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Narrow band imaging for colonoscopic surveillance in hereditary nonpolyposis colorectal cancer
  1. James E East (jameseast6{at}yahoo.com)
  1. St. Mark's Hospital, United Kingdom
    1. Noriko Suzuki (n.suzuki{at}imperial.ac.uk)
    1. St. Mark's Hospital, United Kingdom
      1. Mari Stavrinidis (mari.stav{at}yahoo.co.uk)
      1. St. Mark's Hospital, United Kingdom
        1. Thomas Guenther (thomas.guenther{at}nwlh.nhs.uk)
        1. St. Mark's Hospital, United Kingdom
          1. Huw J W Thomas (huw.thomas{at}cancer.org.uk)
          1. St. Mark's Hospital, United Kingdom
            1. Brian P Saunders (b.saunders{at}imperial.ac.uk)
            1. St. Mark's Hospital, United Kingdom

              Abstract

              Background: Colonoscopic surveillance for hereditary nonpolyposis colorectal cancer (HNPCC) reduces death rates but early interval cancers still occur, probably due to missed small, aggressive adenomas. Narrow band imaging (NBI), a novel endoscopic technology, highlights superficial mucosal capillaries and improves contrast for adenomas. This study examined whether a second pass with NBI in the proximal colon helped detect additional adenomas in patients with HNPCC.

              Methods: 62 patients from HNPCC families (Amsterdam II or genetic criteria) attending for colonoscopic surveillance were examined twice from caecum to sigmoid-descending junction, first with high definition white light and then a second pass with NBI in a back-to-back fashion. All polyps detected were removed for histopathological analysis.

              Results: At least one adenoma in the proximal colon was detected during the initial white light pass in 17/62(27%). NBI detected additional adenomas in 17/62(27%). 26/62(42%) patients had at least one adenoma detected after both white light and NBI, absolute difference 15% (95% confidence interval 4-25%), P=0.004 versus white light alone. The total number of adenomas increased from 25 before NBI to 46 after NBI examination, P<0.001. The proportion of flat adenomas detected in the NBI pass, 9/21(45%) was higher than in the white light pass 3/25(12%), P=0.03. Including white light examination of the sigmoid and rectum, overall 28/62(45%) patients had at least one adenoma detected.

              Conclusions: Use of NBI in the proximal colon for patients undergoing surveillance HNPCC appears to improve adenoma detection, particularly those with a flat morphology. NBI could help reduce interval cancer rates. ClinicalTrials.gov Identifier:NCT00313755

              • colonic polyp
              • colonoscopy
              • hereditary nonpolyposis colorectal cancer
              • hyperplastic polyp
              • surveillance

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