title: 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.
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.
  
  
  METHODS
  Multicenter, prospective, randomized, controlled trial.
  
  
  METHODS
  Two academic medical centers in the United States.
  
  
  METHODS
  Subjects undergoing screening or surveillance colonoscopy.
  
  
  METHODS
  Subjects were randomized to undergo colonoscopy with one of the following: SD-WL, HD-WL, or NBI.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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. (
  
  
  BACKGROUND
  NCT 00614770.).
authors.affiliation: University of Kansas School of Medicine, Veterans Affairs Medical Center, Kansas City, Missouri 64128-2295, USA. amitr68@hotmail.com
authors.forename: Amit
authors.initials: A
authors.lastname: Rastogi
authors.forename: Dayna S
authors.initials: DS
authors.lastname: Early
authors.forename: Neil
authors.initials: N
authors.lastname: Gupta
authors.forename: Ajay
authors.initials: A
authors.lastname: Bansal
authors.forename: Vikas
authors.initials: V
authors.lastname: Singh
authors.forename: Michael
authors.initials: M
authors.lastname: Ansstas
authors.forename: Sreenivasa S
authors.initials: SS
authors.lastname: Jonnalagadda
authors.forename: Christine E
authors.initials: CE
authors.lastname: Hovis
authors.forename: Srinivas
authors.initials: S
authors.lastname: Gaddam
authors.forename: Sachin B
authors.initials: SB
authors.lastname: Wani
authors.forename: Steven A
authors.initials: SA
authors.lastname: Edmundowicz
authors.forename: Prateek
authors.initials: P
authors.lastname: Sharma
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000473:pathology; D000368:Aged; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D003111:Colonic Polyps / Q000175:diagnosis* / Q000473:pathology; D003113:Colonoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008027:Light; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests