenterology.

[89]  Y. Sano.  New diagnostic method based on color imaging using narrow band imaging (NBI) system for gastrointestinal tract , 2001 .

[90]  D. Rex,et al.  Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. , 1997, Gastroenterology.