Colorectal sessile serrated lesion detection using linked-color imaging versus narrow-band imaging: a parallel randomized controlled trial

Abstract

Background Previous studies have reported the effectiveness of narrow-band imaging (NBI) and linked-color imaging (LCI) in improving the detection of colorectal neoplasms. There has however been no direct comparison between LCI and NBI in the detection of colorectal sessile serrated lesions (SSLs). The present study aimed to compare the effectiveness of LCI and NBI in detecting colorectal SSLs.

Methods A prospective, parallel, randomized controlled trial was conducted. The participants were randomly assigned to the LCI or NBI arms. The primary end point was the SSL detection rate (SDR).

Results 406 patients were involved; 204 in the LCI arm and 202 in the NBI arm. The total polyp detection rate, adenoma detection rate, and SDR were 54.2 %, 38.7 %, and 10.8%, respectively. The SDR was not significantly different between the LCI and NBI arms (12.3 % vs. 9.4 %; P = 0.36). The differences in the detection rate and the per-patient number of polyps, adenomas, diminutive lesions, and flat lesions between LCI and NBI also were not statistically significant. Multivariate analysis showed that LCI and NBI were not independent factors associated with SDR, whereas Boston Bowel Preparation Scale score (odds ratio [OR] 1.35, 95 %CI 1.03–1.76; P = 0.03), withdrawal time (OR 1.13, 95 %CI 1.00–1.26; P = 0.04), and operator experience (OR 3.73, 95 %CI 1.67–8.32; P = 0.001) were independent factors associated with SDR.

Conclusions LCI and NBI are comparable for SSL detection, as well as for the detection of polyps and adenomas.

Publication History

Received: 03 August 2022

Accepted after revision: 08 December 2022

Accepted Manuscript online:
08 December 2022

Article published online:
22 February 2023

• References

• 1 Sung H, Ferlay J, Siegel RL. et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021; 71: 209-249
• 2 Wang P, Liu P, Glissen Brown JR. et al. Lower adenoma miss rate of computer-aided detection-assisted colonoscopy vs routine white-light colonoscopy in a prospective tandem study. Gastroenterology 2020; 159: 1252-1261.e5
• 3 Corley DA, Jensen CD, Marks AR. et al. Adenoma detection rate and risk of colorectal cancer and death. NEJM 2014; 370: 1298-1306
• 4 Tadepalli US, Feihel D, Miller KM. et al. A morphologic analysis of sessile serrated polyps observed during routine colonoscopy (with video). Gastrointest Endosc 2011; 74: 1360-1368
• 5 Jaramillo E, Tamura S, Mitomi H. Endoscopic appearance of serrated adenomas in the colon. Endoscopy 2005; 37: 254-260
• 6 van Toledo DEFWM, IJspeert JEG, Bossuyt PMM. et al. Serrated polyp detection and risk of interval post-colonoscopy colorectal cancer: a population-based study. Lancet Gastroenterol Hepatol 2022; 7: 747-754
• 7 Matsuda T, Ono A, Sekiguchi M. et al. Advances in image enhancement in colonoscopy for detection of adenomas. Nat Rev Gastroenterol Hepatol 2017; 14: 305-314
• 8 Glover B, Teare J, Patel N. A review of new and emerging techniques for optical diagnosis of colonic polyps. J Clin Gastroenterol 2019; 53: 495-506
• 9 Atkinson NSS, Ket S, Bassett P. et al. Narrow-band imaging for detection of neoplasia at colonoscopy: a meta-analysis of data from individual patients in randomized controlled trials. Gastroenterology 2019; 157: 462-471
• 10 Shinozaki S, Kobayashi Y, Hayashi Y. et al. Colon polyp detection using linked color imaging compared to white light imaging: Systematic review and meta-analysis. Dig Endosc 2020; 32: 874-881
• 11 Li J, Zhang D, Wei Y. et al. Colorectal sessile serrated lesion detection using linked color imaging: a multicenter, parallel randomized controlled trial. Clin Gastroenterol Hepatol 2022;
• 12 Leung WK, Guo CG, Ko MKL. et al. Linked color imaging versus narrow-band imaging for colorectal polyp detection: a prospective randomized tandem colonoscopy study. Gastrointest Endosc 2020; 91: 104-112.e5
• 13 ASGE American Society for Gastrointestinal Endoscopy. Appropriate use of gastrointestinal endoscopy. Gastrointest Endosc 2000; 52: 831-837
• 14 Rex DK, Boland CR, Dominitz JA. et al. Colorectal cancer screening: recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2017; 153: 307-323
• 15 Săftoiu A, Hassan C, Areia M. et al. Role of gastrointestinal endoscopy in the screening of digestive tract cancers in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2020; 52: 293-304
• 16 World Health Organisation. Classification of Tumors of the Digestive Tract. Lyon: IARC Press; 2019
• 17 Kaltenbach T, Friedland S, Soetikno R. A randomised tandem colonoscopy trial of narrow band imaging versus white light examination to compare neoplasia miss rates. Gut 2008; 57: 1406-1412
• 18 Adler A, Pohl H, Papanikolaou IS. et al. A prospective randomised study on narrow-band imaging versus conventional colonoscopy for adenoma detection: does narrow-band imaging induce a learning effect?. Gut 2008; 57: 59-64
• 19 Sabbagh LC, Reveiz L, Aponte D. et al. Narrow-band imaging does not improve detection of colorectal polyps when compared to conventional colonoscopy: a randomized controlled trial and meta-analysis of published studies. BMC Gastroenterol 2011; 11: 100
• 20 Pasha SF, Leighton JA, Das A. et al. Comparison of the yield and miss rate of narrow band imaging and white light endoscopy in patients undergoing screening or surveillance colonoscopy: a meta-analysis. Am J Gastroenterol 2012; 107: 363-370 quiz 371
• 21 Atkinson NSS, Ket S, Bassett P. et al. Narrow-band imaging for detection of neoplasia at colonoscopy: a meta-analysis of data from individual patients in randomized controlled trials. Gastroenterology 2019; 157: 462-471
• 22 Leung WK, Lo OS, Liu KS. et al. Detection of colorectal adenoma by narrow band imaging (HQ190) vs. high-definition white light colonoscopy: a randomized controlled trial. Am J Gastroenterol 2014; 109: 855-863
• 23 Ogiso K, Yoshida N, Siah KT. et al. New-generation narrow band imaging improves visibility of polyps: a colonoscopy video evaluation study. J Gastroenterol 2016; 51: 883-890
• 24 Horimatsu T, Sano Y, Tanaka S. et al. Next-generation narrow band imaging system for colonic polyp detection: a prospective multicenter randomized trial. Int J Colorectal Dis 2015; 30: 947-954
• 25 Minamide T, Sashiyama H, Muramatsu Y. et al. Second-generation narrow-band imaging to detect colorectal adenomas: A prospective study including community hospitals. J Gastroenterol Hepatol 2021; 36: 3084-3091
• 26 Uraoka T, Saito Y, Matsuda T. et al. Detectability of colorectal neoplastic lesions using a narrow-band imaging system: a pilot study. J Gastroenterol Hepatol 2008; 23: 1810-1815
• 27 Rex DK, Clodfelter R, Rahmani F. et al. Narrow-band imaging versus white light for the detection of proximal colon serrated lesions: a randomized, controlled trial. Gastrointest Endosc 2016; 83: 166-171
• 28 Hazewinkel Y, Tytgat KM, van Leerdam ME. et al. Narrow-band imaging for the detection of polyps in patients with serrated polyposis syndrome: a multicenter, randomized, back-to-back trial. Gastrointest Endosc 2015; 81: 531-538
• 29 Aziz M, Desai M, Hassan S. et al. Improving serrated adenoma detection rate in the colon by electronic chromoendoscopy and distal attachment: systematic review and meta-analysis. Gastrointest Endosc 2019; 90: 721-731.e1
• 30 Oliveira Dos Santos CE, Malaman D, Pereira-Lima JC. et al. Impact of linked-color imaging on colorectal adenoma detection. Gastrointest Endosc 2019; 90: 826-834
• 31 Fujimoto D, Muguruma N, Okamoto K. et al. Linked color imaging enhances endoscopic detection of sessile serrated adenoma/polyps. Endosc Int Open 2018; 6: E322-E334
• 32 Paggi S, Radaelli F, Senore C. et al. Linked-color imaging versus white-light colonoscopy in an organized colorectal cancer screening program. Gastrointest Endosc 2020; 92: 723-730
• 33 Kudo T, Horiuchi A, Kyodo R. et al. Linked colour imaging versus white-light colonoscopy for the detection of flat colorectal lesions: A randomized controlled trial. Colorectal Dis 2021; 23: 1414-1420
• 34 Hasegawa I, Yamamura T, Suzuki H. et al. Detection of colorectal neoplasms using linked color imaging: a prospective, randomized, tandem colonoscopy trial. Clin Gastroenterol Hepatol 2021; 19: 1708-1716.e4
• 35 Zimmermann-Fraedrich K, Pohl H, Rösch T. et al. Designs of colonoscopic adenoma detection trials: more positive results with tandem than with parallel studies – an analysis of studies on imaging techniques and mechanical devices. Gut 2021; 70: 268-275
• 36 Zhao S, Yang X, Wang S. et al. Impact of 9-minute withdrawal time on the adenoma detection rate: a multicenter randomized controlled trial. Clin Gastroenterol Hepatol 2022; 20: e168-e181
• 37 Butterly L, Robinson CM, Anderson JC. et al. Serrated and adenomatous polyp detection increases with longer withdrawal time: results from the New Hampshire Colonoscopy Registry. Am J Gastroenterol 2014; 109: 417-426
• 38 East JE, Ignjatovic A, Suzuki N. et al. A randomized, controlled trial of narrow-band imaging vs high-definition white light for adenoma detection in patients at high risk of adenomas. Colorectal Dis 2012; 14: e771-e778