Detectability of colorectal neoplastic lesions using a novel endoscopic system with blue laser imaging: a multicenter randomized controlled trial.
OBJECTIVE
Most studies have not reported an improvement in the detection of adenomas with the use of image-enhanced colonoscopy methods, possibly because of the darkness of the images. To overcome this limitation, a new-generation endoscopic system has been developed. This system has 2 blue-laser imaging (BLI) observation modes. The BLI observation was set to BLI-bright mode to detect lesions. We aimed to evaluate the efficacy of BLI in detecting lesions.


METHODS
This study was designed as a randomized controlled trial with participants from 8 institutions. We enrolled patients aged ≥40 years. The participants were randomly assigned to 2 groups: observation by using white-light imaging (WLI) with a conventional xenon light source (WLI group) or observation by using BLI-bright mode with a laser light source (BLI group). All of the detected lesions were resected or had a biopsy taken for histopathologic analysis. The primary outcome was the mean number of adenomas per patient (MAP) that were detected per procedure.


RESULTS
The WLI and BLI groups consisted of 474 and 489 patients, respectively. The MAP was significantly higher in the BLI group than in the WLI group (mean ± standard deviation [SD] WLI 1.01 ± 1.36, BLI 1.27 ± 1.73; P = .008). Adenoma detection rate in the BLI group was not significantly higher than in the WLI group. Observation times differed significantly, with BLI (9.48 minutes) being longer than WLI (8.42; P < .001). The mean (± SD) number of polyps per patient was significantly higher in the BLI group compared with the WLI group (WLI 1.43 ± 1.64, BLI 1.84 ± 2.09; P = .001).


CONCLUSIONS
A newly developed system that uses BLI improves the detection of adenomatous lesions compared with WLI. (Clinical trial registration number: UMIN 000014555.).
Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
Hiroaki
H
Ikematsu
Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
Taku
T
Sakamoto
Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Aizuwakmatsu, Fukushima, Japan.
Kazutomo
K
Togashi
Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.
Naohisa
N
Yoshida
Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
Takashi
T
Hisabe
Department of Surgery, Gunma Chuo General Hospital, Maebashi, Gunma, Japan.
Shinsuke
S
Kiriyama
Department of Endoscopy, The Jikei University Katsushika Medical Center, Tokyo, Japan.
Koji
K
Matsuda
Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
Yoshikazu
Y
Hayashi
Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
Takahisa
T
Matsuda
Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
Shozo
S
Osera
Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
Kazuhiro
K
Kaneko
Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Aizuwakmatsu, Fukushima, Japan.
Kenichi
K
Utano
Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.
Yuji
Y
Naito
Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
Hiroshi
H
Ishihara
Department of Endoscopy, The Jikei University Katsushika Medical Center, Tokyo, Japan.
Masayuki
M
Kato
Innovative Clinical Research Center, Kanazawa University Hospital, Kanazawa, Japan.
Kenichi
K
Yoshimura
Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Hideki
H
Ishikawa
Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
Hironori
H
Yamamoto
Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
Yutaka
Y
Saito
D000236:Adenoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D000368:Aged; D001706:Biopsy; D003111:Colonic Polyps / Q000000981:diagnostic imaging*; D003113:Colonoscopy / Q000295:instrumentation* / Q000379:methods; D003116:Color; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007834:Lasers; D008297:Male; D008875:Middle Aged