Narrow Band Imaging versus White Light for the Detection of Sessile Serrated Colorectal Lesions: A Randomized Clinical Trial

Abstract

<b><i>Background:</i></b> Colorectal cancer (CRC) is a leading cause of cancer. The detection of pre-malignant lesions by colonoscopy is associated with reduced CRC incidence and mortality. Narrow band imaging has shown promising but conflicting results for the detection of serrated lesions. <b><i>Methods:</i></b> We performed a randomized clinical trial to compare the mean detection of serrated lesions and hyperplastic polyps ≥10 mm with NBI or high-definition white light (HD-WL) withdrawal. We also compared all sessile serrated lesions (SSLs), adenoma, and polyp prevalence and rates. <b><i>Results:</i></b> Overall, 782 patients were randomized (WL group 392 patients; NBI group 390 patients). The average number of serrated lesions and hyperplastic polyps ≥10 mm detected per colonoscopy (primary endpoint) was similar between the HD-WL and NBI group (0.118 vs. 0.156, <i>p</i> = 0.44). Likewise, the adenoma detection rate (55.2% vs. 53.2%, <i>p</i> = 0.58) and SSL detection rate (6.8% vs. 7.5%, <i>p</i> = 0.502) were not different between the two study groups. Withdrawal time was higher in the NBI group (10.88 vs. 9.47 min, <i>p</i> = 0.004), with a statistically nonsignificant higher total procedure time (20.97 vs. 19.30 min, <i>p</i> = 0.052). <b><i>Conclusions:</i></b> The routine utilization of narrow band imaging does not improve the detection of serrated class lesions or any pre-malignant lesion and increases the withdrawal time.