title: Meta-analysis for evaluating the accuracy of endoscopy with narrow band imaging in detecting colorectal adenomas.
abstract: OBJECTIVE
  The aim of this study was to determine whether the use of the narrow band imaging (NBI) system could enhance the accuracy of adenoma detection during an endoscopic examination of the colon and rectum.
  
  
  METHODS
  MEDLINE, EMBASE, and the Cochrane Library databases were searched along with a hand search of abstracts from relevant conferences up to June 2011. The rates of adenoma and flat adenoma detection, and withdrawal time were analyzed using Review Manager 4.2.
  
  
  RESULTS
  A total of 3049 subjects in eight trials were included. Meta-analysis revealed that there was no statistically significant difference in the rates of adenoma detection between the NBI group and the white light colonoscopy group (pooled relative risk [RR]: 1.09, 95% confidence interval [CI]: 1.00-1.19, P = 0.05). However, after exclusion of high-definition television modalities, the rate of adenoma detection by NBI was significantly higher than that by white light, particularly for patients with one adenoma (pooled RR 1.36, 95%CI 1.07-1.71, P = 0.02). Endoscopy with the NBI system significantly increased the rate of flat adenoma detection (pooled RR 1.96, 95%CI 1.09-3.52, P = 0.02). However, endoscopy with NBI had longer withdrawal time than that with white light (pooled weighted mean difference: 0.90, 95%CI: 0.38-1.42, P = 0.0006).
  
  
  CONCLUSIONS
  Endoscopy with NBI seems to improve the detection of flat adenomas, particularly with high-definition technology, but prolongs the withdrawal time. These results indicate that endoscopy routinely using the NBI system for the surveillance of adenomas may be recommended after the technique is further modified.
authors.affiliation: Department of Gastroenterology, Central People's Hospital of Tengzhou, Tengzhou, Shandong Province, China. violetmoodee1210@126.com
authors.forename: Xi-Feng
authors.initials: XF
authors.lastname: Jin
authors.forename: Tong-Hai
authors.initials: TH
authors.lastname: Chai
authors.forename: Jun-Wen
authors.initials: JW
authors.lastname: Shi
authors.forename: Xiu-Cheng
authors.initials: XC
authors.lastname: Yang
authors.forename: Qing-Yan
authors.initials: QY
authors.lastname: Sun
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000473:pathology; D003113:Colonoscopy / Q000379:methods*; D003116:Color; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D007089:Image Enhancement; D013997:Time Factors