Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan.
J Gastroenterol. 2012 Oct;47(10):1099-107. doi: 10.1007/s00535-012-0575-2. Epub 2012 Mar 24.
Previous studies have yielded conflicting results on the adenoma detection rate with narrow band imaging (NBI) compared with white light imaging (WLI). To overcome the confounding factors of these studies, we aimed to evaluate the colonic adenoma detection rate with primary NBI versus that with primary WLI by using consistent NBI system, endoscope, and imaging settings, and experienced colonoscopists.
In this multicenter prospective trial, 813 patients were randomized to undergo high-definition, tandem colonoscopy in the right colon with either NBI followed by WLI (NBI-WLI group) or WLI followed by NBI (WLI-NBI group). The NBI settings were fixed at surface structure enhancement level A-5 and adaptive index of hemoglobin color enhancement level 3. All detected polyps were resected or biopsied for histopathological analysis. The primary and secondary outcome measures were the adenoma detection rates and miss rates, respectively, with primary imaging.
The NBI-WLI and WLI-NBI groups comprised 389 and 393 patients, respectively, who met the inclusion criteria. The groups did not differ significantly in age, gender, institution, indication for colonoscopy, bowel preparation, or observation time. The adenoma detection rates of primary NBI and WLI were 42.3 and 42.5 %, respectively [difference not significant (NS)]. The adenoma miss rate was significantly less with primary NBI than with primary WLI (21.3 vs. 27.8 %; p = 0.03).
NBI does not improve the adenoma detection rate during primary colonoscopy; however, it has a lower miss rate for adenoma lesions in the proximal colon than WLI.
与白光成像（WLI）相比，窄带成像（NBI）在腺瘤检测率方面的先前研究结果相互矛盾。为了克服这些研究的混杂因素，我们旨在通过使用一致的 NBI 系统、内镜和成像设置以及经验丰富的结肠镜检查医师，评估原发性 NBI 与原发性 WLI 对结肠腺瘤的检测率。
在这项多中心前瞻性试验中，813 名患者被随机分为两组，分别在右半结肠进行高清串联结肠镜检查，一组先进行 NBI 后进行 WLI（NBI-WLI 组），另一组先进行 WLI 后进行 NBI（WLI-NBI 组）。NBI 设定为表面结构增强水平 A-5 和血红蛋白颜色增强水平 3 的自适应指数。所有检测到的息肉均进行切除或活检进行组织病理学分析。主要和次要结局指标分别为原发性成像的腺瘤检测率和漏诊率。
NBI-WLI 和 WLI-NBI 组分别纳入 389 例和 393 例符合纳入标准的患者。两组在年龄、性别、机构、结肠镜检查指征、肠道准备或观察时间方面无显著差异。原发性 NBI 和 WLI 的腺瘤检出率分别为 42.3%和 42.5%（差异无统计学意义（NS））。原发性 NBI 的腺瘤漏诊率明显低于原发性 WLI（21.3%比 27.8%；p=0.03）。
NBI 不能提高原发性结肠镜检查的腺瘤检出率；然而，它对近端结肠的腺瘤病变的漏诊率较低。
