Narrow-band versus white-light high definition television endoscopic imaging for screening colonoscopy: a prospective randomized trial.
OBJECTIVE
Narrow-band imaging (NBI) has been implemented in gastrointestinal endoscopy to improve the contrast of endoluminal pathologic structures, one of the aims being to increase colonic adenoma detection. Previous studies from referral centers have yielded variable and conflicting results with regard to improvement in adenoma detection rates by using NBI. The present large randomized trial was designed to finally settle this issue.


METHODS
In a prospective study performed exclusively in a multicenter private practice setting involving 6 examiners with substantial lifetime experience (>10,000 colonoscopies), 1256 patients (men:women, 47%:53%; mean age, 64.4 y) were randomized to HDTV screening colonoscopy with either NBI or white-light imaging on instrument withdrawal. The primary outcome measure was the adenoma detection rate (ie, number of adenomas/total number of patients).


RESULTS
There was no difference between the 2 groups in terms of the general adenoma detection rate (0.32 vs 0.34), the total number of adenomas (200 vs 216), or in detection in subgroups of adenomas. This was despite a minimal, but significantly longer, withdrawal time in the NBI group (8.5 vs 7.9 min; P < .05). Only hyperplastic polyps were found more frequently in the NBI group (P = .03).


CONCLUSIONS
This large randomized trial in a homogeneous private practice screening setting could not show any objective advantage of the NBI technique over white-light high definition television imaging in terms of improved adenoma detection rate. Contrast enhancement therefore likely will not contribute to a reduction in adenoma miss rates among experienced colonoscopists.
Adler
Andreas
A
Central Interdisciplinary Endoscopy Unit, Charité Medical University Hospitals, Campus Virchow, Berlin, Germany.
Aschenbeck
Jens
J
Yenerim
Timur
T
Mayr
Michael
M
Aminalai
Alireza
A
Drossel
Rolf
R
Schröder
Andreas
A
Scheel
Matthias
M
Wiedenmann
Bertram
B
Rösch
Thomas
T
D000236:Adenoma / Q000175:diagnosis* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D020685:Colonoscopes; D003113:Colonoscopy / Q000379:methods*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013690:Television / Q000295:instrumentation*