WASHINGTON — Narrow-band imaging colonoscopy appears to offer no advantage over white-light colonoscopy in detecting colorectal neoplasia, according to clinical trial data presented at the annual Digestive Disease Week.
Modern colonoscopy can limit the miss rate for detection of adenomas to 13%, compared with the often-cited rate of 24%. But the use of narrow-band imaging (NBI) colonoscopy, which uses only blue (415-nm) and green (540-nm) wavelengths with the intent of making blood vessels and neoplasia stand out, does not lead to a lower miss rate, reported Dr. Tonya R. Kaltenbach and her colleagues at Stanford (Calif.) University.
They enrolled 284 patients over a 13-month period and performed two consecutive same-day colonoscopies in 240 of the patients. Patients were randomly assigned to undergo first either standard white-light colonoscopy (121 patients) or NBI colonoscopy (119 patients). Each patient then underwent a second white-light colonoscopy, to determine how many lesions had been missed on the first colonoscopy. All polyps were removed upon detection.
The investigators found a total of 259 neoplasias in 130 patients. The 12% rate of undetected adenomas with white-light colonoscopy did not differ significantly from the 13% rate with NBI colonoscopy.
Those rates stand in stark contrast to the 24% miss rate reported for colonoscopy by Dr. Douglas Rex and colleagues in 1997 (Gastroenterology 1997;112:24–8).
Coinvestigator Dr. Roy Soetikno noted at a press briefing that it is erroneous to compare results obtained using modern colonoscopes—which have a wider field of vision, improved resolution, and more flexibility—with results obtained with prior-generation scopes, and pointed out that there is now a better understanding of the morphology of colorectal lesions.
The investigators reported no potential conflicts of interest.