Journal of Gastroenterology

, Volume 47, Issue 10, pp 1099–1107

The impact of narrow band imaging for colon polyp detection: a multicenter randomized controlled trial by tandem colonoscopy


    • Department of Gastroenterology and Gastrointestinal OncologyNational Cancer Center Hospital East
  • Yutaka Saito
    • Endoscopy DivisionNational Cancer Center Hospital
  • Shinji Tanaka
    • Department of EndoscopyHiroshima University
  • Toshio Uraoka
    • Department of EndoscopyOkayama University Hospital
  • Yasushi Sano
    • Gastrointestinal CenterSano Hospital
  • Takahiro Horimatsu
    • Department of Gastroenterology and HepatologyKyoto University
  • Takahisa Matsuda
    • Endoscopy DivisionNational Cancer Center Hospital
  • Shiro Oka
    • Department of EndoscopyHiroshima University
  • Reiji Higashi
    • Department of EndoscopyOkayama University Hospital
  • Hideki Ishikawa
    • Department of Molecular-Targeting Cancer PreventionKyoto Prefectural University of Medicine
  • Kazuhiro Kaneko
    • Department of Gastroenterology and Gastrointestinal OncologyNational Cancer Center Hospital East
Original Article—Alimentary Tract

DOI: 10.1007/s00535-012-0575-2

Cite this article as:
Ikematsu, H., Saito, Y., Tanaka, S. et al. J Gastroenterol (2012) 47: 1099. doi:10.1007/s00535-012-0575-2



Previous studies have yielded conflicting results on the adenoma detection rate with narrow band imaging (NBI) compared with white light imaging (WLI). To overcome the confounding factors of these studies, we aimed to evaluate the colonic adenoma detection rate with primary NBI versus that with primary WLI by using consistent NBI system, endoscope, and imaging settings, and experienced colonoscopists.


In this multicenter prospective trial, 813 patients were randomized to undergo high-definition, tandem colonoscopy in the right colon with either NBI followed by WLI (NBI–WLI group) or WLI followed by NBI (WLI–NBI group). The NBI settings were fixed at surface structure enhancement level A-5 and adaptive index of hemoglobin color enhancement level 3. All detected polyps were resected or biopsied for histopathological analysis. The primary and secondary outcome measures were the adenoma detection rates and miss rates, respectively, with primary imaging.


The NBI–WLI and WLI–NBI groups comprised 389 and 393 patients, respectively, who met the inclusion criteria. The groups did not differ significantly in age, gender, institution, indication for colonoscopy, bowel preparation, or observation time. The adenoma detection rates of primary NBI and WLI were 42.3 and 42.5 %, respectively [difference not significant (NS)]. The adenoma miss rate was significantly less with primary NBI than with primary WLI (21.3 vs. 27.8 %; p = 0.03).


NBI does not improve the adenoma detection rate during primary colonoscopy; however, it has a lower miss rate for adenoma lesions in the proximal colon than WLI.


Adenoma detection rateColonoscopyScreening

Copyright information

© Springer 2012