Comparison of the Yield and Miss Rate of Narrow Band Imaging and White Light Endoscopy in Patients Undergoing Screening or Surveillance Colonoscopy: A Meta-Analysis

OBJECTIVES:Colonoscopy has an appreciable miss rate for adenomas and colorectal cancer. The goal of advanced endoscopic imaging is to improve lesion detection. Compared with standard definition, high-definition (HD) colonoscopes have the advantage of increased field of visualization and higher resolution; narrow band imaging (NBI) utilizes narrow band filters for enhanced visualization of surface architecture and capillary pattern. The objective of this study was to compare the yield and miss rates of HD-NBI and HD-WLE (white light endoscopy) for the detection of colon polyps using meta-analysis.METHODS:A recursive literature search of randomized controlled trials (RCTs) comparing the yield of HD-NBI and HD-WLE for detection of colon polyps in patients undergoing screening/surveillance colonoscopy. Authors were contacted for missing data. In RCT with tandem colonoscopy (RCT-t), findings from the first-pass examinations were used in the yield analysis and from the tandem pass for the 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 (CIs) 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:The yield analysis revealed no significant difference between HD-NBI and HD-WLE for the detection of adenomas (six studies; n=2,284; OR: 1.01; CI: 0.74–1.37; REM); patients with polyps (six studies; n=2,275; OR: 1.15; CI: 0.8–1.64; REM); patients with adenomas (four studies; n=2,177; OR: 1.0; CI: 0.83–1.20; FEM); detection of adenomas <10 mm (five studies; n=1,618; OR: 1.32; CI: 0.92–1.88; FEM); flat adenomas (five studies; n=1,675; OR: 1.26; CI: 0.62–2.57; REM); and flat adenomas per patient (five studies; n=2,200; OR: 1.63; CI: 0.71–3.74; REM). The miss rate analysis revealed no difference in polyp miss rate (three studies; n=524; OR: 1.17; CI: 0.8–1.71; FEM) or adenoma miss rate (three studies; n=524; OR: 0.65; CI: 0.4–1.06; FEM) between the two techniques.CONCLUSIONS:Compared with HD-WLE, HD-NBI does not increase the yield of colon polyps, adenomas, or flat adenomas, nor does it decrease the miss rate of colon polyps or adenomas in patients undergoing screening/surveillance colonoscopy.

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

[2]  J. Johanson,et al.  Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. , 2006, The New England journal of medicine.

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

[4]  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 .

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

[6]  Walter Willett,et al.  Risk factors for advanced colonic neoplasia and hyperplastic polyps in asymptomatic individuals. , 2003, JAMA.

[7]  Douglas K Rex,et al.  Endoscopist Can Be More Powerful than Age and Male Gender in Predicting Adenoma Detection at Colonoscopy , 2007, The American Journal of Gastroenterology.

[8]  L M Schuman,et al.  Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. , 1993, The New England journal of medicine.

[9]  Douglas K. Rex,et al.  Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: Recommendations of the U.S. Multi-Society Task Force on Colorectal Cancer , 2002 .

[10]  A. Jemal,et al.  Cancer statistics, 2011 , 2011, CA: a cancer journal for clinicians.

[11]  Marcin Polkowski,et al.  Quality indicators for colonoscopy and the risk of interval cancer. , 2010, The New England journal of medicine.

[12]  M. Wallace,et al.  High-definition colonoscopy detects colorectal polyps at a higher rate than standard white-light colonoscopy. , 2010, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[13]  P. Bossuyt,et al.  Polyp Miss Rate Determined by Tandem Colonoscopy: A Systematic Review , 2006, The American Journal of Gastroenterology.

[14]  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.

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

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

[17]  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.

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

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

[20]  Emre Gorgun,et al.  Flat Adenomas of the Large Bowel: A Single Endoscopist Study , 2009, Diseases of the colon and rectum.

[21]  Walter Park,et al.  Prevalence of nonpolypoid (flat and depressed) colorectal neoplasms in asymptomatic and symptomatic adults. , 2008, JAMA.

[22]  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.

[23]  J. Watari,et al.  Usefulness of Narrow Band Imaging System as a Digital Chromoendoscopy in Screening Colonoscopy: A Prospective Pilot Study , 2005 .

[24]  S. Woolf,et al.  Colorectal cancer screening and surveillance: clinical guidelines and rationale-Update based on new evidence. , 2003, Gastroenterology.

[25]  S. Cross,et al.  A prospective clinicopathological and endoscopic evaluation of flat and depressed colorectal lesions in the United Kingdom. , 2003 .

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

[27]  R. Hawes,et al.  Does Narrow Band Imaging (NBI) Enhance Colon Polyp Detection , 2005 .

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

[29]  Steven Brown,et al.  A prospective clinicopathological and endoscopic evaluation of flat and depressed colorectal lesions in the United Kingdom , 2003, American Journal of Gastroenterology.

[30]  A. Riphaus,et al.  Reduction of miss rates of colonic adenomas by zoom chromoendoscopy , 2006, International Journal of Colorectal Disease.

[31]  R. Pearson,et al.  Narrow-Band Versus White-Light High Definition Television Endoscopic Imaging for Screening Colonoscopy: A Prospective Randomized Trial , 2009 .