Narrow band imaging and white light endoscopy in the characterization of a polypectomy scar: A single-blind observational study

Pons, Fausto Riu; Andreu, Montserrat; Beltrán, Javier Gimeno; Álvarez-González, Marco A.; Urgorri, Agustín Seoane; Dedéu, Josep Maria; Priego, Luis Barranco; Bessa, Xavier

doi:10.3748/wjg.v24.i45.5179

Cited by 8 publications

(12 citation statements)

References 22 publications

(25 reference statements)

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“…Another prospective multicenter study, which evaluated 255 colorectal scars after a median of 7 months following a colorectal piecemeal EMR, showed a NPV of 100 % (95 %CI 98 % -100 %) and sensitivity of 100 % (95 %CI 93 % -100 %) for NBI with near-focus imaging [216]. However, slightly lower values were observed in a study of 112 scars, which showed that the accuracy of NBI for the detection of residual neoplasia at the resection site was 86.8 %, compared to 81.6 % for WLE and (P = 0.15) [217]. This study has however several limitations, including the single operator, high recurrence rates, and non-blinded pathologist.…”

Section: Follow-up After Endoscopic Resection Of Lesionsmentioning

confidence: 95%

Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019

et al. 2019

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Main Recommendations 1 ESGE suggests that high definition endoscopy, and dye or virtual chromoendoscopy, as well as add-on devices, can be used in average risk patients to increase the endoscopist’s adenoma detection rate. However, their routine use must be balanced against costs and practical considerations.Weak recommendation, high quality evidence. 2 ESGE recommends the routine use of high definition systems in individuals with Lynch syndrome.Strong recommendation, high quality evidence. 3 ESGE recommends the routine use, with targeted biopsies, of dye-based pancolonic chromoendoscopy or virtual chromoendoscopy for neoplasia surveillance in patients with long-standing colitis.Strong recommendation, moderate quality evidence. 4 ESGE suggests that virtual chromoendoscopy and dye-based chromoendoscopy can be used, under strictly controlled conditions, for real-time optical diagnosis of diminutive (≤ 5 mm) colorectal polyps and can replace histopathological diagnosis. The optical diagnosis has to be reported using validated scales, must be adequately photodocumented, and can be performed only by experienced endoscopists who are adequately trained, as defined in the ESGE curriculum, and audited.Weak recommendation, high quality evidence. 5 ESGE recommends the use of high definition white-light endoscopy in combination with (virtual) chromoendoscopy to predict the presence and depth of any submucosal invasion in nonpedunculated colorectal polyps prior to any treatment. Strong recommendation, moderate quality evidence. 6 ESGE recommends the use of virtual or dye-based chromoendoscopy in addition to white-light endoscopy for the detection of residual neoplasia at a piecemeal polypectomy scar site. Strong recommendation, moderate quality evidence. 7 ESGE suggests the possible incorporation of computer-aided diagnosis (detection and characterization of lesions) to colonoscopy, if acceptable and reproducible accuracy for colorectal neoplasia is demonstrated in high quality multicenter in vivo clinical studies. Possible significant risks with implementation, specifically endoscopist deskilling and over-reliance on artificial intelligence, unrepresentative training datasets, and hacking, need to be considered. Weak recommendation, low quality evidence.

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Section: Follow-up After Endoscopic Resection Of Lesionsmentioning

confidence: 95%

Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019

et al. 2019

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“…Narrow-band imaging (NBI) improves the visibility of vascular structures of colon polyps by using optical interference filters to spectrally narrow the bandwidths used in conventional white light, resulting in more visual detail of the superficial mucosal structures and capillaries seen in neoplastic tissue. 67,68 Several early meta-analyses did not show NBI to improve the ADR compared with white-light colonoscopy. [69][70][71] One meta-analysis did not show any benefit of NBI when compared with high-definition white-light colonoscopy but suggested that it may improve the ADR when compared with standard white-light colonoscopy.…”

Section: Technologymentioning

confidence: 99%

Interventions to improve adenoma detection rates for colonoscopy

Shaukat¹,

Tuskey²,

Rao³

et al. 2022

Gastrointestinal Endoscopy

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“…However, recent studies have provided new evidence on the efficacy of advanced endoscopic imaging in the detection of residual or recurrent lesions in post-EMR scars [9][10][11][12]. A prospective single-center study, which analyzed 183 scars using systematic narrow-band imaging (NBI) after WLE, showed significantly higher sensitivity and negative predictive values (NPVs) for detection of endoscopic residual neoplasia in a combination of WLE plus NBI vs. WLE alone (93.3 % vs. 66.7 % and 98.6 % vs. 93.6 %, respectively) [9].…”

mentioning

confidence: 99%

“…The only randomized crossover trial to be reported included 112 scars and aimed to evaluate the incremental benefit of NBI and WLE by randomizing the initial technique for the assessment of post-EMR scars [11]. This study did not find significant differences between NBI vs. WLE in sensitivity (85.0 % vs. 78.9 %), specificity (77.1 % vs. 84.2 %), or accuracy (82.5 % vs. 80.0 %), and concluded that scar biopsy was still required [11]. Recently, a classification for post-EMR scar evaluation using specific criteria based on advanced imaging was created and validated [12].…”

mentioning

confidence: 99%

Can white-light endoscopy or narrow-band imaging avoid biopsy of colorectal endoscopic mucosal resection scars? A multicenter randomized single-blind crossover trial

et al. 2023

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Background and aims: Current guidelines suggest that routine biopsy of post-endoscopic mucosal resection (EMR) scars can be abandoned, provided that a standardized imaging protocol with virtual chromoendoscopy is used. However, few studies have examined the accuracy of advanced endoscopic imaging, such as Narrow Band Imaging (NBI) versus White Light Endoscopy (WLE) to predict histological recurrence. We aimed to assess whether NBI accuracy is superior to WLE and whether one or both techniques can replace biopsies. Patients and methods: Multicentre, randomized, patient-blinded, crossover trial, with consecutive patients undergoing the first colonoscopy after EMR of lesions ≥20mm. Computer-generated randomization and opaque envelope concealed allocation. Patients were randomly assigned to scar examination with NBI followed by WLE (NBI+WLE), or WLE followed by NBI (WLE+NBI). Histology was the reference method, with biopsies being performed in all tissues, either or not showing recurrence. Results: The study included 203 scars, 103 in group NBI+WLE and 100 in group WLE+NBI. Recurrence was confirmed histologically in 29.6% of the scars. The diagnostic accuracy of NBI was not statistically different from WLE 95% (95%CI, 92%-98%) vs. 94% (95%CI, 90%-97%); P=0.48). When assessing NBI vs. WLE, the negative predictive values were (NPV) 96% (95% CI, 93%-99%) vs. 93% (95% CI, 89%-97%), not reaching statistically significance (P=0.06). Conclusions: The accuracy of NBI for the diagnosis of recurrence was not superior to that of WLE. Endoscopic assessment of EMR scars with WLE and NBI achieved a NPV that precludes routine biopsy in cases of negative optical diagnosis.

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Narrow band imaging and white light endoscopy in the characterization of a polypectomy scar: A single-blind observational study

Cited by 8 publications

References 22 publications

Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019

Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019

Interventions to improve adenoma detection rates for colonoscopy

Can white-light endoscopy or narrow-band imaging avoid biopsy of colorectal endoscopic mucosal resection scars? A multicenter randomized single-blind crossover trial

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