Narrow-band imaging for the detection of polyps in patients with serrated polyposis syndrome:a multicenter, randomized, back-to-back trial

Background: Serrated polyposis syndrome (SPS) is characterized by the presence of multiple serrated polyps spread throughout the colon.Patients with SPS are considered to be at risk of colorectal cancer and are advised to undergo endoscopic surveillance. Narrow-band imaging (NBI) may improve the detection of polyps during these surveillance colonoscopies.Objective: To compare polyp miss rates between NBI and high-resolution white-light endoscopy (HR-WLE).Design: Multicenter, randomized, crossover study.Setting: Four tertiary referral institutions.Patients: A total of 52 patients with SPS undergoing surveillance colonoscopy.Intervention: All patients underwent back-to-back colonoscopies with HR-WLE and NBI in a randomized order.Main Outcome Measurements: Polyp miss rates of HR-WLE and NBI.Results: In the HR-WLE group, 116 polyps were detected during the first inspection. A second inspection with NBI added 47 polyps, resulting in an overall polyp miss rate of 29% with HR-WLE (95% confidence interval, 22-36). In the NBI group, a total of 128 polyps were detected during the first inspection. Subsequent inspection with HR-WLE added 32 polyps, resulting in an overall polyp miss rate of NBI of 20% (95% confidence interval, 15-27). Comparison of the overall polyp miss rates of HR-WLE and NBI showed no significant difference (P = .065).Limitations: Small sample size; second inspection was performed by the same endoscopist.Conclusions: The results of our study suggest that NBI does not reduce polyp miss rates in patients with SPS compared with HR-WLE. Further multinational studies with larger numbers of patients are warranted to verify these results.