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Adjunctive use of chromoendoscopy may improve the diagnostic performance of narrow‐band imaging for small sessile serrated adenoma/polyp
Author(s) -
Chang LiChun,
Tu ChiaHung,
Lin BeenRen,
Shun ChiaTung,
Hsu WengFeng,
Liang JinTung,
Wang HsiuPo,
Wu MingShiang,
Chiu HanMo
Publication year - 2018
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.13863
Subject(s) - medicine , chromoendoscopy , colonoscopy , narrow band imaging , gastroenterology , cohort , endoscopy , prospective cohort study , hyperplastic polyp , adenoma , mucus , radiology , colorectal cancer , cancer , ecology , biology
Background and Aim Endoscopic diagnosis of sessile serrated adenoma/polyp (SSA/P) is challenging because of their subtle appearance. Narrow‐band imaging (NBI) is useful for diagnosis, but its utility with concurrent chromoendoscopy (CE), especially to detect small SSA/P, is unproven. Methods This prospective study enrolled 367 consecutive patients who underwent screening colonoscopy with the finding of serrated polyps. Patients were divided into derivation and validation cohorts: Diagnostic criteria using different endoscopic modalities were generated by regression analysis in the derivation cohort and were validated in the validation cohort for sensitivity, specificity, and accuracy. Results There were 180 patients with 119 SSA/P and 147 hyperplastic polyps (HP) in the derivation cohort and 187 patients with 177 SSA/P and 125 HP in the validation cohort. With white‐light endoscopy plus NBI, mucus cap, surface grooves, and expanded crypt were most associated with SSA/P. With white‐light endoscopy plus CE, II‐O pit pattern, mucus cap, and superficial telangiectasia were most associated with SSA/P. With the combined use of these three modalities, II‐O pit pattern, mucus cap, and surface grooves were most associated with SSA/P. For large serrated polyp, NBI in combination with CE had a better accuracy than NBI alone (91% vs 86%, P = 0.025) to distinguish SSA/P from HP. CE alone had a better accuracy than NBI alone for distinguishing small SSA/P from small HP (85% vs 72%, P < 0.0001). Conclusion Compared with NBI alone, adjunctive use of CE can improve the diagnostic accuracy for distinguishing SSA/P from HP, especially for small SSA/P.