Randomized, controlled trial of standard-definition white-light, high-definition white-light, and narrow-band imaging colonoscopy for the detection of colon polyps and prediction of polyp histology

Background Missing adenomas and the inability to accurately differentiate between polyp histology remain the main limitations of standard-definition white-light (SD-WL) colonoscopy. Objective To compare the adenoma detection rates of SD-WL with those of high-definition white-light (HD-WL) and narrow-band imaging (NBI) as well as the accuracy of predicting polyp histology. Design Multicenter, prospective, randomized, controlled trial. Setting Two academic medical centers in the United States. Patients Subjects undergoing screening or surveillance colonoscopy. Intervention Subjects were randomized to undergo colonoscopy with one of the following: SD-WL, HD-WL, or NBI. Main Outcome Measurements The proportion of subjects detected with adenomas, adenomas detected per subject, and the accuracy of predicting polyp histology real time. Results A total of 630 subjects were included. The proportion of subjects with adenomas was 38.6% with SD-WL compared with 45.7% with HD-WL and 46.2% with NBI ( P = .17 and P = .14, respectively). Adenomas detected per subject were 0.69 with SD-WL compared with 1.12 with HD-WL and 1.13 with NBI ( P = .016 and P = .014, respectively). HD-WL and NBI detected more subjects with flat and right-sided adenomas compared with SD-WL (all P values P values Limitations Academic medical centers with experienced endoscopists. Conclusions There was no difference in the proportion of subjects with adenomas detected with SD-WL, HD-WL, and NBI. However, HD-WL and NBI detected significantly more adenomas per subject (>60%) compared with SD-WL. NBI had the highest accuracy in predicting adenomas in real time during colonoscopy. (Clinical Trial registration number: NCT 00614770.)