Impact of Narrow-Band Imaging on Sessile Serrated Lesion Miss Rate: A Multicenter Randomized Tandem Colonoscopy Trial

Sessile serrated lesions (SSLs) are precursors to post-colonoscopy colorectal cancer but are frequently missed because of their subtle morphology. Previous studies have reported the effectiveness of narrow-band imaging (NBI) for detecting colorectal adenomas, but its value for detecting SSLs remains unclear. This study aimed to determine whether NBI reduces the SSL miss rate (SSLMR).

This multicenter, randomized tandem trial was conducted in a colorectal cancer screening population across 15 endoscopy centers. The participants were randomly assigned to NBI-first or white light imaging-first (WLI-first) colonoscopy, followed by a second examination using the alternate modality. The primary outcome was the SSLMR, and secondary outcomes included the proximal serrated polyp miss rate, adenoma miss rate, and changes in surveillance intervals.

NBI significantly reduced the SSLMR compared with WLI (17.5% vs 43.6%; P = .003), with consistent decreasing trends in subgroups stratified by location, sex, age, and other variables. The NBI-first group also had lower miss rates for proximal serrated lesions (19.3% vs 40.7%; P < .001) and adenomas (20.1% vs 29.5%; P = .002). However, the detection rates of adenomas and SSLs did not significantly differ between the 2 groups. NBI was the only independent factor associated with a reduced SSLMR in a multivariate regression model (odds ratio, 0.24) and increased the proportion of individuals recommended for intensive surveillance (11.8% vs 6.0%; P = .003).

NBI significantly reduces the miss rates of SSLs, proximal serrated lesions, and adenomas without reducing that of advanced SSLs.

gov, Number: NCT05684328).