Blue-laser imaging and new-generation narrow-band imaging may both be suitable for the detection of colorectal neoplasms

We read with interest the recent article by Shimoda et al. [1] evaluating the adenoma detection ability of a new advanced endoscopic imaging, named blue-laser imaging (BLI), compared with white-light imaging (WLI). The authors concluded that BLI did not improve the adenoma detection rate but had lower colon adenoma miss rates compared with WLI. However, we have some questions as follows.

First, this study was considered as a randomized tandem trial with patients randomized to BLI followed by WLI or to WLI followed by WLI. We think the design would be better if the second group was randomized to undergo WLI followed by BLI. The actual number of missed adenomas may be higher than the reported number for WLI. In addition, the number of patients with one or more adenoma in the WLI – WLI group may also be higher if BLI were conducted after the first WLI examination.

Second, we think that narrow-band imaging (NBI) has shown no superiority over WLI for the detection of colonic adenomas because of low brightness. Actually, new-generation NBI has demonstrated more polyp detection or adenoma detection and improved visibility of polyps [2] [3] [4]. Therefore, we think that both new-generation NBI and BLI-bright may be suitable for the detection of colorectal neoplasms, and validation from a randomized controlled trail is warranted.

• References

• 1 Shimoda R. Sakata Y. Fujise T. et al. The adenoma miss rate of blue-laser imaging vs. white-light imaging during colonoscopy: a randomized tandem trial. Endoscopy 2016;
• 2 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
• 3 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
• 4 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