Narrow band imaging and white light endoscopy in the characterization of a polypectomy scar: A single-blind observational study

Fausto Riu Pons, Montserrat Andreu, Javier Gimeno Beltran, Marco Antonio Álvarez-Gonzalez, Agustín Seoane Urgorri, Josep Maria Dedeu, Luis Barranco Priego, Xavier Bessa, Fausto Riu Pons, Montserrat Andreu, Javier Gimeno Beltran, Marco Antonio Álvarez-Gonzalez, Agustín Seoane Urgorri, Josep Maria Dedeu, Luis Barranco Priego, Xavier Bessa

Abstract

Aim: To assess the incremental benefit of narrow band imaging (NBI) and white light endoscopy (WLE), randomizing the initial technique for the detection of residual neoplasia at the polypectomy scar after an endoscopic piecemeal mucosal resection (EPMR).

Methods: We conducted an observational study in an academic center to assess the incremental benefit of NBI and WLE randomly applied 1:1 (NBI-WLE or WLE-NBI) in the follow-up of a post-EPMR scar by the same endoscopist.

Results: A total of 112 EPMR scars were included. The median baseline polyp size was 20 mm (interquartile range: 14-30). At first review, NBI and WLE showed good sensitivity (85.0% vs 78.9%), specificity (77.1% vs 84.2%) and overall accuracy (80.0% vs 82.5%). NBI after WLE (WLE-NBI group) improved accuracy, but this difference was not statistically significant [area under the curve (AUC): 86.8% vs 81.6%, P = 0.15]. WLE after NBI (NBI-WLE group) did not improve accuracy (AUC: 81.4% vs 81.1%, P = 0.9). Overall, recurrence was found in 39/112 (34.8%) lesions.

Conclusion: Although no statistically significant differences were found between the two techniques at the first post-EPMR assessment, the use of NBI after WLE may improve residual neoplasia detection. Nevertheless, biopsy is still required in the first scar review.

Keywords: Colonoscopy; Endoscopic mucosal resection; Narrow band imaging.

Conflict of interest statement

Conflict-of-interest statement: There are no conflicts of interest to report for any of the authors.

Figures

Figure 1
Figure 1
Study protocol. Prediction of residual adenoma/hyperplastic tissue by the endoscopist with a level of confidence: Positive or: Negative. WLE: White light endoscopy; NBI: Narrow band imaging.
Figure 2
Figure 2
Flow diagram of study selection. WLE: White light endoscopy; NBI: Narrow band imaging; EPMR: Endoscopic piecemeal mucosal resection; CRC: Colorectal cancer.
Figure 3
Figure 3
Receiver operating characteristic curve. Global assessment of white light endoscopy (WLE) and narrow band imaging (NBI) is drawn for each group. A: WLE-NBI; B: NBI-WLE. The cut-off of the best area under the operating characteristic curve (ROC) curve is the true positive rate (sensitivity) plotted to the false positive rate (1.0-specificity). The closer the ROC curve to the upper left corner, the higher the accuracy of the test.
Figure 4
Figure 4
Examples of endoscopic mucosal scar with white light endoscopy and narrow band imaging (above and below and from left to right). A: Normal scar; B: Clear residual tissue of a surprisingly sessile serrated polyp/adenoma with no dysplasia on either the scar or endoscopic piecemeal mucosal resection; C: Apparent normal tissue with low-grade dysplasia at histology; D: Small residual tissue with low-grade dysplasia surrounding a clip (a clip artifact).

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