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Detection of Colorectal Adenoma by Narrow Band Imaging (HQ190) vs. High-Definition White Light Colonoscopy: A Randomized Controlled Trial

Leung, Wai K MD, FACG1; Lo, Oswens S H MBBS, FRCS2; Liu, Kevin S H MBBS, MRCP1; Tong, Teresa1; But, David Y K MBBS, MRCP1; Lam, Frank Y F MBBS, MRCP1; Hsu, Axel S J MBBS, MRCP1; Wong, S Y MBBS, FRCP1; Walter Seto, W K MD, MRCP1; Hung, Ivan F N MD, FRCP1; Law, W L MS, FACS2

American Journal of Gastroenterology: June 2014 - Volume 109 - Issue 6 - p 855–863
doi: 10.1038/ajg.2014.83

OBJECTIVES: The benefits of narrow band imaging (NBI) on enhancing colorectal adenoma detection remain questionable. We tested whether the new generation of NBI (190-NBI), which is twice as bright as the previous version, would improve adenoma detection when compared with high-definition white light (HD-WL) colonoscopy.

METHODS: It was a randomized controlled trial with tandem colonoscopy. We recruited patients who underwent colonoscopy for symptoms, screening, or surveillance. Patients were randomized for the use of either 190-NBI or HD-WL on withdrawal. Tandem colonoscopy was performed by using the same assigned colonoscope and withdrawal method. Lesions detected on first-pass and second-pass examination were used for adenoma detection and miss rates, respectively. The primary outcomes were adenoma and polyp detection rates.

RESULTS: A total of 360 patients were randomized to undergo either 190-NBI or HD-WL colonoscopy. Both the adenoma and polyp detection rates were significantly higher in the 190-NBI group compared with the HD-WL group (adenoma: 48.3% vs. 34.4%,P=0.01; polyps: 61.1% vs. 48.3%,P=0.02). The mean number of polyps detected per patient was higher in the 190-NBI group (1.49% vs. 1.13,P=0.07). There was no significant difference in the adenoma miss rates between the two groups (21.8% vs. 21.2%). Multivariate analysis showed that the use of 190-NBI (odds ratio (OR) 1.85; 95% confidence interval (CI) 1.10–3.12), withdrawal time (OR 1.29; CI 1.19–1.38), patient's age (OR 1.04; CI 1.01–1.06), and male gender (OR 2.38; CI 1.42–3.99) were associated with adenoma detection.

CONCLUSIONS: 190-NBI colonoscopy was superior to the conventional HD-WL in detecting colorectal adenomas or polyps, but there was no significant difference in adenoma miss rates.

1 Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Hong Kong

2 Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, Hong Kong

Correspondence: Wai K. Leung, MD, FACG, FACG, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Room 413, Professorial Block, 102 Pokfulam Road, Hong Kong, Hong Kong. E-mail:

Received 2 December 2013; accepted 18 February 2014

published online 22 April 2014

© The American College of Gastroenterology 2014. All Rights Reserved.
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