Observational Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2018; 24(45): 5179-5188
Published online Dec 7, 2018. doi: 10.3748/wjg.v24.i45.5179
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, Marco Antonio Álvarez-Gonzalez, Agustín Seoane Urgorri, Josep Maria Dedeu, Luis Barranco Priego, Xavier Bessa, Gastroenterology Department, Hospital del Mar, Barcelona 08003, Spain
Fausto Riu Pons, Montserrat Andreu, Javier Gimeno Beltran, Marco Antonio Álvarez-Gonzalez, Agustín Seoane Urgorri, Josep Maria Dedeu, Luis Barranco Priego, Xavier Bessa, IMIM (Hospital del Mar Medical Research Institute), Barcelona 08003, Spain
Fausto Riu Pons, Montserrat Andreu, Marco Antonio Álvarez-Gonzalez, Josep Maria Dedeu, Xavier Bessa, Department of Medicine, Autonomous University of Barcelona, Barcelona 08003, Spain
Montserrat Andreu, Pompeu Fabra University, Barcelona 08003, Spain
Javier Gimeno Beltran, Pathology Department, Hospital del Mar, Barcelona 08003, Spain.
Author contributions: Riu Pons F, Andreu M and Bessa X designed research and wrote the paper; Gimeno Beltran J supervised the pathological assessment; Riu Pons F, Álvarez-Gonzalez MA, Seoane Urgorri A, Dedeu JM and Barranco Priego L performed the follow-up colonoscopy; Riu Pons F, Andreu M and Bessa X analyzed data.
Correspondence author to: Fausto Riu Pons, MD, Senior Researcher, Gastroenterology Department, Hospital del Mar, Passeig Marítim 25-29, Barcelona 08003, Spain. friu@parcdesalutmar.cat
Telephone: +34-93-2483217
Received: August 20, 2018
Peer-review started: August 20, 2018
First decision: October 14, 2018
Revised: October 18, 2018
Accepted: November 16, 2018
Article in press: November 16, 2018
Published online: December 7, 2018
Processing time: 109 Days and 7.8 Hours
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; Narrow band imaging; Endoscopic mucosal resection

Core tip: Endoscopic mucosal resection of colon polyps in a piecemeal fashion requires a first close follow-up to detect residual neoplasia. There are limited data on the optimal approach to reviewing polypectomy scars with narrow band imaging (NBI). In this prospective observational study, which randomized the initial technique for the detection of residual neoplasia, NBI was slightly more accurate than white light endoscopy. To improve the assessment of polypectomy scars, high-definition endoscopes with NBI should be the rule. However, biopsies are still required at the first follow-up, even if there are no macroscopically evident lesions.