Narrow-band imaging does not improve detection of colorectal polyps when compared to conventional colonoscopy: a randomized controlled trial and meta-analysis of published studies

BMC Gastroenterology

Sylvia de Aguiar¹  Diego Aponte³  Ludovic Reveiz²  Luis C Sabbagh⁴ 

[1] General Practice Department, Clínica Reina Sofía, Bogota, Colombia;Research Institute, Sanitas University Foundation, Bogota, Colombia;Gastroenterology Department, Clínica Colombia, Bogota, Colombia;Gastroenterology Department, Clínica Reina Sofía, Sanitas University Foundation, Bogota, Colombia

关键词: narrow-band imaging;    polyps;    colonoscopy;    Randomized controlled trial;   

Others  :  1113261
DOI  :  10.1186/1471-230X-11-100

 received in 2010-02-16, accepted in 2011-09-23,  发布年份 2011

【 摘 要 】

Background

A colonoscopy may frequently miss polyps and cancers. A number of techniques have emerged to improve visualization and to reduce the rate of adenoma miss.

Methods

We conducted a randomized controlled trial (RCT) in two clinics of the Gastrointestinal Department of the Sanitas University Foundation in Bogota, Colombia. Eligible adult patients presenting for screening or diagnostic elective colonoscopy were randomlsy allocated to undergo conventional colonoscopy or narrow-band imaging (NBI) during instrument withdrawal by three experienced endoscopists. For the systematic review, studies were identified from the Cochrane Library, PUBMED and LILACS and assessed using the Cochrane risk of bias tool.

Results

We enrolled a total of 482 patients (62.5% female), with a mean age of 58.33 years (SD 12.91); 241 into the intervention (NBI) colonoscopy and 241 into the conventional colonoscopy group. Most patients presented for diagnostic colonoscopy (75.3%). The overall rate of polyp detection was significantly higher in the conventional group compared to the NBI group (RR 0.75, 95%CI 0.60 to 0.96). However, no significant differences were found in the mean number of polyps (MD -0.1; 95%CI -0.25 to 0.05), and the mean number of adenomas (MD 0.04 95%CI -0.09 to 0.17). Meta-analysis of studies (regardless of indication) did not find any significant differences in the mean number of polyps (5 RCT, 2479 participants; WMD -0.07 95% CI -0.21 to 0.07; I2 68%), the mean number of adenomas (8 RCT, 3517 participants; WMD -0.08 95% CI -0.17; 0.01 to I2 62%) and the rate of patients with at least one adenoma (8 RCT, 3512 participants, RR 0.96 95% CI 0.88 to 1,04;I2 0%).

Conclusion

NBI does not improve detection of colorectal polyps when compared to conventional colonoscopy (Australian New Zealand Clinical Trials Registry ACTRN12610000456055).

【 授权许可】

   
2011 Sabbagh et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]U.S. Preventive Services Task Force: Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2008, 149(9):627-37.
• [2]Whitlock EP, Lin JS, Liles E, Beil TL, Fu R, O'Connor E, Thompson RN, Cardenas T: Screening for colorectal cancer: an updated systematic review. Evidence Synthesis No. 65, Part 1. AHRQ publication no. 08-05124-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2008.
• [3]Whitlock E, Lin JS, Liles E, Beil TL, Fu R: Screening for colorectal cancer: a targeted systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2008, 149.
• [4]Robertson DJ, Greenberg ER, Beach M, Sandler RS, Ahnen D, Haile RW, Burke CA, Snover DC, Bresalier RS, McKeown-Eyssen G, Mandel JS, Bond JH, Van Stolk RU, Summers RW, Rothstein R, Church TR, Cole BF, Byers T, Mott L, Baron JA: Colorectal cancer in patients under close colonoscopic surveillance. Gastroenterology 2005, 129:34-41.
• [5]Winawer SJ, Zauber AG, Ho MN, O'Brien MJ, Gottlieb LS, Sternberg SS, Waye JD, Schapiro M, Bond JH, Panish JF, Ackroyd F, Shike M, Kurtz RC, Hornsby-Lewis L, Gerdes H, Stewart ET, and the National Polyp Study Workgroup: The National Polyp Study Workgroup. Prevention of Colorectal Cancer by Colonoscopic Polypectomy. N Engl J Med 1993, 329:1977-81.
• [6]Bensen S, Mott LA, Dain B, Rothstein R, Baron J: The colonoscopic miss rate and true one-year recurrence of colorectal neoplastic polyps. Polyp Prevention Study Group. Am J Gastroenterol 1999, 94:194-9.
• [7]van Rijn JC, Reitsma JB, Stoker J, Bossuyt PM, van Deventer SJ, Dekker E: Polyp miss rate determined by tandem colonoscopy: a systematic review. Am J Gastroenterol 2006, 101(2):343-50.
• [8]Heresbach D, Barrioz T, Lapalus MG, Coumaros D, Bauret P, Potier P, Sautereau D, Boustière C, Grimaud JC, Barthélémy C, Sée J, Serraj I, D'Halluin PN, Branger B, Ponchon T: Miss rate for colorectal neoplastic polyps: a prospective multicenter study of back-to-back video colonoscopies. Endoscopy 2008, 40(4):284-90.
• [9]Postic G, Lewin D, Bickerstaff C, Wallace MB: Colonoscopic miss rates determined by direct comparison of colonoscopy with colon resection specimens. Am J Gastroenterol 2002, 97(12):3182-5.
• [10]Simmons DT, Harewood GC, Baron TH, Petersen BT, Wang KK, Boyd-Enders F, Ott BJ: Impact of endoscopist withdrawal speed on polyp yield: implications for optimal colonoscopy withdrawal time. Aliment Pharmacol Ther 2006, 15;24(6):965-71.
• [11]Morini S, Hassan C, Zullo A, Lorenzetti R, de Matthaeis M, Stella F, Campo SM: Detection of colonic polyps according to insertion/withdrawal phases of colonoscopy. Int J Colorectal Dis 2009, 24(5):527-30.
• [12]Pickhardt PJ, Nugent PA, Mysliwiec PA, Choi JR, Schindler WR: Location of adenomas missed by optical colonoscopy. Ann Intern Med 2004, 7;141(5):352-9.
• [13]Huh KC, Rex DK: Advances in colonoscope technique and technology. Rev Gastroenterol Disord 2008, Fall;8(4):223-32.
• [14]Gono K, Obi T, Yamaguchi M, Ohyama N, Machida H, Sano Y, Yoshida S, Hamamoto Y, Endo T: Appearance of enhanced tissue features in narrow-band endoscopic imaging. J Biomed Opt 2004, 9:568-77.
• [15]Rastogi A, Bansal A, Wani S, Callahan P, Pandya P, Mathur S, Sharma P: Does Narrow Band Imaging (NBI) Colonoscopy Increase the Detection Rate of Colon Polyps? - A Pilot Feasibility Study Gastrointestinal Endoscopy. 2007, 65(5):AB259-AB259.
• [16]Sano Y, Kobayashi M, Hamamoto Y: New diagnostic method based on color imaging using narrow-band imaging (NBI) system for gastrointestinal tract. Gastrointest Endosc 2001, 53:AB125.
• [17]Machida H, Sano Y, Hamamoto Y, Muto M, Kozu T, Tajiri H, Yoshida S: Narrow-band imaging for differential diagnosis of colorectal mucosal lesions: a pilot study. Endoscopy 2004, 36:1094-8.
• [18]Sano Y, Tajiri H, Shigeaki A: Optical/Digital Chromoendoscopy during colonoscopy using Narrow-Banding Imaging system Digestive Endoscopy. 2005, 17(Suppl):S43-S48.
• [19]Adler A, Pohl H, Papanikolaou IS, Abou-Rebyeh H, Schachschal G, Veltzke-Schlieker W: A prospective randomised study on narrow-band imaging versus conventional colonoscopy for adenoma detection: does narrow-band imaging induce a learning effect? Gut 2008, 57(1):59-64.
• [20]Adler A, Aschenbeck J, Yenerim T, Mayr M, Aminalai A, Drossel R: Narrow-band versus white-light high definition television endoscopic imaging for screening colonoscopy: a prospective randomized trial. Gastroenterology 2009, 136(2):410-6.e1.
• [21]Kaltenbach T, Friedland S, Soetikno R: A randomised tandem colonoscopy trial of narrow band imaging versus white light examination to compare neoplasia miss rates. Gut 2008, 57(10):1406-12.
• [22]Rastogi A, Bansal A, Wani S, Callahan P, Pandya P, Mathur S, Sharma P: Does Narrow Band Imaging (NBI) Colonoscopy Increase the Detection Rate of Colon Polyps? - A Pilot Feasibility Study Gastrointestinal Endoscopy. 2007, 65(5):AB259-AB259.
• [23]Paggi S, Radaelli F, Amato A, Meucci G, Mandelli G, Imperiali G, Spinzi G, Terreni N, Lenoci N, Terruzzi V: The Impact of Narrow Band Imaging in Screening Colonoscopy: A Randomized Controlled Trial. Clin Gastroenterol Hepatol 2009, 7(10):1049-54.
• [24]Rastogi A, Bansal A, Wani S, Callahan P, McGregor DH, Cherian R, Sharma P: Narrow-band imaging colonoscopy--a pilot feasibility study for the detection of polyps and correlation of surface patterns with polyp histologic diagnosis. Gastrointest Endosc 2008, 67(2):280-6.
• [25]Rex DK, Helbiig CC: High Yield of small and flat adenomas with high definition colonoscopes using either white light or narrow band imaging. Gastroenterology 2007, 133:42-47.
• [26]Inoue T, Murano M, Murano N, Kuramoto T, Kawakami K, Abe Y, Morita E, Toshina K, Hoshiro H, Egashira Y, Umegaki E, Higuchi K: Comparative study of conventional colonoscopy and pan-colonic narrow -band imaging system in the detection of neoplastic colonic polyps: a randomized controlled trial. J Gastroenterol 2008, 43:45-50.
• [27]East JE, Suzuki N, Guenther T, Palmer N, Stavrinidis M, Ignjatovic A, Saunders BP: Narrow band imaging (NBI) for adenoma detection in high risk patients: a randomised, controlled trial. Endoscopy 2009, 41(Suppl 1):A223.
• [28]Uraoka T, Saito Y, Matsuda T, Sano Y, Ikehara H, Mashimo Y, Kikuchi T, Saito D, Saito H: Detectability of colorectal neoplastic lesions using a narrow-band imaging system: a pilot study. J Gastroenterol Hepatol 2008, 23(12):1810-5.
• [29]Dekker E, van den Broek FJ, Reitsma JB, Hardwick JC, Offerhaus GJ, van Deventer SJ, Hommes DW, Fockens P: Narrow-band imaging compared with conventional colonoscopy for the detection of dysplasia in patients with longstanding ulcerative colitis. Gut 2007, 56(3):373-9.
• [30]Dekker E, van den Broek FJ, Reitsma JB, Hardwick JC, Offerhaus GJ, van Deventer SJ, Hommes DW, Fockens P: Narrow-band imaging compared with conventional colonoscopy for the detection of dysplasia in patients with longstanding ulcerative colitis. Endoscopy 2007, 39(3):216-21.
• [31]Rastogi A, Bansal A, Wani S, Callahan P, McGregor DH, Cherian R, Sharma P: Narrow-band imaging colonoscopy--a pilot feasibility study for the detection of polyps and correlation of surface patterns with polyp histologic diagnosis. Gastrointest Endosc 2008, 67(2):280-6.
• [32]Sikka S, Ringold DA, Jonnalagadda S, Banerjee B: Comparison of white light and narrow band high definition images in predicting colon polyp histology, using standard colonoscopes without optical magnification. Endoscopy 2008, 40(10):818-22.
• [33]East JE, Suzuki N, Bassett P, Stavrinidis M, Thomas HJ, Guenther T, Tekkis PP, Saunders BP: Narrow band imaging with magnification for the characterization of small and diminutive colonic polyps: pit pattern and vascular pattern intensity. Endoscopy 2008, 40(10):811-7.
• [34]Horiuchi A, Nakayama Y, Kato N, Ichise Y, Kajiyama M, Tanaka N: Hood-Assisted Colonoscopy Is More Effective in Detection of Colorectal Adenomas Than Narrow-Band Imaging. Clin Gastroenterol Hepatol 2009, in press.
• [35]Higgins JPT, Green S, (editors): Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 [updated February 2008]. [http://www.cochrane-handbook.org] webciteThe Cochrane Collaboration 2008. The Cochrane Collaboration, 2008
• [36]van den Broek FJ, Reitsma JB, Curvers WL, Fockens P, Dekker E: Systematic review of narrow-band imaging for the detection and differentiation of neoplastic and nonneoplastic lesions in the colon (with videos). Gastrointest Endosc 2009, 69(1):124-35.
• [37]Barclay RL, Vicari JJ, Doughty AS, Johanson JF, Greenlaw RL: Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med 2006, 355:2533-2541.
• [38]Sieg A, Theilmeier A: Results of coloscopy screening in 2005--an Internet-based documentation. Dtsch Med Wochenschr 2006, 131:379-383.
• [39]Byeon JS, Yang SK, Kim TI, Kim WH, Lau JY, Leung WK, for the Asia Pacific Working Group for Colorectal Cancer: Colorectal neoplasm in asymptomatic Asians: a prospective multinational multicenter colonoscopy survey. Gastrointest Endosc 2007, 65(7):1015-1022.
• [40]Adler A, Roll S, Marowski B, Drossel R, Rehs HU, Willich SN, Riese J, Wiedenmann B, Rösch T, Berlin Private-Practice Gastroenterology Working Group: Appropriateness of colonoscopy in the era of colorectal cancer screening: a prospective, multicenter study in a private-practice setting (Berlin Colonoscopy Project 1, BECOP 1). Dis Colon Rectum 2007, 50(10):1628-1638.
• [41]Mariño G, Arango JH, Hoyos JA, Vallejo JF, Kestemberg A: Pólipos de colon en Cali, Colombia 1995-1996. Correlación de hallazgos endoscópicos e histopatológicos. Rev colomb Gastroenterol 1997, 12(3):151-3.
• [42]Peñaloza A, Piña R, Reyes P, Murillo O: Pólipos de colon: revisión 1984 a 1989. Rev colomb Gastroenterol 1991, 6(1):13-7.
• [43]Restrepo C, Correa P, Duque E, Cuello C: Polyps in a low-risk colonic cancer population in Colombia, South America. Dis Colon Rectum 1981, 24(1):29-36.
• [44]Cardona Villamizar HJ, Otero Regino W, Forero Piñeros EA, Gutiérrez Ceballos O: Significado de los pólipos en colon distal en una población de un país en vía de desarrollo: prevalencia y asociación con neoplasia proximal sincrónica. Rev Col Gastroenterol 2004, 19(4):253-262.
• [45]Uraoka T, Higashi R, Saito Y, Matsuda T, Yamamoto K: Impact of narrow-band imaging in screening colonoscopy Digestive Endoscopy. 2010, 22(Suppl 1):S54-6.