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A prospective dual-center proof-of-principle study evaluating the incremental benefit of narrow-band imaging with a fixed zoom function in real-time prediction of polyp histology. Can we resect and discard?

Published:April 01, 2015DOI:https://doi.org/10.1016/j.gie.2015.01.014

      Background

      Advancements in endoscopic technology have increased the ability to distinguish neoplastic polyps during colonoscopy. If a minimum accuracy can be achieved, then a resect-and-discard model can be implemented, although studies to date have demonstrated limited success, especially in the assessment of serrated polyps.

      Objective

      To perform a proof-of-principle study assessing the accuracy of narrow-band imaging with near focus in predicting polyp histology including serrated polyps and to determine whether the minimum requirements can be achieved for a resect-and-discard policy.

      Design

      Dual-center, prospective case series.

      Setting

      Two tertiary-care referral endoscopic centers in Australia.

      Patients

      Two hundred consecutive patients undergoing colonoscopy for routine indications were recruited.

      Interventions

      Any polyps identified were assessed by using standard white light followed by narrow-band imaging with near focus for Kudo pit patterns and modified Sano capillary patterns. Based on this assessment and the macroscopic appearance, the polyp histology was predicted and subsequently compared with histopathology results.

      Main Outcome Measurements

      Correlation in postpolypectomy surveillance intervals between endoscopic and pathologic assessments as well as negative predictive value for rectosigmoid hyperplastic polyps.

      Results

      There was a 96% agreement for surveillance intervals between endoscopic assessment and histology by using the American Society for Gastrointestinal Endoscopy guidelines. There was a 96% negative predictive value in assessing rectosigmoid hyperplastic polyps.

      Limitations

      Because this was a proof-of-principle study, there was no control arm, and there were small numbers, especially in assessing subgroups. The results have limited generalizability with the training requirements for polyp recognition, with confidence to be determined.

      Conclusion

      Narrow-band imaging with near focus can predict polyp histology (including serrated polyps) accurately in the hands of trained endoscopists. Further studies with larger numbers are required to further validate this practice.

      Abbreviations:

      ASGE (American Society for Gastrointestinal Endoscopy), ESGE (European Society for Gastrointestinal Endoscopy), NBI (narrow-band imaging), NF (near focus), NHMRC (National Health and Medical Research Council), NPV (negative predictive value), PIVI (Preservation and Incorporation of Valuable Endoscopic Innovations), PPV (positive predictive value), SSA (sessile serrated adenoma)
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