Nathan S S Atkinson1, Shara Ket2, Paul Bassett3, Diego Aponte4, Silvia De Aguiar5, Neil Gupta6, Takahiro Horimatsu7, Hiroaki Ikematsu8, Takuya Inoue9, Tonya Kaltenbach10, Wai Keung Leung11, Takahisa Matsuda12, Silvia Paggi13, Franco Radaelli13, Amit Rastogi6, Douglas K Rex14, Luis C Sabbagh4, Yutaka Saito12, Yasushi Sano15, Giorgio M Saracco16, Brian P Saunders17, Carlo Senore18, Roy Soetikno19, Krishna C Vemulapalli14, Vipul Jairath20, James E East21. 1. Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, UK; Oxford National Institute for Health Research Biomedical Research Centre, Oxford, UK; Department of Gastroenterology, Waitemata District Health Board, Auckland, New Zealand. 2. Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, UK; Oxford National Institute for Health Research Biomedical Research Centre, Oxford, UK; Department of Gastroenterology, Alfred Hospital, Melbourne, Australia; Monash University, Melbourne, Australia. 3. Statsconsultancy Ltd, Amersham, Buckinghamshire, UK. 4. Gastroenterology Department, Clínica Reina Sofía, Sanitas University Foundation, Bogota, Colombia. 5. General Practice Department, Clínica Reina Sofía, Bogota, Colombia. 6. University of Kansas School of Medicine, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri. 7. Department of Therapeutic Oncology, Kyoto University Hospital, Kyoto, Japan. 8. Division of Science and Technology for Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan. 9. Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan. 10. San Francisco Veterans Affairs Medical Center, University of California, San Francisco, California. 11. Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong. 12. Endoscopy Division, National Cancer Centre Hospital, Tokyo, Japan. 13. Division of Gastroenterology, Valduce Hospital, Como, Italy. 14. Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana. 15. Gastrointestinal Center and Institute of Minimally Invasive Endoscopic Care, Sano Hospital, Kobe, Japan. 16. Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy. 17. Wolfson Unit for Endoscopy, St Mark's Hospital, Imperial College London, London, UK. 18. Epidemiology and Screening Unit, Centro di Prevenzione Oncologica Piemonte, University Hospital Città della Salute e della Scienza, Turin, Italy. 19. Department of Medicine, Western University, London, Ontario, Canada. 20. Department of Medicine, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada. 21. Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, UK; Oxford National Institute for Health Research Biomedical Research Centre, Oxford, UK. Electronic address: james.east@ndm.ox.ac.uk.
Abstract
BACKGROUND & AIMS: Adenoma detection rate (ADR) is an important quality assurance measure for colonoscopy. Some studies suggest that narrow-band imaging (NBI) may be more effective at detecting adenomas than white-light endoscopy (WLE) when bowel preparation is optimal. We conducted a meta-analysis of data from individual patients in randomized controlled trials that compared the efficacy of NBI to WLE in detection of adenomas. METHODS: We searched MEDLINE, EMBASE, and Cochrane Library databases through April 2017 for randomized controlled trials that assessed detection of colon polyps by high-definition WLE vs NBI and from which data on individual patients were available. The primary outcome measure was ADR adjusted for bowel preparation quality. Multilevel regression models were used with patients nested within trials, and trial included as a random effect. RESULTS: We collected data from 11 trials, comprising 4491 patients and 6636 polyps detected. Adenomas were detected in 952 of 2251 (42.3%) participants examined by WLE vs 1011 of 2239 (45.2%) participants examined by NBI (unadjusted odds ratio [OR] for detection of adenoma by WLE vs NBI, 1.14; 95% CI, 1.01-1.29; P = .04). NBI outperformed WLE only when bowel preparation was best: adequate preparation OR, 1.07 (95% CI, 0.92-1.24; P = .38) vs best preparation OR, 1.30 (95% CI, 1.04-1.62; P = .02). Second-generation bright NBI had a better ADR than WLE (second-generation NBI OR, 1.28; 95% CI, 1.05-1.56; P = .02), whereas first-generation NBI did not. NBI detected more non-adenomatous polyps than WLE (OR, 1.24; 95% CI, 1.06-1.44; P = .008) and flat polyps than WLE (OR, 1.24; 95% CI, 1.02-1.51; P = .03). CONCLUSIONS: In a meta-analysis of data from individual patients in randomized controlled trials, we found NBI to have a higher ADR than WLE, and that this effect is greater when bowel preparation is optimal.
BACKGROUND & AIMS:Adenoma detection rate (ADR) is an important quality assurance measure for colonoscopy. Some studies suggest that narrow-band imaging (NBI) may be more effective at detecting adenomas than white-light endoscopy (WLE) when bowel preparation is optimal. We conducted a meta-analysis of data from individual patients in randomized controlled trials that compared the efficacy of NBI to WLE in detection of adenomas. METHODS: We searched MEDLINE, EMBASE, and Cochrane Library databases through April 2017 for randomized controlled trials that assessed detection of colon polyps by high-definition WLE vs NBI and from which data on individual patients were available. The primary outcome measure was ADR adjusted for bowel preparation quality. Multilevel regression models were used with patients nested within trials, and trial included as a random effect. RESULTS: We collected data from 11 trials, comprising 4491 patients and 6636 polyps detected. Adenomas were detected in 952 of 2251 (42.3%) participants examined by WLE vs 1011 of 2239 (45.2%) participants examined by NBI (unadjusted odds ratio [OR] for detection of adenoma by WLE vs NBI, 1.14; 95% CI, 1.01-1.29; P = .04). NBI outperformed WLE only when bowel preparation was best: adequate preparation OR, 1.07 (95% CI, 0.92-1.24; P = .38) vs best preparation OR, 1.30 (95% CI, 1.04-1.62; P = .02). Second-generation bright NBI had a better ADR than WLE (second-generation NBI OR, 1.28; 95% CI, 1.05-1.56; P = .02), whereas first-generation NBI did not. NBI detected more non-adenomatous polyps than WLE (OR, 1.24; 95% CI, 1.06-1.44; P = .008) and flat polyps than WLE (OR, 1.24; 95% CI, 1.02-1.51; P = .03). CONCLUSIONS: In a meta-analysis of data from individual patients in randomized controlled trials, we found NBI to have a higher ADR than WLE, and that this effect is greater when bowel preparation is optimal.