Journal of Gastroenterology

, Volume 43, Issue 1, pp 45–50

Comparative study of conventional colonoscopy and pan-colonic narrow-band imaging system in the detection of neoplastic colonic polyps: a randomized, controlled trial

  • Takuya Inoue
  • Mitsuyuki Murano
  • Naoko Murano
  • Takanori Kuramoto
  • Ken Kawakami
  • Yosuke Abe
  • Eijiro Morita
  • Ken Toshina
  • Hideo Hoshiro
  • Yutaro Egashira
  • Eiji Umegaki
  • Kazuhide Higuchi
Article

Abstract

Background. Detection and removal of adenomas by colonoscopy is an important means for preventing cancer; however, small adenomas may be missed during colonoscopy. The narrow-band imaging (NBI) system clearly enhances the microvasculature in neoplastic lesions, making it appear as a dark complex. Therefore, the NBI system may improve the detection of colonic neoplasias. However, no randomized, controlled trials have evaluated the efficacy of a pan-colonic NBI system in adenoma detection. We conducted a randomized, controlled trial to determine the efficacy of the pancolonic NBI system in adenoma detection. Methods. Two hundred forty-three patients were randomized, 121 to conventional colonoscopy and 122 to pan-colonic NBI system. Demographics, indication for colonoscopy, and quality of preparation were similar between groups. Results. Extubation time was not significantly different between the conventional colonoscopy and pan-colonic NBI system. The proportions of patients with at least one adenoma and those with multiple adenomas were not significantly different between groups. However, the pan-colonic NBI system significantly increased the total number of adenomas detected (P < 0.05) and the number of diminutive (<5 mm) adenomas detected (P < 0.05). The pan-colonic NBI system allowed detection of more diminutive adenomas in the distal colon than did conventional colonoscopy (P < 0.01), and more patients in the NBI group had at least one diminutive adenoma than in the control group (P < 0.05). Conclusions. The pan-colonic NBI system improves the total number of adenomas detected, including significantly more diminutive adenomas, without prolongation of extubation time. These results indicate that routine use of the NBI system for surveillance of diminutive adenomas may be recommended.

Key words

narrow-band imaging conventional colonoscopy detection randomized controlled trial 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, et al. Cancer statistics, 2006. CA Cancer J Clin 2006;56:106–30.PubMedGoogle Scholar
  2. 2.
    Yiu HY, Whittemore AS, Shibata A. Increasing colorectal cancer incidence rates in Japan. Int J Cancer 2004;109:777–81.PubMedCrossRefGoogle Scholar
  3. 3.
    Winawer SJ, Zauber AG. Colonoscopic polypectomy and the incidence of colorectal cancer. Gut 2001;48:753–4.PubMedCrossRefGoogle Scholar
  4. 4.
    Winawer SJ, Zauber AG, Ho MN, O’Brien MJ, Gottlieb LS, Sternberg SS, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 1993;329:1977–81.PubMedCrossRefGoogle Scholar
  5. 5.
    Rex DK, Cutler CS, Lemmel GT, Rahmani EY, Clark DW, Helper DJ, et al. Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology 1997;112:24–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Bensen S, Mott LA, Dain B, Rothstein R, Baron J. The colonoscopic miss rate and true one-year recurrence of colorectal neoplastic polyps. Polyp Prevention Study Group. Am J Gastroenterol 1999;94:194–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Tada M, Katoh S, Kohli Y, Kawai K. On the dye spraying method in colonofiberscopy. Endoscopy 1977;8:70–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Tada M, Kawai K. Research with the endoscope: new techniques using magnification and chromoscopy. Clin Gastroenterol 1986;15:417–37.PubMedGoogle Scholar
  9. 9.
    Brooker JC, Saunders BP, Shah SG, Thapar CJ, Thomas HJ, Atkin WS, et al. Total colonic dye-spray increases the detection of diminutive adenomas during routine colonoscopy: a randomized controlled trial. Gastrointest Endosc 2002;56:333–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Hurlstone DP, Cross SS, Slater R, Sanders DS, Brown S. Detecting diminutive colorectal lesions at colonoscopy: a randomised controlled trial of pan-colonic versus targeted chromoscopy. Gut 2004;53:376–80.PubMedCrossRefGoogle Scholar
  11. 11.
    Le Rhun M, Coron E, Parlier D, Nguyen JM, Canard JM, Alamdari A, et al. High resolution colonoscopy with chromoscopy versus standard colonoscopy for the detection of colonic neoplasia: a randomized study. Clin Gastroenterol Hepatol 2006;4:349–54.PubMedCrossRefGoogle Scholar
  12. 12.
    Lapalus MG, Helbert T, Napoleon B, Rey JF, Houcke P, Ponchon T, et al. Does chromoendoscopy with structure enhancement improve the colonoscopic adenoma detection rate? Endoscopy 2006;38:444–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Machida H, Sano Y, Hamamoto Y, Muto M, Kozu T, Tajiri H, et al. Narrow-band imaging in the diagnosis of colorectal mucosal lesions: a pilot study. Endoscopy 2004;36:1094–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Su MY, Hsu CM, Ho YP, Chen PC, Lin CJ, Chiu CT. Comparative study of conventional colonoscopy, chromoendoscopy, and narrow-band imaging systems in differential diagnosis of neoplastic and nonneoplastic colonic polyps. Am J Gastroenterol 2006;101:2711–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Chiu HM, Chang CY, Chen CC, Lee YC, Wu MS, Lin JT, et al. A prospective comparative study of narrow-band imaging, chromoendoscopy, and conventional colonoscopy in the diagnosis of colorectal neoplasia. Gut 2007;56:373–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Muto T, Kamiya J, Sawada T, Konishi F, Sugihara K, Kubota Y, et al. Small “flat adenoma” of the large bowel with special reference to its clinicopathologic features. Dis Colon Rectum 1985;28:847–51.PubMedCrossRefGoogle Scholar
  17. 17.
    Schlemper RJ, Riddell RH, Kato Y, Borchard F, Cooper HS, Dawsey SM, et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000;47:251–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Citarda F, Tomaselli G, Capocaccia R, Barcherini S, Crespi M; Italian Multicentre Study Group. Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence. Gut 2001;48:812–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Thiis-Evensen E, Hoff GS, Sauar J, Langmark F, Majak BM, Vatn MH. Population-based surveillance by colonoscopy: effect on the incidence of colorectal cancer. Telemark Polyp Study I. Scand J Gastroenterol 1999;34:414–20.PubMedCrossRefGoogle Scholar
  20. 20.
    Rex DK. Maximizing detection of adenomas and cancers during colonoscopy. Am J Gastroenterol 2006;101:2866–77.PubMedCrossRefGoogle Scholar
  21. 21.
    Kudo S, Tamura S, Nakajima T, Yamano H, Kusaka H, Watanabe H. Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointest Endosc 1996;44:8–14.PubMedCrossRefGoogle Scholar
  22. 22.
    Mitooka H, Fujimori T, Ohno S, Morimoto S, Nakashima T, Ohmoto A, et al. Chromoscopy of the colon using indigo carmine dye with electrolyte lavage solution. Gastrointest Endosc 1992;38:373–4.PubMedGoogle Scholar
  23. 23.
    Atkin WS, Morson BC, Cuzick J. Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med 1992;326:658–62.PubMedCrossRefGoogle Scholar
  24. 24.
    Sano Y, Muto M, Tajiri H, Ohtsu A, Yoshida S. Optical/digital chromoendoscopy during colonoscopy using narrow-band imaging system. Dig Endosc 2005;17:S43–8.CrossRefGoogle Scholar
  25. 25.
    Hirata M, Tanaka S, Oka S, Kaneko I, Yoshida S, Yoshihara M, et al. Magnifying endoscopy with narrow band imaging for diagnosis of colorectal tumors. Gastrointest Endosc 2007;65:988–95.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Japan 2008

Authors and Affiliations

  • Takuya Inoue
    • 1
  • Mitsuyuki Murano
    • 1
  • Naoko Murano
    • 1
  • Takanori Kuramoto
    • 1
  • Ken Kawakami
    • 1
  • Yosuke Abe
    • 1
  • Eijiro Morita
    • 1
  • Ken Toshina
    • 1
  • Hideo Hoshiro
    • 1
  • Yutaro Egashira
    • 2
  • Eiji Umegaki
    • 1
  • Kazuhide Higuchi
    • 1
  1. 1.Second Department of Internal MedicineOsaka Medical CollegeTakatsukiJapan
  2. 2.Department of PathologyOsaka Medical CollegeOsakaJapan

Personalised recommendations