Nagorni Aleksandar, Bjelakovic Goran, Petrovic Bratislav
Department of Internal Medicine - Gastroenterology and Hepatology, Medical Faculty, University of Nis, Nis, Serbia.
Cochrane Database Syst Rev. 2012 Jan 18;1(1):CD008361. doi: 10.1002/14651858.CD008361.pub2.
It has been suggested that narrow band imaging colonoscopy (NBI) might be better for detection of colorectal polyps than white light colonoscopy (WLC).
To compare standard or high definition white light colonoscopy with narrow band imaging colonoscopy for detection of colorectal polyps.
We searched The Cochrane Library, MEDLINE, and EMBASE to August 2011. We scanned bibliographies of relevant publications and wrote to experts for additional trials.
Two authors (NA and GB) independently applied the inclusion criteria and extracted the data to all potential studies without blinding.
Authors extracted data independently. Trials with adequate randomisation, allocation concealment, and complete outcome data reporting, as well as without selective outcome reporting or other bias were classified as having a lowest risk of bias. Random-effects and fixed-effect meta-analyses were conducted.
We identified 11 randomised trials comparing WLC with NBI for detection of colorectal polyps. In total eight randomised trials with 3673 participants provided data for our analyses. There was no statistically significant difference between WLC (standard definition and high definition pooled) and NBI for the detection of patients with colorectal polyps (6 trials, n = 2832, RR 0.97, 95% CI 0.91 to 1.04), patients with colorectal adenomas (8 trials, n = 3673, RR 0.94, 95% CI 0.87 to 1.02), or patients with colorectal hyperplastic polyps (2 trials, n = 645, RR 0.87, 95% CI 0.76 to 1.00). Number of patients with at least one colorectal adenoma was not significantly different between WLC and NBI group irrespective of adenoma size (< 5 mm:RR 0.95, 95% CI 0.84 to 1.08, I(2) = 56%; 6 to 9 mm: RR 1.06, 95% CI 0.81 to 1.39, I(2) = 0%; ≥ 10 mm: RR 1.06, 95% CI 0.77 to 1.45, I(2) = 0%). Number of patients with at least one colorectal polyp, or colorectal adenoma was significantly lower in the standard definition WLC group compared to NBI group in fixed-effect meta-analysis (RR 0.87, 95% CI 0.78 to 0.97, I(2) = 78%; RR 0.87, 95% CI 0.77 to 0.99, I(2) = 0%, respectively), but not significantly different in random-effects meta-analysis (RR 0.86, 95% CI 0.68 to 1.10, I(2) = 78%). There was no statistically significant difference between high definition WLC and NBI in the number of patiens with at least one colorectal polyp or colorectal adenoma (RR 1.10, 95% CI 0.95 to 1.28; RR 0.87, 95% CI 0.77 to 0.99, I(2) = 0%, respectively).
AUTHORS' CONCLUSIONS: We could not find convincing evidence that NBI is significantly better than high definition WLC for the detection of patients with colorectal polyps, or colorectal adenomas. We found evidence that NBI might be better than standard definition WLC and equal to high definition WLC for detection the patients with colorectal polyps, or colorectal adenomas.
有人提出，窄带成像结肠镜检查（NBI）在检测大肠息肉方面可能比白光结肠镜检查（WLC）更好。
比较标准或高清白光结肠镜检查与窄带成像结肠镜检查在检测大肠息肉方面的效果。
我们检索了截至2011年8月的Cochrane图书馆、MEDLINE和EMBASE。我们查阅了相关出版物的参考文献，并写信给专家询问其他试验。
两位作者（NA和GB）独立应用入选标准，对所有潜在研究提取数据，未设盲。
作者独立提取数据。具有充分随机化、分配隐藏和完整结局数据报告，且无选择性结局报告或其他偏倚的试验被归类为偏倚风险最低。进行了随机效应和固定效应荟萃分析。
我们确定了11项比较WLC和NBI检测大肠息肉的随机试验。共有8项随机试验，3673名参与者为我们的分析提供了数据。在检测大肠息肉患者（6项试验，n = 2832，RR 0.97，95%CI 0.91至1.04）、大肠腺瘤患者（8项试验，n = 3673，RR 0.94，95%CI 0.87至1.02）或大肠增生性息肉患者（2项试验，n = 645，RR 0.87，95%CI 0.76至1.00）方面，WLC（标准清晰度和高清晰度合并）与NBI之间无统计学显著差异。无论腺瘤大小如何（<5mm：RR 0.95，95%CI 0.84至1.08，I² = 56%；6至9mm：RR 1.06，95%CI 0.81至1.39，I² = 0%；≥10mm：RR 1.06，95%CI 0.77至1.45，I² = 0%），WLC组和NBI组中至少有一个大肠腺瘤的患者数量无显著差异。在固定效应荟萃分析中，标准清晰度WLC组中至少有一个大肠息肉或大肠腺瘤的患者数量显著低于NBI组（RR 0.87，95%CI 0.78至0.97，I² = 78%；RR 0.87，95%CI 0.77至0.99，I² = 0%），但在随机效应荟萃分析中无显著差异（RR 0.86，95%CI 0.68至1.10，I² = 78%）。在至少有一个大肠息肉或大肠腺瘤的患者数量方面，高清晰度WLC与NBI之间无统计学显著差异（RR 1.10，95%CI 0.95至1.28；RR 0.87，95%CI 0.77至0.99，I² = 0%）。
我们未找到令人信服的证据表明NBI在检测大肠息肉或大肠腺瘤患者方面明显优于高清晰度WLC。我们发现有证据表明，在检测大肠息肉或大肠腺瘤患者方面，NBI可能优于标准清晰度WLC且等同于高清晰度WLC。
