Leaving colorectal polyps in place can be achieved with high accuracy using Blue Light Imaging (BLI)

Objectives:

The ASGE PIVI statement is proposing a negative predictive value (NPV) > 90% for a new technology to leave distal diminutive colorectal polyps in place without resection. To our knowledge no prior prospective study has yet evaluated the feasibility of the most recently introduced Blue Light Imaging (BLI) system for real-time endoscopic prediction of polyp histology for the specific endpoint of leaving hyperplastic polyps in place.

Aims:

Prospective assessment of real-time prediction of colorectal polyps by using BLI.

Material & Methods:

177 consecutive patients undergoing screening or surveillance colonoscopy were included. Colorectal polyps were evaluated in real-time by using high-definition endoscopy and the BLI technology without optical magnification. The endoscopist described each polyp according to size, shape and surface characteristics (pit and vascular pattern, color, depression) and histology was predicted with a level of confidence (high or low).

Results:

High-confidence prediction of histology was performed in 92% of polyps. Sensitivity of BLI for prediction of adenomatous histology was 98.7% with a specificity and accuracy of 97.4% and 98.2%, respectively. The positive and negative predictive values were calculated with 97.9% and 98.4%, respectively.

Conclusion:

The most recently introduced BLI technology is accurate enough to leave distal colorectal polyps in place without resection. This approach has therefore the potential to reduce costs and risks associated with the redundant removal of diminutive colorectal polyps.