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Leaving distal colorectal hyperplastic polyps in place can be achieved with high accuracy by using narrow-band imaging: an observational study.
Gastrointest Endosc 2012; 76(2):374-80GE

Abstract

BACKGROUND

Accurate colonoscopic assessment of colorectal polyp histology could avoid resection of distal nonadenomatous polyps and reduce costs and risk.

OBJECTIVE

To assess the accuracy of predicting histology by using narrow-band imaging (NBI) in real time for distal colorectal polyps.

DESIGN

Prospective observational study.

SETTING

University hospital and ambulatory surgery center.

PATIENTS

This study involved 225 consecutive adults undergoing elective screening or surveillance colonoscopy.

INTERVENTION

We evaluated real-time histology of 235 distal (rectosigmoid) colorectal polyps from 31 patients by using high-definition colonoscopy and NBI without optical magnification. For each polyp, the endoscopist described size, Paris classification, and surface characteristics (vascular and pit pattern, color, pseudodepression). Before resection, histology was predicted, and a level of confidence (high or low) was assigned.

MAIN OUTCOME MEASUREMENTS

Sensitivity and negative predictive value of high-confidence endoscopic predictions of adenomatous versus hyperplastic histology for polyps ≤ 5 mm.

RESULTS

The accuracy of a high-confidence endoscopic prediction was 97.7%, sensitivity for adenomatous histology 93.9%, specificity 98.4%, negative predictive value 97.9%, and positive predictive value 75.6%. The performance characteristics for predicting diminutive distal polyps (≤ 5 mm) with high confidence were sensitivity 96.0%, specificity 99.4%, negative predictive value 99.4%, and positive predictive value 96.0%.

LIMITATIONS

Single-center study with a single endoscopist.

CONCLUSION

NBI without optical magnification is sufficiently accurate to allow distal hyperplastic polyps to be left in place without resection and small, distal adenomas to be discarded without pathologic assessment. These findings validate NBI criteria based on color, vessels, and pit characteristics for predicting real-time colorectal polyp histology.

Authors+Show Affiliations

Indiana University School of Medicine, Indianapolis, Indiana, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

22695207

Citation

Hewett, David G., et al. "Leaving Distal Colorectal Hyperplastic Polyps in Place Can Be Achieved With High Accuracy By Using Narrow-band Imaging: an Observational Study." Gastrointestinal Endoscopy, vol. 76, no. 2, 2012, pp. 374-80.
Hewett DG, Huffman ME, Rex DK. Leaving distal colorectal hyperplastic polyps in place can be achieved with high accuracy by using narrow-band imaging: an observational study. Gastrointest Endosc. 2012;76(2):374-80.
Hewett, D. G., Huffman, M. E., & Rex, D. K. (2012). Leaving distal colorectal hyperplastic polyps in place can be achieved with high accuracy by using narrow-band imaging: an observational study. Gastrointestinal Endoscopy, 76(2), pp. 374-80. doi:10.1016/j.gie.2012.04.446.
Hewett DG, Huffman ME, Rex DK. Leaving Distal Colorectal Hyperplastic Polyps in Place Can Be Achieved With High Accuracy By Using Narrow-band Imaging: an Observational Study. Gastrointest Endosc. 2012;76(2):374-80. PubMed PMID: 22695207.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Leaving distal colorectal hyperplastic polyps in place can be achieved with high accuracy by using narrow-band imaging: an observational study. AU - Hewett,David G, AU - Huffman,Melanie E, AU - Rex,Douglas K, Y1 - 2012/06/12/ PY - 2011/11/28/received PY - 2012/04/09/accepted PY - 2012/6/15/entrez PY - 2012/6/15/pubmed PY - 2012/12/12/medline SP - 374 EP - 80 JF - Gastrointestinal endoscopy JO - Gastrointest. Endosc. VL - 76 IS - 2 N2 - BACKGROUND: Accurate colonoscopic assessment of colorectal polyp histology could avoid resection of distal nonadenomatous polyps and reduce costs and risk. OBJECTIVE: To assess the accuracy of predicting histology by using narrow-band imaging (NBI) in real time for distal colorectal polyps. DESIGN: Prospective observational study. SETTING: University hospital and ambulatory surgery center. PATIENTS: This study involved 225 consecutive adults undergoing elective screening or surveillance colonoscopy. INTERVENTION: We evaluated real-time histology of 235 distal (rectosigmoid) colorectal polyps from 31 patients by using high-definition colonoscopy and NBI without optical magnification. For each polyp, the endoscopist described size, Paris classification, and surface characteristics (vascular and pit pattern, color, pseudodepression). Before resection, histology was predicted, and a level of confidence (high or low) was assigned. MAIN OUTCOME MEASUREMENTS: Sensitivity and negative predictive value of high-confidence endoscopic predictions of adenomatous versus hyperplastic histology for polyps ≤ 5 mm. RESULTS: The accuracy of a high-confidence endoscopic prediction was 97.7%, sensitivity for adenomatous histology 93.9%, specificity 98.4%, negative predictive value 97.9%, and positive predictive value 75.6%. The performance characteristics for predicting diminutive distal polyps (≤ 5 mm) with high confidence were sensitivity 96.0%, specificity 99.4%, negative predictive value 99.4%, and positive predictive value 96.0%. LIMITATIONS: Single-center study with a single endoscopist. CONCLUSION: NBI without optical magnification is sufficiently accurate to allow distal hyperplastic polyps to be left in place without resection and small, distal adenomas to be discarded without pathologic assessment. These findings validate NBI criteria based on color, vessels, and pit characteristics for predicting real-time colorectal polyp histology. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/22695207/Leaving_distal_colorectal_hyperplastic_polyps_in_place_can_be_achieved_with_high_accuracy_by_using_narrow_band_imaging:_an_observational_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(12)02161-X DB - PRIME DP - Unbound Medicine ER -