Staudenmann Dominic, Liu Ken, Varma Poornima, Wong May, Rai Sonam, Tsoutsman Tatiana, Choi Kyung Ho, Saxena Payal, Kaffes Arthur John
AW Morrow Gastroenterology and Liver Centre Royal Prince Alfred Hospital Sydney Australia.
Department of Gastroenterology Praxis Balsiger Seibold und Partner Bern Switzerland.
DEN Open. 2021 Sep 1;2(1):e44. doi: 10.1002/deo2.44. eCollection 2022 Apr.
Colonoscopy is the gold standard diagnostic test used to detect early colorectal lesions and prevent colorectal carcinoma. Narrow band imaging (NBI) is an imaging technique that provides improved image resolution of the mucosa during endoscopy. Whether NBI improves the detection of sessile serrated lesion (SSL) is controversial-our aim was to assess this during routine colonoscopy.
We conducted a multicenter, prospective, randomized, controlled trial. Patients underwent colonoscopy for screening, surveillance, or symptoms. They were randomized to either high-definition white light (HD-WL) or NBI in a 1:1 ratio. The primary outcome was SSL detection rate. Secondary outcomes were adenoma detection rate (ADR) and polyp detection rate (PDR).
A total of 400 patients were randomized to NBI (N = 200) or HD-WL (N = 200). The total colonoscopy time was slightly longer in the NBI group compared to HD-WL (median time 14 vs. 12 min, = 0.033). There were no statistically significant differences in SSL detection rate (7.5% NBI vs. 8.0% HD-WL; = 0.852), ADR (41.0% NBI vs. 37.5% HD-WL; = 0.531), or PDR (61.0% NBI vs. 54.0% HD-WL; = 0.157) between the two groups. No significant predictors of SSL detection were found on univariable or multivariable analysis. Increasing age and increased withdrawal time were an independent predictors of polyp detection and increasing age was also an independent predictor of adenoma detection on multivariable analysis.
In the hands of experienced colonoscopists, NBI does not improve SSL detection compared to HD-WL. Withdrawal time and patient age remain important factors for polyp and adenoma detection.
结肠镜检查是用于检测早期结直肠病变及预防结直肠癌的金标准诊断测试。窄带成像（NBI）是一种在内镜检查期间能提高黏膜图像分辨率的成像技术。NBI是否能改善无蒂锯齿状病变（SSL）的检测存在争议——我们的目的是在常规结肠镜检查期间对此进行评估。
我们开展了一项多中心、前瞻性、随机对照试验。患者因筛查、监测或症状接受结肠镜检查。他们以1:1的比例随机分为高清白光（HD-WL）组或NBI组。主要结局是SSL检测率。次要结局是腺瘤检测率（ADR）和息肉检测率（PDR）。
共有400例患者被随机分为NBI组（N = 200）或HD-WL组（N = 200）。与HD-WL组相比，NBI组的总结肠镜检查时间略长（中位时间14分钟对12分钟，P = 0.033）。两组之间在SSL检测率（NBI组为7.5%，HD-WL组为8.0%；P = 0.852）、ADR（NBI组为41.0%，HD-WL组为37.5%；P = 0.531）或PDR（NBI组为61.0%，HD-WL组为54.0%；P = 0.157）方面均无统计学显著差异。在单变量或多变量分析中均未发现SSL检测的显著预测因素。多变量分析显示，年龄增加和退镜时间延长是息肉检测的独立预测因素，年龄增加也是腺瘤检测的独立预测因素。
在经验丰富的结肠镜检查医师手中，与HD-WL相比，NBI并不能改善SSL检测。退镜时间和患者年龄仍然是息肉及腺瘤检测的重要因素
