In the Journals

When bowel prep is best, narrow band imaging reigns in adenoma detection

Narrow band imaging appeared to be the best at detecting adenomas, according to a meta-analysis published in Gastroenterology, but only at the highest quality bowel preparation.

James E. East, MBChB, MD (Res), of the Oxford NIHR Biomedical Research Centre in the United Kingdom, and colleagues wrote that narrow band imaging (NBI) has been the subject of numerous studies and has shown to be effective in detecting neoplastic lesions and dysplasia. However, bowel preparation has been an important consideration when examining NBI.

“Stool appears brick red with NBI and even a thin film of stool and mucus can significantly impair mucosal visualization. In a post hoc analysis of a parallel group randomized control trial on NBI versus white light for detection in high risk patients, bowel preparation quality was found to be associated with polyp and adenoma detection.”

To further explore the efficacy of NBI compared with white-light endoscopy (WLE), East and colleagues searched the literature for randomized controlled trials that assessed detection of polyps by each technology that also included individual patient data.

They identified 11 trials comprising 4,491 patients and 6,636 polyps that fit their criteria.

Adenomas were detected in a higher percentage of patients examined with NBI compared with WLE (45.2% vs. 42.3%; OR = 1.14; 95% CI, 1.01–1.29).

The effect of NBI on adenoma detection was much greater when patient bowel prep could be described as “best” (OR = 1.3; 95% CI, 1.04–1.62) compared to when it was categorized as just “adequate” (OR = 1.07; 95% CI, 0.92–1.24).

NBI was also more successful at detecting non-adenomatous polyps (OR = 1.24; 95% CI, 1.06–1.44) and flat polyps (OR = 1.24; 95% CI, 1.02–1.51) compared with WLE.

“This improvement in ADR with NBI only maintained statistical significance when bowel preparation was stratified to ‘best’ quality,” East and colleagues wrote. “This effect of bowel preparation remained consistent when the analysis was conducted for polyp detection rate and for when the numbers of polyps were considered, and when we controlled for generation of NBI system and colonoscopy indication.” – by Alex Young

Disclosures: East reports serving on clinical advisory boards for Lumendi and Boston Scientific and receiving speaker’s fees from Flak and Olympus. Please see the full study for all other authors’ relevant financial disclosures.

Narrow band imaging appeared to be the best at detecting adenomas, according to a meta-analysis published in Gastroenterology, but only at the highest quality bowel preparation.

James E. East, MBChB, MD (Res), of the Oxford NIHR Biomedical Research Centre in the United Kingdom, and colleagues wrote that narrow band imaging (NBI) has been the subject of numerous studies and has shown to be effective in detecting neoplastic lesions and dysplasia. However, bowel preparation has been an important consideration when examining NBI.

“Stool appears brick red with NBI and even a thin film of stool and mucus can significantly impair mucosal visualization. In a post hoc analysis of a parallel group randomized control trial on NBI versus white light for detection in high risk patients, bowel preparation quality was found to be associated with polyp and adenoma detection.”

To further explore the efficacy of NBI compared with white-light endoscopy (WLE), East and colleagues searched the literature for randomized controlled trials that assessed detection of polyps by each technology that also included individual patient data.

They identified 11 trials comprising 4,491 patients and 6,636 polyps that fit their criteria.

Adenomas were detected in a higher percentage of patients examined with NBI compared with WLE (45.2% vs. 42.3%; OR = 1.14; 95% CI, 1.01–1.29).

The effect of NBI on adenoma detection was much greater when patient bowel prep could be described as “best” (OR = 1.3; 95% CI, 1.04–1.62) compared to when it was categorized as just “adequate” (OR = 1.07; 95% CI, 0.92–1.24).

NBI was also more successful at detecting non-adenomatous polyps (OR = 1.24; 95% CI, 1.06–1.44) and flat polyps (OR = 1.24; 95% CI, 1.02–1.51) compared with WLE.

“This improvement in ADR with NBI only maintained statistical significance when bowel preparation was stratified to ‘best’ quality,” East and colleagues wrote. “This effect of bowel preparation remained consistent when the analysis was conducted for polyp detection rate and for when the numbers of polyps were considered, and when we controlled for generation of NBI system and colonoscopy indication.” – by Alex Young

Disclosures: East reports serving on clinical advisory boards for Lumendi and Boston Scientific and receiving speaker’s fees from Flak and Olympus. Please see the full study for all other authors’ relevant financial disclosures.