title: Narrow band imaging for detection of dysplasia in colitis: a randomized controlled trial.
abstract: OBJECTIVE
  In ulcerative colitis surveillance, chromoendoscopy improves dysplasia detection 3 – 5-fold compared with white light endoscopy (WLE). The aim of this study was to investigate whether narrow band imaging (NBI) can improve dysplasia detection compared with WLE.
  
  
  METHODS
  This was a randomized, parallel-group trial. A total of 220 patients were needed to be recruited to detect a threefold increase in dysplasia detection. In all, 112 patients with long-standing ulcerative colitis were randomized to colonoscopic extubation with NBI (56) or WLE (56) (1:1 ratio) at two tertiary endoscopy units in the United Kingdom. Targeted biopsies of suspicious areas and quadrantic random biopsies every 10 cm were taken in both groups. The primary outcome measure was the proportion of patients with at least one area of dysplasia detected. In a prespecified mid-point analysis, the criteria for trial discontinuation were met and the trial was stopped and analyzed at this point.
  
  
  RESULTS
  There was no difference in the primary outcome between the two groups, with 5 patients having at least one dysplastic lesion in each group (odds ratio (OR) 1.00, 95 % confidence interval (95 % CI) 0.27 – 3.67, P = 1.00). This remained unchanged when adjusted for other variables (OR 0.69, 95 % CI 0.16 – 2.96, P = 0.62). Overall, dysplasia detection was 9 % in each arm. Yield of dysplasia from random nontargeted biopsies was 1 / 2,707 (0.04 % ).
  
  
  CONCLUSIONS
  Overall, in this multicenter parallel-group trial, there was no difference in dysplasia detection when using NBI compared with high-definition WLE colonoscopy. Random background biopsies were ineffective in detecting dysplasia.
authors.affiliation: Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow, UK. anaignjatovic@me.com
authors.forename: Ana
authors.initials: A
authors.lastname: Ignjatovic
authors.forename: James E
authors.initials: JE
authors.lastname: East
authors.forename: Venkat
authors.initials: V
authors.lastname: Subramanian
authors.forename: Noriko
authors.initials: N
authors.lastname: Suzuki
authors.forename: Thomas
authors.initials: T
authors.lastname: Guenther
authors.forename: Nicky
authors.initials: N
authors.lastname: Palmer
authors.forename: Paul
authors.initials: P
authors.lastname: Bassett
authors.forename: Krish
authors.initials: K
authors.lastname: Ragunath
authors.forename: Brian P
authors.initials: BP
authors.lastname: Saunders
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D003093:Colitis, Ulcerative / Q000473:pathology*; D003113:Colonoscopy / Q000379:methods*; D004396:Coloring Agents; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011159:Population Surveillance / Q000379:methods; D011446:Prospective Studies; D006113:United Kingdom
chemical_list: D004396:Coloring Agents