Conflicts of interest: No conflicts of interest exist.
Is narrow band imaging superior to high-definition white light endoscopy in the assessment of diminutive colorectal polyps?
Article first published online: 26 FEB 2013
© 2012 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd
Journal of Gastroenterology and Hepatology
Volume 28, Issue 3, pages 472–478, March 2013
How to Cite
Singh, R., Bhat, Y. M., Thurairajah, P. H., Shetti, M. P., Jayanna, M., Nind, G., Tam, W., Walmsey, R., Bourke, M., Moss, A., Chen, R., Bampton, P., Roberts-Thomson, I., Schoeman, M. and Tucker, G. (2013), Is narrow band imaging superior to high-definition white light endoscopy in the assessment of diminutive colorectal polyps?. Journal of Gastroenterology and Hepatology, 28: 472–478. doi: 10.1111/jgh.12098
This study was presented as an oral presentation in the New Therapeutic Approaches to Colorectal Disease section at the Digestive Disease Week, 3 May, 2010, New Orleans, LA, USA.
Grant support: None.
Rajvinder Singh: conceptualized the study, performed the procedures, edited the videos, wrote and reviewed the manuscript.
Yasser Maqbool Bhat: assessed the videos.
Prem Harichander Thurairajah: assessed the videos.
Mohit Pramod Shetti: wrote the manuscript.
Mahesh Jayanna: wrote and reviewed the manuscript.
Garry Nind: assessed the videos.
William Tam: conceptualized the study.
Russell Walmsey: assessed the videos.
Micheal Bourke: assessed the videos.
Alan Moss: assessed the videos.
Robert Chen: assessed the videos.
Peter Bampton: assessed the videos.
Ian Roberts-Thomson: assessed the videos.
Mark Schoeman: assessed the videos.
Graeme Tucker: performed statistical analysis.
- Issue published online: 26 FEB 2013
- Article first published online: 26 FEB 2013
- Accepted manuscript online: 27 DEC 2012 05:35AM EST
- Manuscript Accepted: 12 NOV 2012
- diminutive colorectal polyp;
- high definition;
- narrow band imaging;
- white light endoscopy
Background and Aim
Diminutive polyps measuring ≤ 5 mm in size constitute 80% of polyps in the colon. We prospectively assessed the performance of high-definition white light endoscopy (hWLE) and narrow band imaging (NBI) in differentiating diminutive colorectal polyps.
In this prospective, multicenter study, videos of 50 diminutive polyps (31 hyperplastic, 19 adenomatous) in hWLE followed by NBI (total 100 videos) were initially obtained and placed in random order into five separate folders (each folder 20 videos). Eight endoscopists were then invited to predict the histology (each endoscopist 100 videos, 800 video assessments in all). Polyps were classified into types 1–3 (hyperplastic) and type 4 (adenoma). Feedback on individual performance was given after each folder (20 videos) was assessed.
The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in differentiating hyperplastic from adenomatous polyps by hWLE (400 videos) and NBI (400 videos) were 67.8%, 90.7%, 81.7%, 82.1%, and 82.0%; and 82.2%, 81.5%, 73.1%, 88.2%, and 81.8%, respectively. In the pretest and post-test analysis, the accuracy with NBI improved markedly from 68.8% to 91.3% (P = 0.001) compared with hWLE, 76.3–78.8% (P = 0.850). Overall, the interobserver agreement was 0.46 for hWLE (moderate) and 0.64 for NBI (good).
NBI was as accurate as hWLE in differentiating diminutive colorectal polyps. Once a learning curve was reached, NBI achieved significantly higher accuracies with good interobserver agreement. Using a simplified classification, a didactic learning session and feedback on performance, diminutive colorectal polyps could be predicted with high accuracies with NBI.