Journal of Gastroenterology

, Volume 47, Issue 10, pp 1099–1107 | Cite as

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

  • Hiroaki Ikematsu
  • Yutaka Saito
  • Shinji Tanaka
  • Toshio Uraoka
  • Yasushi Sano
  • Takahiro Horimatsu
  • Takahisa Matsuda
  • Shiro Oka
  • Reiji Higashi
  • Hideki Ishikawa
  • Kazuhiro Kaneko
Original Article—Alimentary Tract



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 rate Colonoscopy Screening 


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Copyright information

© Springer 2012

Authors and Affiliations

  • Hiroaki Ikematsu
    • 1
  • Yutaka Saito
    • 2
  • Shinji Tanaka
    • 3
  • Toshio Uraoka
    • 4
  • Yasushi Sano
    • 5
  • Takahiro Horimatsu
    • 6
  • Takahisa Matsuda
    • 2
  • Shiro Oka
    • 3
  • Reiji Higashi
    • 4
  • Hideki Ishikawa
    • 7
  • Kazuhiro Kaneko
    • 1
  1. 1.Department of Gastroenterology and Gastrointestinal OncologyNational Cancer Center Hospital EastKashiwaJapan
  2. 2.Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
  3. 3.Department of EndoscopyHiroshima UniversityHiroshimaJapan
  4. 4.Department of EndoscopyOkayama University HospitalOkayamaJapan
  5. 5.Gastrointestinal CenterSano HospitalKobeJapan
  6. 6.Department of Gastroenterology and HepatologyKyoto UniversityKyotoJapan
  7. 7.Department of Molecular-Targeting Cancer PreventionKyoto Prefectural University of MedicineOsakaJapan

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