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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 01, 2015
Accepted:
January 4,
2015
Received:
June 28,
2014
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this article.
Identification
Copyright
© 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
