![]() ![]() When possible, additional 2×2 tables were constructed for polyps ≤5 mm, 6–9 mm and ≥10 mm, and high-confidence and low-confidence predictions. We constructed 2×2 tables that contained the number of polyps found to be true positives (neoplastic polyps that were endoscopically predicted to be neoplastic), true negatives (non-neoplastic polyps that were endoscopically predicted to be non-neoplastic), false positives (non-neoplastic polyps that were endoscopically predicted to be neoplastic) and false negatives (neoplastic polyps that were endoscopically predicted to be non-neoplastic). We extracted data independently onto standardised paper forms. We discussed and resolved disagreement between investigators. We translated papers that were not written in English. We excluded studies that primarily analysed still images to predict polyp histology those that included patients with inflammatory bowel disease, hereditary nonpolyposis colorectal cancer or familial polyposis syndromes as well as those primarily designed as a retrospective study, review, editorial or meta-analysis. We included studies that prospectively evaluated patients undergoing colonoscopy during which endoscopists used NBI to make a real-time prediction of polyp histology (neoplastic or non-neoplastic), and compared this with histology as the reference standard. ![]() Following the initial search, we identified articles for appropriateness, and performed a detailed full text assessment of potentially relevant studies. We subsequently manually searched the citations from published reviews. The electronic archives of conference proceedings were searched using the term narrow band, and abstracts that included this term were reviewed in detail for potential inclusion. Studies in SCOPUS were identified with the terms narrow band or optical filter combined with the set operator AND with words beginning with colorect, adenoma, colonoscop or polyp. Studies in PubMed were identified with the terms narrow band or optical filter combined with the set operator AND with studies identified with the MeSH terms colonoscopy, colonic neoplasms or colonic polyps or with words beginning with colorect, adenoma, colonoscop or polyp. We designed the search queries with a biomedical research librarian to capture all articles related to NBI and colonoscopy. In addition, we searched the abstracts of conference proceedings of Digestive Diseases Week and American College of Gastroenterology. We (TK and SM) conducted a computerised literature search of the PubMed, SCOPUS (including EMBASE) and Cochrane Library databases up to June 2012. 4 9 It could also decrease unnecessary polypectomy, a risk factor for major colonoscopy-related complications such as perforation and bleeding. 8 Such a strategy could allow for surveillance intervals to be communicated to the patient on the day of colonoscopy, and confer substantial cost savings by avoiding pathology and endoscopy fees. 7 Real-time differentiation has been proposed as part of a ‘resect and discard’ strategy in which diminutive (≤5 mm) neoplastic polyps are resected without pathological evaluation, and diminutive rectosigmoid non-neoplastic polyps are left in situ. 6 As such, an international classification to distinguish neoplasms such as adenomas from non-neoplasms such as hyperplastic polyps with the use of NBI has been developed and validated ( figure 1). This allows for improved differentiation of polyps compared with that using white light. Narrow band imaging (NBI) technology highlights the increased vasculature of neoplastic tissue and makes neoplastic polyps appear darker than surrounding mucosa. 5 Real-time endoscopic diagnosis, in which endoscopists diagnose polyp histology at the moment of identification, may have similar diagnostic operating characteristics as pathological evaluation at a significantly reduced cost. 4 Pathology diagnoses are needed to determine the patient's interval to the next surveillance colonoscopy. 2 All polyps, even diminutive polyps that rarely harbour dysplasia, 3 are routinely sent for pathological evaluation, and this can incur major costs. 1 However, its expense makes it potentially less cost effective than other screening methods. ![]() Colonoscopy with polypectomy is considered effective at preventing colorectal cancer deaths. ![]()
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