Narrow-band imaging and high-definition white-light endoscopy in patients with serrated lesions not fulfilling criteria for serrated polyposis syndrome: a randomized controlled trial with tandem colonoscopy

Abstract

Background: It is unknown whether narrow-band imaging (NBI) could be more effective than high-definition white-light endoscopy (HD-WLE) in detecting serrated lesions in patients with prior serrated lesions > 5 mm not completely fulfilling serrated polyposis syndrome (SPS) criteria. Methods: We conducted a randomized, cross-over trial in consecutive patients with prior detection of at least one serrated polyp ≥10 mm or ≥ 3 serrated polyps larger than 5 mm, both proximal to the sigmoid colon. Five experienced endoscopists performed same-day tandem colonoscopies, with the order being randomized 1:1 to NBI-HD-WLE or HD-WLE-NBI. All tandem colonoscopies were performed by the same endoscopist. Results: We included 41 patients. Baseline characteristics were similar in the two cohorts: NBI-HD-WLE (n = 21) and HD-WLE-NBI (n = 20). No differences were observed in the serrated lesion detection rate of NBI versus HD-WLE: 47.4% versus 51.9% (OR 0.84, 95% CI: 0.37-1.91) for the first and second withdrawal, respectively. Equally, no differences were found in the polyp miss rate of NBI versus HD-WLE: 21.3% versus 26.1% (OR 0.77, 95% CI: 0.43-1.38). Follow-up colonoscopy in nine patients (22%) allowed them to be reclassified as having SPS. Conclusions: In patients with previous serrated lesions, the serrated lesion detection rate was similar with NBI and HD-WLE. A shorter surveillance colonoscopy interval increases the detection of missed serrated polyps and could change the diagnosis of SPS in approximately one in every five patients.

Updates in narrow‐band imaging for colorectal polyps: Narrow‐band imaging generations, detection, diagnosis, and artificial intelligence

“…55 A prospective tandem RCT showed that NBI and WLI yielded a similar detection rate of HPs and SSLs (HP: 18 vs. 19, SSL: 6 vs. 5, not significant) among patients diagnosed with serrated polyposis syndrome (SPS), 56 while another prospective tandem RCT similarly showed no differences in the SSLDR (NBI 47.4% vs. WLI 51.9%, OR 0.84, 95% CI 0.37-1.91) among patients without SPS. 57 Although favorable outcomes for NBI in the detection of proximal SLs were reported, the difference was not significant (NBI 204 vs. WLI 158; P = 0.085). 58 Therefore, the current evidence suggests that NBI may be used as a supplemental modality to improve the detection of SSLs, but WLI seems to be the standard approach for the detection of SLs.…”

Narrow band imaging versus white light for detecting sessile serrated lesion: A prospective randomized multicenter study

“… 29 Additionally, a randomized controlled trial with tandem colonoscopy in patients with previous SSLs also reported no benefit of NBI over HD‐WL. 30 In a multicenter study with 138 patients, NBI has also failed to improve detection of remnant SSL tissue after EMR of serrated lesions. 31 …”

“…Another multicenter study similarly found no significant improvement in SSLDR using NBI compared to HD‐WL endoscopy in patients with sessile serrated polyposis syndrome 29 . Additionally, a randomized controlled trial with tandem colonoscopy in patients with previous SSLs also reported no benefit of NBI over HD‐WL 30 . In a multicenter study with 138 patients, NBI has also failed to improve detection of remnant SSL tissue after EMR of serrated lesions 31 …”

Intervenciones endoscópicas para mejorar la tasa de detección de lesiones serradas durante la colonoscopia

“…Más recientemente, 1 ECA evaluó el rol del NBI en la detección de lesiones serradas. Riu Pons et al (40) en un estudio de colonoscopias tándem realizadas el mismo día por el mismo endoscopista, evaluaron 41 pacientes, en 21 se realizó la retirada del colonoscopio primero con NBI y luego con luz blanca de HD, y en los otros 20 se realizó la retirada primero con luz blanca de HD y luego con NBI. No hubo diferencias en la TD LS con NBI versus luz blanca de HD: 47,4% versus 51,9% (OR 0,84, IC de 95%: 0,37-1,91).…”