Narrow band imaging versus conventional white light colonoscopy for the detection of colorectal polyps

Abstract

BACKGROUND It has been suggested that narrow band imaging colonoscopy (NBI) might be better for detection of colorectal polyps than white light colonoscopy (WLC). OBJECTIVES To compare standard or high definition white light colonoscopy with narrow band imaging colonoscopy for detection of colorectal polyps. SEARCH METHODS We searched The Cochrane Library, MEDLINE, and EMBASE to August 2011. We scanned bibliographies of relevant publications and wrote to experts for additional trials. SELECTION CRITERIA Two authors (NA and GB) independently applied the inclusion criteria and extracted the data to all potential studies without blinding. DATA COLLECTION AND ANALYSIS Authors extracted data independently. Trials with adequate randomisation, allocation concealment, and complete outcome data reporting, as well as without selective outcome reporting or other bias were classified as having a lowest risk of bias. Random-effects and fixed-effect meta-analyses were conducted. MAIN RESULTS We identified 11 randomised trials comparing WLC with NBI for detection of colorectal polyps. In total eight randomised trials with 3673 participants provided data for our analyses. There was no statistically significant difference between WLC (standard definition and high definition pooled) and NBI for the detection of patients with colorectal polyps (6 trials, n = 2832, RR 0.97, 95% CI 0.91 to 1.04), patients with colorectal adenomas (8 trials, n = 3673, RR 0.94, 95% CI 0.87 to 1.02), or patients with colorectal hyperplastic polyps (2 trials, n = 645, RR 0.87, 95% CI 0.76 to 1.00). Number of patients with at least one colorectal adenoma was not significantly different between WLC and NBI group irrespective of adenoma size (< 5 mm:RR 0.95, 95% CI 0.84 to 1.08, I(2) = 56%; 6 to 9 mm: RR 1.06, 95% CI 0.81 to 1.39, I(2) = 0%; ≥ 10 mm: RR 1.06, 95% CI 0.77 to 1.45, I(2) = 0%). Number of patients with at least one colorectal polyp, or colorectal adenoma was significantly lower in the standard definition WLC group compared to NBI group in fixed-effect meta-analysis (RR 0.87, 95% CI 0.78 to 0.97, I(2) = 78%; RR 0.87, 95% CI 0.77 to 0.99, I(2) = 0%, respectively), but not significantly different in random-effects meta-analysis (RR 0.86, 95% CI 0.68 to 1.10, I(2) = 78%). There was no statistically significant difference between high definition WLC and NBI in the number of patiens with at least one colorectal polyp or colorectal adenoma (RR 1.10, 95% CI 0.95 to 1.28; RR 0.87, 95% CI 0.77 to 0.99, I(2) = 0%, respectively). AUTHORS' CONCLUSIONS We could not find convincing evidence that NBI is significantly better than high definition WLC for the detection of patients with colorectal polyps, or colorectal adenomas. We found evidence that NBI might be better than standard definition WLC and equal to high definition WLC for detection the patients with colorectal polyps, or colorectal adenomas.