***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose The purpose of this study is to evaluate an endoscopic trimodal imaging ( ETMI ) system ( high resolution , autofluorescence , and NBI ) in the detection and differentiation of  colorectal adenomas .  Methods A prospect i ve r and omised trial of t and em colonoscopies was carried out using the Olympus XCF-FH260AZI system . Each colonic segment was examined twice for lesions , once with HRE and once with AFI , in r and om order per patient . All detected lesions were assessed with NBI for pit pattern and with AFI for colour . All lesions were removed and sent for histology . Any lesion identified on the second examination was considered as missed by the first examination . Outcome measures are adenoma miss rates of AFI and HRE , and diagnostic accuracy of NBI and AFI for differentiating neoplastic from non-neoplastic lesions . Results Ninety-four patients underwent colonoscopy with ETMI ( 47 in each group ) . Among 47 patients examined with AFI first , 31 adenomas in 15 patients were detected initially [ detection rate 0.66 ( 0.52–0.75 ) ] . Subsequent HRE inspection identified six additional adenomas . Among 47 patients examined with HRE first , 29 adenomas in 14 patients were detected initially [ detection rate 0.62 ( 0.53–0.79 ) ] . Successive AFI yielded seven additional adenomas . Adenoma miss rates of AFI and HRE were 14 % and 16.2 % , respectively ( p = 0.29 ) . Accuracy of AFI alone for differentiation was lower than NBI ( 63 % vs. 80 % , p < 0.001 ) . Combined use of AFI and NBI achieved improved accuracy for differentiation ( 84 % ) , showing a trend for superiority compared with NBI alone ( p = 0.064 ) . Conclusions AFI did not significantly reduce the adenoma miss rate compared with HRE . AFI alone had a disappointing accuracy for adenoma differentiation , which could be improved by combination of AFI and NBI Objective : Colonoscopy is the accepted gold st and ard for screening of neoplastic colorectal lesions , but the substantial miss rate remains a challenge . Computed virtual chromoendoscopy with the Fujinon intelligent colour enhancement ( FICE ) system is a new dyeless imaging technique that might allow higher rates of adenoma detection . Methods : This is a prospect i ve r and omised five tertiary care centre trial of colonoscopy in the FICE mode versus st and ard colonoscopy with targeted indigocarmine chromoscopy ( control group ) in consecutive patients attending for routine colonoscopy .  Histopathology of detected lesions was confirmed by evaluation of endoscopic resection or biopsy specimens . Results : 871 patients were enrolled , and 764 patients ( 344 female , mean age 64 years ) were subjected to final analysis ( 368 in the FICE group , 396 in the control group ) . In total , 236 adenomas ( mean of 0.64 per case ) were detected in the FICE group and 271 adenomas ( mean of 0.68 per case ) in the control group ( p = 0.92 ) . There was no statistically significant difference in the percentage of patients with ⩾1 adenoma between the control group ( 35.4 % ) and the FICE group ( 35.6 % ) ( p = 1.0 ) . For the differential diagnosis of adenomas and non-neoplastic polyps , the sensitivity of FICE ( 92.7 % ) was comparable with that of indigocarmine ( 90.4 % ) ( p = 0.44 ) . Conclusions : At colonoscopy , adenoma detection rates are not improved by virtual chromoendoscopy with the FICE system compared with white light endoscopy with targeted indigocarmine spraying . However , FICE can effectively substitute for chromoscopy concerning the differentiation of neoplastic and non-neoplastic lesions Background : Diminutive and flat colorectal lesions can be difficult to detect using conventional colonoscopic techniques . Previous data have suggested that pan-chromoscopy may improve detection rates . No r and omised control trial has been performed examining detection rates of such lesions while controlling for extubation time and lavage effect . Aim : We conducted a r and omised controlled trial of pan-colonic chromoscopic colonoscopy for the detection of diminutive and flat colorectal lesions while controlling for extubation time and lavage effect . Methods : Consecutive patients attending for routine colonoscopy were r and omised to either pan-chromoscopy using 0.5 % indigo carmine ( IC ) or targeted chromoscopy ( control group ) . A minimum diagnostic extubation time was set at eight minutes with controls undergoing a matched volume of saline wash . Results : A total of 260 patients were r and omised ; 132 controls and 128 to pan-colonic chromoscopy .  Extubation times did not differ significantly between the control ( median 15 minutes ( range 8–41 ) ) and chromoscopy ( median 17 minutes ( range 8–39 ) ) groups . The volume of IC  used in the pan-chromoscopy group ( median 68 ml ( range 65–90 ) ) and normal saline used in the control group ( 69 ml ( range 60–93 ) ) did not differ significantly . There was a statistically significant difference between the groups regarding the total number of adenomas detected ( p<0.05 ) with significantly more diminutive ( < 4 mm ) adenomas detected in the pan-chromoscopy group ( p = 0.03 ) . Pan-chromoscopy diagnosed more diminutive and flat lesions in the right colon compared with controls ( p<0.05 ) , with more patients with multiple adenomas ( > 3 ) detected using pan-chromoscopy ( p<0.01 ) . Hyperplastic lesions were more commonly detected in the pan-chromoscopy group compared with controls ( p<0.001 ) . More hyperplastic polyps were detected in the left colon ( 86 % rectosigmoid ) using chromoscopy compared with controls . Conclusion : Chromoscopy improves the total number of adenomas detected and enhances the detection of diminutive and flat lesions . Importantly , eight diminutive lesions had foci of high grade dysplasia . Chromoscopy may benefit patients , assuming a high risk of colorectal cancer , and help in risk stratification and planning follow up colonoscopy intervals Background and aims : Colonoscopy is an established method of colorectal cancer screening , but has an adenoma miss rate of 10–20 % . Detection rates are expected to improve with optimised visualisation methods . This prospect i ve r and omised study evaluated narrow-b and imaging ( NBI ) , a new technique that may enhance image contrast in colon adenoma detection . Methods : Eligible patients presenting for diagnostic colonoscopy  were r and omly assigned to undergo wide-angle colonoscopy using either conventional high-resolution imaging or NBI during instrument withdrawal . The primary outcome parameter was the difference in the adenoma detection rate between the two techniques . Results : A total of 401 patients were included ( mean age 59.4 years , 52.6 % men ) .  Adenomas were detected more frequently in the NBI group ( 23 % ) than in the control group ( 17 % ) with a number of 17 colonoscopies needed to find one additional adenoma patient ; however , the difference was not statistically significant ( p = 0.129 ) . When the two techniques were compared in consecutive subgroups of 100 study patients , adenoma rates in the NBI group remained fairly stable , whereas these rates steadily increased in the control group ( 8 % , 15 % , 17 % , and 26.5 % , respectively ) . Significant differences in the first 100 cases ( 26.5 % versus 8 % ; p = 0.02 ) could not be maintained in the last 100 cases ( 25.5 % versus 26.5 % , p = 0.91 ) . Conclusions : The increased adenoma detection rate means of NBI colonoscopy were statistically not significant . It remains speculative as to whether the increasing adenoma rate in the conventional group may have been caused by a training effect of better polyp recognition on NBI BACKGROUND AND STUDY AIMS Hyperplastic polyposis syndrome ( HPS ) is associated with colorectal cancer and is characterized by multiple hyperplastic polyps , sessile serrated adenomas ( SSAs ) and adenomas . Narrow b and imaging ( NBI ) may improve the detection of polyps in HPS . We aim ed to compare polyp miss rates with NBI with those of high resolution endoscopy ( HRE ) . PATIENTS AND METHODS In a single center , r and omized crossover study consecutive HPS patients underwent  t and em colonoscopy with HRE and NBI , in r and omized order with removal of all detected polyps . RESULTS In 22 patients with HPS , 209 polyps were detected , including 27 with normal histology , 116 hyperplastic polyps , 42 SSAs , and 24 adenomas . Among patients assigned to HRE first ( n = 11 ) a total of 78 polyps was detected ; subsequent NBI added 44 polyps . In patients examined with NBI first , 78 polyps were detected and subsequent HRE added 9 . Polyp miss rates of HRE and NBI were 36 % and 10 % ( OR 0.21 ; 0.09 - 0.45 ) . Flat polyp shape was independently associated with increased miss rate . CONCLUSION NBI significantly reduces polyp miss rates in HPS patients . We recommend using either NBI or chromoendoscopy for colonoscopic surveillance of HPS patients with removal of all detected polyps BACKGROUND Missing adenomas and the inability to accurately differentiate between polyp histology remain the main limitations of st and ard-definition white-light ( SD-WL ) colonoscopy . OBJECTIVE To compare the adenoma detection rates of SD-WL with those of high-definition white-light ( HD-WL ) and narrow-b and imaging ( NBI ) as well as the accuracy of predicting polyp histology . DESIGN Multicenter , prospect i ve , r and omized , controlled trial . SETTING Two academic medical centers in the United States . PATIENTS Subjects undergoing screening or surveillance colonoscopy .  INTERVENTION Subjects were r and omized to undergo colonoscopy with one of the following : SD-WL , HD-WL , or NBI . MAIN OUTCOME MEASUREMENTS The proportion of subjects detected with adenomas , adenomas detected per subject , and the accuracy of predicting polyp histology real time . RESULTS A total of 630 subjects were included . The proportion of subjects with adenomas was 38.6 % with SD-WL compared with 45.7 % with HD-WL and 46.2 % with NBI ( P = .17 and P = .14 , respectively ) . Adenomas detected per subject were 0.69 with SD-WL compared with 1.12 with HD-WL and 1.13 with NBI ( P = .016 and P = .014 , respectively ) . HD-WL and NBI detected more subjects with flat and right-sided adenomas compared with SD-WL ( all P values < .005 ) . NBI had a superior sensitivity ( 90 % ) and accuracy ( 82 % ) to predict adenomas compared with SD-WL and HD-WL ( all P values < .005 ) . LIMITATIONS Academic medical centers with experienced endoscopists . CONCLUSIONS There was no difference in the proportion of subjects with adenomas detected with SD-WL , HD-WL , and NBI . However , HD-WL and NBI detected significantly more adenomas per subject ( > 60 % ) compared with SD-WL . NBI had the highest accuracy in predicting adenomas in real time during colonoscopy . ( CLINICAL TRIAL REGISTRATION NUMBER NCT 00614770 . ) Background Some patients under close colonoscopic surveillance still develop colorectal cancer , thus suggesting the overlook of colorectal adenoma by endoscopists . AFI detects colorectal adenoma as a clear magenta , therefore the efficacy of AFI is expected to improve the detection ability of colorectal adenoma . The aim of this study is to determine the efficacy of AFI in detecting colorectal adenoma . Methods This study enrolled 88 patients who underwent colonoscopy at Asahikawa Medical University and Kushiro Medical Association Hospital . A r and omly selected colonoscopist first observed the sigmoid colon and rectum with conventional high resolution endosopy ( HRE ) . Then the colonoscopist changed the mode to AFI and h and ed to the scope to another colonoscopist who knew no information about the HRE . Then the second colonoscopist observed the sigmoid colon and rectum . Each colonoscopist separately recorded the findings . The detection rate , miss rate and procedural time were assessed in prospect i ve manner . Results The detection rate of flat and depressed adenoma , but not elevated adenoma , by AFI is significantly higher than that by HRE . In less-experienced endoscopists , AFI dramatically increased the detection rate ( 30.3 % ) and reduced miss rate ( 0 % ) of colorectal adenoma in comparison to those of HRE ( 7.7 % , 50.0 % ) , but not for experienced endoscopists . The procedural time of HRE was significantly shorter than that of AFI . Conclusions AFI increased the detection rate and reduced the miss rate of flat and depressed adenomas . These advantages of AFI were limited to less-experienced endoscopists because experienced endoscopists exhibited a substantially high detection rate for colorectal adenoma with HRE Introduction . To compare the accuracy of digital and real-time chromoendoscopy for the differential diagnosis of 
    Output:
    
Based on the meta- analysis , NBI , FICE and AFI were significantly better compared with SDWL at detecting patients with adenoma .