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A Prospective Randomized Study on Narrow-Band Imaging versus Conventional Colonoscopy for Adenoma Detection: Does NBI Induce a Learning Effect ?
  1. A Adler
  1. Virchow Clinic Campus, Charité Medical University, Berlin, Germany
    1. H Pohl
    1. Virchow Clinic Campus, Charité Medical University, Berlin, Germany
      1. I S Papanikolaou
      1. Virchow Clinic Campus, Charité Medical University, Berlin, Germany
        1. H Abou-Rebyeh
        1. Virchow Clinic Campus, Charité Medical University, Berlin, Germany
          1. G Schachschal
          1. Virchow Clinic Campus, Charité Medical University, Berlin, Germany
            1. W Veltzke-Schlieker
            1. Virchow Clinic Campus, Charité Medical University, Berlin, Germany
              1. A C Khalifa
              1. Virchow Clinic Campus, Charité Medical University, Berlin, Germany
                1. E Setka
                1. Virchow Clinic Campus, Charité Medical University, Berlin, Germany
                  1. M Koch
                  1. Virchow Clinic Campus, Charité Medical University, Berlin, Germany
                    1. B Wiedenmann
                    1. Virchow Clinic Campus, Charité Medical University, Berlin, Germany
                      1. Thomas Rosch (thomas.roesch{at}charite.de)
                      1. Virchow Clinic Campus, Charité Medical University, Berlin, Germany

                        Abstract

                        Background and aims: Colonoscopy as an established method of colorectal cancer screening; however, with an adenoma miss rate of 10-20%. Detection rates are expected to improve with optimized visualization methods. This prospective randomized study evaluated narrow-band imaging (NBI), a new technique that may enhance image contrast in colon adenoma detection.

                        Methods: Eligible patients presenting for diagnostic colonoscopy were randomly assigned to undergo wide-angle colonoscopy using either conventional high-resolution imaging or NBI during instrument withdrawal. The primary outcome parameter was the difference in the adenoma detection rate between the two techniques.

                        Results: A total of 401 patients were included (mean age 59.4 years, 52.6% men). Adenomas were detected more frequently in the NBI group (23%) than in the control group (17%) with a number of 17 colonoscopies needed to find one additional adenoma patient; however, the difference was not statistically significant (P = 0.129),. When the two techniques were compared in consecutive subgroups of 100 study patients, adenoma rates in the NBI group remained fairly stable, whereas these rates steadily increased in the control group (8%, 15%, 17%, and 26.5%, respectively). Thus, significant differences in the first 100 cases (26.5% vs. 8%; P = 0.02) could not be maintained in the last 100 cases (25.5% vs. 26.5%, P = 0.91).

                        Conclusions: The increased adenoma detection rate means of NBI colonoscopy was statistically not significant. It remains speculative whether the increasing adenoma rate in the conventional group may have been due to a training effect of better polyp recognition on NBI.

                        • adenoma detection
                        • colonoscopy
                        • narrow-band imaging

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