Blue-light imaging superior to white-light imaging for detection of proximal colonic lesions

Hong Kong: A recent study has shown the superiority of both blue-light imaging (BLI) and narrow-band imaging (NBI) to white-light imaging (WLE) for the detection of proximal colonic lesions. Only BLI had a lower proximal adenoma miss rate compared to WLE.

The findings from the three-arm randomized controlled tandem colonoscopy study, published in the journal Gastrointestinal Endoscopy, provide valuable insights into improving the accuracy of colorectal cancer screening and surveillance.

Colorectal cancer is a prevalent form of cancer worldwide, and early detection of colonic lesions, particularly adenomas, can greatly reduce morbidity and mortality associated with the disease. Traditional white-light imaging has limitations in identifying subtle lesions, leading to missed diagnoses. This has prompted the development of advanced endoscopic imaging techniques such as BLI and narrow-band imaging (NBI).

The study, led by a team of researchers from Hong Kong led by W K Leung, enrolled 901 patients aged 40 years or above who underwent tandem examination of the proximal colon using BLI, NBI, or WLE during the first withdrawal. The second withdrawal was performed under WLE in all patients for comparison. The primary outcomes measured were the proximal polyp detection rate (pPDR) and proximal adenoma detection rate (pADR), while the secondary outcome was the miss rates of proximal lesions identified during tandem examination.

● The results revealed that both BLI and NBI outperformed WLE in detecting proximal colonic lesions.

● The pPDR for BLI, NBI, and WLE was 45.8%, 41.6%, and 36.6%, respectively, whereas the corresponding pADR was 36.6%, 33.8%, and 28.3%.

● Significantly higher pPDR and pADR were observed with BLI compared to WLE (difference: 9.2% and 8.3%, respectively) and NBI compared to WLE (difference: 5.0% and 5.6%, respectively).

● Remarkably, BLI demonstrated a significantly lower proximal adenoma miss rate (19.4%) than WLE (27.4%), representing a crucial improvement in diagnostic accuracy.

● However, there was no significant difference observed between NBI and WLE in terms of proximal adenoma miss rates.

These findings underscore the potential of BLI as an advanced imaging technique for more precise detection of colonic lesions, particularly adenomas, which are critical precursors of colorectal cancer. By enhancing visualization and improving lesion detection rates, BLI holds promise for improving the effectiveness of colorectal cancer screening and surveillance programs.

While this study presents groundbreaking results, further research is necessary to validate these findings in other settings and populations. Nonetheless, the potential impact of BLI in enhancing the early detection of colonic lesions cannot be overstated. Implementation of BLI

technology in routine clinical practice has the potential to revolutionize colorectal cancer screening, resulting in improved patient outcomes and reduced mortality rates.

Colorectal cancer remains a global health concern, and studies like this bring us one step closer to more effective detection and prevention strategies. By harnessing the power of advanced imaging techniques such as BLI, medical professionals can offer patients more accurate and reliable diagnoses, ultimately saving lives through early intervention.

Reference:

BLUE-LIGHT IMAGING OR NARROW-BAND IMAGING FOR PROXIMAL COLONIC LESIONS: A PROSPECTIVE RANDOMIZED TANDEM COLONOSCOPY STUDYGastrointest. Endosc. 2023 Jun 10;[EPub Ahead of Print], WK Leung, VW Man Tsui, L Lung-Yi Mak, M Ka-Shing Cheung, C Ka-Yin Hui, C Pui-Mei Lam, SY Wong, K Sze-Hang Liu, M Kwan-Lung Ko, E Wai-Pan To, CG Guo, T Ka-Luen Lui.