CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(10): E1207-E1213
DOI: 10.1055/a-0982-3111
Original article
Owner and Copyright © Georg Thieme Verlag KG 2019

A prospective randomized study of colonoscopy using blue laser imaging and white light imaging in detection and differentiation of colonic polyps

Tiing Leong Ang
1  Department of Gastroenterology and Hepatology, Changi General Hospital
,
James Weiquan Li
1  Department of Gastroenterology and Hepatology, Changi General Hospital
,
Yu Jen Wong
1  Department of Gastroenterology and Hepatology, Changi General Hospital
,
Yi-Lyn Jessica Tan
1  Department of Gastroenterology and Hepatology, Changi General Hospital
,
Kwong Ming Fock
1  Department of Gastroenterology and Hepatology, Changi General Hospital
,
Malcolm Teck Kiang Tan
1  Department of Gastroenterology and Hepatology, Changi General Hospital
,
Andrew Boon Eu Kwek
1  Department of Gastroenterology and Hepatology, Changi General Hospital
,
Eng Kiong Teo
1  Department of Gastroenterology and Hepatology, Changi General Hospital
,
Daphne Shih-Wen Ang
1  Department of Gastroenterology and Hepatology, Changi General Hospital
,
Lai Mun Wang
2  Department of Laboratory Medicine, Changi General Hospital
› Author Affiliations
TRIAL REGISTRATION: Single-Center, randomized, prospective trial NCT03421600 at clinicaltrials.gov
Further Information

Publication History

submitted 29 April 2019

accepted after revision 26 June 2019

Publication Date:
01 October 2019 (online)

  

Abstract

Background and study aims Published data on blue laser imaging (BLI) for detection and differentiation of colonic polyps are limited compared to narrow band imaging (NBI). This study investigated whether BLI can increase the detection rate of colonic polyps and adenomas when compared to white light imaging (WLI), and examined use of NICE (NBI International Colorectal Endoscopic) and JNET (Japan NBI Expert Team) classifications with BLI.

Patients and methods Patients aged 50 years and above referred for colonoscopy were randomized to BLI or WLI on withdrawal. Detected polyps were characterized using NICE and JNET classifications under BLI mode and correlated with histology. Primary outcome was adenoma detection rate. Secondary outcomes were utility of NICE and JNET classifications to predict histology using BLI.

Results A total of 182 patients were randomized to BLI (92) or WLI (90). Comparing BLI with WLI, the polyp detection rate was 59.8 % vs 40.0 %, P = 0.008, and the adenoma detection rate was 46.2 % vs 27.8 %, P = 0.010. NICE 1 and JNET 1 diagnosed hyperplastic polyps with sensitivity of 87.18 % and specificity of 84.35 %. NICE 2 diagnosed low- (LGD) or high-grade dysplasia (HGD) with sensitivity of 92.31 % and specificity of 77.45 %. JNET 2A diagnosed LGD with sensitivity of 91.95 %, and specificity of 74.53 %. Four cases of focal HGD all had JNET 2A morphology.

Conclusion BLI increased adenoma detection rate compared to WLI. NICE and JNET classifications can be applied when using BLI for endoscopic diagnosis of HP and LGD but histological confirmation remains crucial.