Blue-light imaging or narrow-band imaging for proximal colonic lesions: a prospective randomized tandem colonoscopy study

Abstract

<p>Background & Aim: Blue-light imaging (BLI) is a new image-enhanced endoscopy with wavelength filter similar to narrow-band imaging (NBI). We compared the two with white-light imaging (WLE) on proximal colonic lesion detection and miss rates. <br></p><p>Methods: It is a three-arm prospective randomized study with tandem examination of the proximal colon. We enrolled patients aged 40 years or above. Eligible patients were randomized in 1:1:1 ratio to receive BLI, NBI or WLE during first withdrawal of the proximal colon. Second withdrawal was performed under WLE in all patients. Primary outcomes were proximal polyp (pPDR) and adenoma (pADR) detection rates. Secondary outcomes were the miss rates of proximal lesions found on tandem examination. <br></p><p>Results: 901 patients were included (mean age 64.7 years, 52.9% male) and 48.1% underwent colonoscopy for screening or surveillance. The corresponding pPDR of the BLI, NBI and WLE group was 45.8%, 41.6 and 36.6%, whereas the corresponding pADR was 36.6%, 33.8% and 28.3%. There was a significant difference in pPDR and pADR between BLI and WLE (difference: 9.2%, 95% CI 3.3-16.9%; and 8.3%, 95%CI 2.7-15.9%) or between NBI and WLE (difference: 5.0%, 95%CI 1.4-12.9%; and 5.6%, 95%CI 2.1-13.3%). BLI also had significantly lower proximal adenoma miss rate (19.4%) than WLE (27.4%; difference -8.0%, 95%CI -15.8% to -0.1%), but not between NBI (27.2%) and WLE. <br></p><p>Conclusion: Both BLI and NBI were superior to WLE on detecting proximal colonic lesions, but only BLI had lower proximal adenoma miss rate than WLE.<br></p>