Digestive Diseases and Sciences

, Volume 56, Issue 2, pp 472–478 | Cite as

Narrow Band Imaging to Detect Residual or Recurrent Neoplastic Tissue During Surveillance Endoscopy

  • Jason N. Rogart
  • Harry R. Aslanian
  • Uzma D. Siddiqui
Original Article



There is little data on the prevalence of residual neoplastic tissue or the rate of endoscopically detected recurrence in patients with prior surgical or endoscopic resection of advanced neoplasia.


To compare standard white light with NBI for both the detection, as well as the differentiation, of residual or recurrent neoplastic tissue during real-time endoscopy.


A prospective study of 46 consecutive patients undergoing surveillance colonoscopy or upper endoscopy was conducted. Prior resection sites were examined first with white light and then with NBI. Main outcome measurements included the number of distinct lesions identified with white light, the number of additional lesions identified with NBI, and the overall accuracy of endoscopic diagnosis using white light alone or with NBI.


Sixty discrete lesions were identified, 43 with white light alone, and an additional 17 with NBI. NBI identified more lesions per patient than white light alone (mean 1.33 vs. 0.96, p < 0.05) and there was a trend towards increased detection of neoplastic lesions. Recurrent/residual neoplasia was present in 14 patients (30%) and there was a trend towards increased detection with the addition of NBI. About 63% of lesions identified with white light appeared more extensive when examined with NBI. The diagnostic accuracy in predicting histology was equivalent for NBI and white light (87 vs. 88%), though there was a trend towards higher sensitivity for neoplastic lesions with NBI (88 vs. 69%, p = 0.16).


A substantial number of patients undergoing surveillance endoscopy had residual or recurrent neoplastic tissue identified at the prior resection site. As NBI detected additional neoplastic lesions as well as demonstrated that lesions detected with white light were more extensive, adjunctive use of NBI for examining post-endoscopy resection sites should be studied in future, larger studies.


Narrow band imaging Endoscopy Gastrointestinal neoplasms Colorectal neoplasms 



None of the authors have any disclosures to make regarding this manuscript.

Grant support



  1. 1.
    Risau W. Mechanisms of angiogenesis. Nature. 1997;386:671–674.CrossRefPubMedGoogle Scholar
  2. 2.
    Sano Y, Kobayahi M, Hamamoto Y, et al. New diagnostic method based on color imaging using narrow band imaging (NBI) system for gastrointestinal tract. Gastrointest Endosc. 2001;53:AB125.Google Scholar
  3. 3.
    Gono K, Obi T, Yamaguchi M, et al. Appearance of enhanced tissue feature in narrow-band endoscopic imaging. J Biomed Opt. 2004;9:568–577.CrossRefPubMedGoogle Scholar
  4. 4.
    Hirata M, Tanaka S, Oka S, et al. Evaluation of microvessels in colorectal tumors by narrow band imaging magnification. Gastrointest Endosc. 2007;66:945–952.CrossRefPubMedGoogle Scholar
  5. 5.
    Sano Y, Ikematsu H, Fu KI, et al. Meshed capillary vessels using narrow band imaging for differential diagnosis of small colorectal polyps. Gastrointest Endosc. 2009;69:278–283.CrossRefPubMedGoogle Scholar
  6. 6.
    Robertson DJ, Greenberg ER, Beach M, et al. Colorectal cancer in patients under close colonoscopic surveillance. Gastroenterology. 2005;129:34–41.CrossRefPubMedGoogle Scholar
  7. 7.
    Farrar WD, Sawhney MS, Nelson DB, et al. Colorectal cancers found after a complete colonoscopy. Clin Gastroenterol Hepatol. 2006;4:1259–1264.CrossRefPubMedGoogle Scholar
  8. 8.
    Efthymiou M, Chen R, Taylor A, Desmond P. Assessing the efficacy of cold biopsy forceps polypectomy for diminutive polyps. Gastrointest Endosc. 2009;69:AB108. (abstract).CrossRefGoogle Scholar
  9. 9.
    Humphris JL, Tippett J, Kowk A, Katelaris PH. Cold snare polypectomy for diminutive polyps: an assessment of the risk of incomplete removal of small adenomas. Gastrointest Endosc. 2009;69:AB207. (abstract).CrossRefGoogle Scholar
  10. 10.
    Khashab M, Eid E, Rusche M, Rex DK. Incidence and predictors of “late” recurrences after endoscopic piecemeal resection of large sessile adenomas. Gastrointest Endosc. 2009;70:344–349.CrossRefPubMedGoogle Scholar
  11. 11.
    Machida H, Sano Y, Hamamoto Y, et al. Narrow-band imaging in the diagnosis of colorectal mucosal lesions: a pilot study. Endoscopy. 2004;36:1094–1098.CrossRefPubMedGoogle Scholar
  12. 12.
    Kara MA, Ennahachi M, Fockens P, et al. Detection and classification of the mucosal and vascular patterns (mucosal morphology) in Barrett’s esophagus by using narrow band imaging. Gastrointest Endosc. 2006;64:155–166.CrossRefPubMedGoogle Scholar
  13. 13.
    Rogart JN, Jain D, Siddiqui UD, et al. Narrow band imaging without high magnification to differentiate polyps during real-time colonoscopy: improvement with experience. Gastrointest Endosc. 2008;68:1136–1145.CrossRefPubMedGoogle Scholar
  14. 14.
    Wolfsen HC, Crook JE, Krishna M, et al. Prospective, controlled tandem endoscopy study of narrow band imaging for dysplasia detection in Barrett’s Esophagus. Gastroenterology. 2008;135:24–31.CrossRefPubMedGoogle Scholar
  15. 15.
    Kato M, Kaise M, Yonezawa J, et al. Trimodal imaging endoscopy may improve diagnostic accuracy of early gastric neoplasia: a feasibility study. Gastrointest Endosc. 2009;70:899–906.CrossRefPubMedGoogle Scholar
  16. 16.
    Kudo S, Rubio CA, Teixeira CR, et al. Pit pattern in colorectal neoplasia: endoscopic magnifying view. Endoscopy. 2001;33:367–373.PubMedGoogle Scholar
  17. 17.
    Herrero LA, Curvers WL, Bansal A, et al. Zooming in on Barrett oesophagus using narrow-band imaging: an international observer agreement study. Eur J Gastroenterol Hepatol. 2009;21:1068–1075.CrossRefPubMedGoogle Scholar
  18. 18.
    Kaise M, Kato M, Urashima M, et al. Magnifying endoscopy combined with narrow-band imaging for differential diagnosis of superficial depressed gastric lesions. Endoscopy. 2009;41:310–315.CrossRefPubMedGoogle Scholar
  19. 19.
    Togashi K, Konishi F, Ishizuka T, et al. Efficacy of magnifying endoscopy in the differential diagnosis of neoplastic and non-neoplastic polyps of the large bowel. Dis Col Rectum. 1999;42:1602–1608.CrossRefGoogle Scholar
  20. 20.
    Eisen GM, Kim CY, Fleisher DE, et al. High-resolution chromoendoscopy for classifying colonic polyps: a multicenter study. Gastrointest Endosc. 2002;55:687–694.CrossRefPubMedGoogle Scholar
  21. 21.
    Hurlstone DP, Fujii T. Practical uses of chromoendoscopy and magnification at colonoscopy. Gastrointest Endosc Clin N Am. 2005;15:687–702.CrossRefGoogle Scholar
  22. 22.
    Dhar A, Johnson KS, Novelli MR, et al. Elastic scattering spectroscopy for the diagnosis of colonic lesions: initial results of a novel optical biopsy technique. Gastrointest Endosc. 2006;63:257–261.CrossRefPubMedGoogle Scholar
  23. 23.
    Kiesslich R, Burg J, Vieth M, et al. Confocal laser endoscopy for diagnosing intraepithelial neoplasias and colorectal cancer in vivo. Gastroenterology. 2004;127:706–713.CrossRefPubMedGoogle Scholar
  24. 24.
    Molckovsky A, Song LM, Shim MG, et al. Diagnostic potential of near-infrared Raman spectroscopy in the colon: differentiating adenomatous from hyperplastic polyps. Gastrointest Endosc. 2003;57:396–402.CrossRefPubMedGoogle Scholar
  25. 25.
    Pfau PR, Sivak MV Jr, Chak A, et al. Criteria for the diagnosis of dysplasia by endoscopic topical coherence tomography. Gastrointest Endosc. 2003;58:196–202.CrossRefPubMedGoogle Scholar
  26. 26.
    Kwon RS, Song L, Adler DG, et al. Report on emerging technology: endocytoscopy. Gastrointest Endosc. 2009;70:610–613.CrossRefPubMedGoogle Scholar
  27. 27.
    Hirata M, Tanaka S, Oka S, et al. Evaluation of microvessels in colorectal tumors by narrow band imaging magnification. Gastrointest Endosc. 2007;66:945–952.CrossRefPubMedGoogle Scholar
  28. 28.
    Kanao H, Tanaka S, Oka S, et al. Narrow-band imaging magnification predicts the histology and invasion depth of colorectal tumors. Gastrointest Endosc. 2009;69:631–636.CrossRefPubMedGoogle Scholar
  29. 29.
    East JE, Suzuki N, Bassett P, et al. Narrow band imaging with magnification for the characterization of small and diminutive colonic polyps: pit pattern and vascular pattern intensity. Endoscopy. 2008;40:811–817.CrossRefPubMedGoogle Scholar
  30. 30.
    Folkman J. Induction of angiogenesis during the transition from hyperplasia to neoplasia. Nature. 1989;339:58–61.CrossRefPubMedGoogle Scholar
  31. 31.
    Aotake T, Lu CD, Chiba Y, et al. Changes of angiogenesis and tumor cell apoptosis during colorectal carcinogenesis. Clin Cancer Res. 1999;5:135–142.PubMedGoogle Scholar
  32. 32.
    Rastogi A, Pondugula K, Bansal A, et al. Recognition of surface mucosal and vascular patterns of colon polyps by using narrow-band imaging: interobserver and intraobserver agreement and prediction of polyp histology. Gastrointest Endosc. 2009;69:716–722.CrossRefPubMedGoogle Scholar
  33. 33.
    Naselli A, Introini C, Bertolotto F, et al. Narrow band imaging for detecting residual/recurrent cancerous tissue during second transurethral resection of newly diagnosed non-muscle-invasive high grade bladder cancer. BJU Int. 2010;105:208–211.CrossRefPubMedGoogle Scholar
  34. 34.
    Itoi T, Tsuji S, Sofuni A, et al. A novel approach emphasizing preoperative margin enhancement of tumor of the major duodenal papilla with narrow-band imaging in comparison to indigo carmine chromoendoscopy (with videos). Gastrointest Endosc. 2009;69:136–141.CrossRefPubMedGoogle Scholar
  35. 35.
    Kadowaki S, Tanaka K, Toyoda H, et al. Ease of early gastric cancer demarcation recognition: a comparison of four magnifying endoscopy methods. J Gastroenterol Hepatol. 2009;24:1625–1630.CrossRefPubMedGoogle Scholar
  36. 36.
    Zlatanic J, Waye JD, Kim PS, et al. Large sessile colonic adenomas: use of argon plasma coagulator to supplement piecemeal snare polypectomy. Gastrointest Endosc. 1999;49:731–735.CrossRefPubMedGoogle Scholar
  37. 37.
    Yang G, Zheng W, Sun QR, et al. Pathologic features of initial adenomas as predictors for metachronous adenomas of the rectum. J Natl Cancer Inst. 1998;90:1661–1665.CrossRefPubMedGoogle Scholar
  38. 38.
    Noshirwani N, van Stolk R, Rybicki L, Beck G. Adenoma size and number are predictive of adenoma recurrence: implications for surveillance colonoscopy. Gastrointest Endosc. 2000;51:433–437.CrossRefPubMedGoogle Scholar
  39. 39.
    Loeve F, van Ballegooijen M, Boer R, et al. Colorectal cancer risk in adenoma patients: a nation-wide study. Int J Cancer. 2004;111:147–151.CrossRefPubMedGoogle Scholar
  40. 40.
    Lieberman DA, Weiss DG, Harford WV, et al. Five-year colon surveillance after screening colonoscopy. Gastroenterology. 2007;133:1077–1085.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Jason N. Rogart
    • 1
    • 2
  • Harry R. Aslanian
    • 1
  • Uzma D. Siddiqui
    • 1
  1. 1.Section of Digestive Diseases, Department of MedicineYale University School of MedicineNew HavenUSA
  2. 2.Division of Gastroenterology & Hepatology, Department of MedicineUMDNJ-Robert Wood Johnson Medical SchoolNew BrunswickUSA

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