Randomized, controlled trial of standard-definition white-light, high-definition white-light, and narrow-band imaging colonoscopy for the detection of colon polyps and prediction of polyp histology - 27/08/11
Reprint requests: Amit Rastogi, MD, FASGE, University of Kansas School of Medicine, Kansas City Veterans Affairs Medical Center, 4801 East Linwood Blvd., Kansas City, MO 64128-2295Résumé |
Background |
Missing adenomas and the inability to accurately differentiate between polyp histology remain the main limitations of standard-definition white-light (SD-WL) colonoscopy.
Objective |
To compare the adenoma detection rates of SD-WL with those of high-definition white-light (HD-WL) and narrow-band imaging (NBI) as well as the accuracy of predicting polyp histology.
Design |
Multicenter, prospective, randomized, controlled trial.
Setting |
Two academic medical centers in the United States.
Patients |
Subjects undergoing screening or surveillance colonoscopy.
Intervention |
Subjects were randomized to undergo colonoscopy with one of the following: SD-WL, HD-WL, or NBI.
Main Outcome Measurements |
The proportion of subjects detected with adenomas, adenomas detected per subject, and the accuracy of predicting polyp histology real time.
Results |
A total of 630 subjects were included. The proportion of subjects with adenomas was 38.6% with SD-WL compared with 45.7% with HD-WL and 46.2% with NBI (P = .17 and P = .14, respectively). Adenomas detected per subject were 0.69 with SD-WL compared with 1.12 with HD-WL and 1.13 with NBI (P = .016 and P = .014, respectively). HD-WL and NBI detected more subjects with flat and right-sided adenomas compared with SD-WL (all P values <.005). NBI had a superior sensitivity (90%) and accuracy (82%) to predict adenomas compared with SD-WL and HD-WL (all P values <.005).
Limitations |
Academic medical centers with experienced endoscopists.
Conclusions |
There was no difference in the proportion of subjects with adenomas detected with SD-WL, HD-WL, and NBI. However, HD-WL and NBI detected significantly more adenomas per subject (>60%) compared with SD-WL. NBI had the highest accuracy in predicting adenomas in real time during colonoscopy. (Clinical Trial registration number: NCT 00614770.)
Le texte complet de cet article est disponible en PDF.Abbreviations : HD-WL, NBI, PIVI, SD-WL
Plan
| Dr Rastogi was supported by a research grant from Olympus America Inc. |
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| DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: Dr Rastogi: research grant from Olympus America Inc; Dr Edmundowicz: consultant to, honorarium from, and member of the advisory board of Olympus America Inc; Dr Sharma: grant support from Olympus America Inc. The other authors disclosed no financial relationships relevant to this publication. Dr Rastogi is the recipient of the Michael V. Sivak Jr. MD Endoscopic Research Award from the American Society for Gastrointestinal Endoscopy. |
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| See CME section; p. 634. |
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| If you would like to chat with an author of this article, you may contact Dr. Rastogi at amitr68@hotmail.com. |
Vol 74 - N° 3
P. 593-602 - septembre 2011 Retour au numéro
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