ORIGINAL ARTICLE Narrow-band imaging for the detection of polyps in patients with serrated polyposis syndrome: a multicenter, randomized, back-to- back trial Yark Hazewinkel, MD, 1 Kristien M.A.J. Tytgat, MD, PhD, 1 Monique E. van Leerdam, MD, PhD, 2 Jan-Jacob Koornstra, MD, PhD, 3 Barbara A. Bastiaansen, MD, 1 Susanne van Eeden, MD, PhD, 4 Paul Fockens, MD, PhD, 1 Evelien Dekker, MD, PhD 1 Amsterdam, Rotterdam, Groningen, the Netherlands Background: Serrated polyposis syndrome (SPS) is characterized by the presence of multiple serrated polyps spread throughout the colon. Patients with SPS are considered to be at risk of colorectal cancer and are advised to undergo endoscopic surveillance. Narrow-band imaging (NBI) may improve the detection of polyps during these surveillance colonoscopies. Objective: To compare polyp miss rates between NBI and high-resolution white-light endoscopy (HR-WLE). Design: Multicenter, randomized, crossover study. Setting: Four tertiary referral institutions. Patients: A total of 52 patients with SPS undergoing surveillance colonoscopy. Intervention: All patients underwent back-to-back colonoscopies with HR-WLE and NBI in a randomized order. Main Outcome Measurements: Polyp miss rates of HR-WLE and NBI. Results: In the HR-WLE group, 116 polyps were detected during the first inspection. A second inspection with NBI added 47 polyps, resulting in an overall polyp miss rate of 29% with HR-WLE (95% confidence interval, 22-36). In the NBI group, a total of 128 polyps were detected during the first inspection. Subsequent inspection with HR- WLE added 32 polyps, resulting in an overall polyp miss rate of NBI of 20% (95% confidence interval, 15-27). Comparison of the overall polyp miss rates of HR-WLE and NBI showed no significant difference (P Z .065). Limitations: Small sample size; second inspection was performed by the same endoscopist. Conclusions: The results of our study suggest that NBI does not reduce polyp miss rates in patients with SPS compared with HR-WLE. Further multinational studies with larger numbers of patients are warranted to verify these results. (Clinical trial registration number: NTR2497.) (Gastrointest Endosc 2014;-:1-8.) Abbreviations: CI, confidence interval; CRC, colorectal cancer; HR-WLE, high-resolution white light endoscopy; NBI, narrow-band imaging; OR, odds ratio; SPS, serrated polyposis syndrome; WHO, World Health Organization. DISCLOSURE: The following authors disclosed financial relationships relevant to this article: Dr Fockens is a consultant to and has received research support from Olympus. Dr Dekker has received a research grant from Olympus. All other authors disclosed no financial relationships relevant to this article. This study was supported by grant number UVA 2010-4717 from the Dutch Cancer Society. Copyright ª 2014 by the American Society for Gastrointestinal Endoscopy 0016-5107/$36.00 http://dx.doi.org/10.1016/j.gie.2014.06.043 Received April 18, 2014. Accepted June 26, 2014. Current affiliations: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands (1), Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands and Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, the Netherlands (2), Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, the Netherlands (3), Department of Pathology, Academic Medical Center, Amsterdam, the Netherlands (4). Reprint requests: Evelien Dekker, MD, PhD, Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands. If you would like to chat with an author of this article, you may contact Dr Dekker at e.dekker@amc.nl www.giejournal.org Volume -, No. - : 2014 GASTROINTESTINAL ENDOSCOPY 1