Cochrane Database of Systematic Reviews, Feb 17, 2010
It has been suggested that narrow band imaging colonoscopy (NBI) might be better for detection of... more It has been suggested that narrow band imaging colonoscopy (NBI) might be better for detection of colorectal polyps than white light colonoscopy (WLC). To compare standard or high definition white light colonoscopy with narrow band imaging colonoscopy for detection of colorectal polyps. We searched The Cochrane Library, MEDLINE, and EMBASE to August 2011. We scanned bibliographies of relevant publications and wrote to experts for additional trials. Two authors (NA and GB) independently applied the inclusion criteria and extracted the data to all potential studies without blinding. Authors extracted data independently. Trials with adequate randomisation, allocation concealment, and complete outcome data reporting, as well as without selective outcome reporting or other bias were classified as having a lowest risk of bias. Random-effects and fixed-effect meta-analyses were conducted. We identified 11 randomised trials comparing WLC with NBI for detection of colorectal polyps. In total eight randomised trials with 3673 participants provided data for our analyses. There was no statistically significant difference between WLC (standard definition and high definition pooled) and NBI for the detection of patients with colorectal polyps (6 trials, n = 2832, RR 0.97, 95% CI 0.91 to 1.04), patients with colorectal adenomas (8 trials, n = 3673, RR 0.94, 95% CI 0.87 to 1.02), or patients with colorectal hyperplastic polyps (2 trials, n = 645, RR 0.87, 95% CI 0.76 to 1.00). Number of patients with at least one colorectal adenoma was not significantly different between WLC and NBI group irrespective of adenoma size (< 5 mm:RR 0.95, 95% CI 0.84 to 1.08, I(2) = 56%; 6 to 9 mm: RR 1.06, 95% CI 0.81 to 1.39, I(2) = 0%; ≥ 10 mm: RR 1.06, 95% CI 0.77 to 1.45, I(2) = 0%). Number of patients with at least one colorectal polyp, or colorectal adenoma was significantly lower in the standard definition WLC group compared to NBI group in fixed-effect meta-analysis (RR 0.87, 95% CI 0.78 to 0.97, I(2) = 78%; RR 0.87, 95% CI 0.77 to 0.99, I(2) = 0%, respectively), but not significantly different in random-effects meta-analysis (RR 0.86, 95% CI 0.68 to 1.10, I(2) = 78%). There was no statistically significant difference between high definition WLC and NBI in the number of patiens with at least one colorectal polyp or colorectal adenoma (RR 1.10, 95% CI 0.95 to 1.28; RR 0.87, 95% CI 0.77 to 0.99, I(2) = 0%, respectively). We could not find convincing evidence that NBI is significantly better than high definition WLC for the detection of patients with colorectal polyps, or colorectal adenomas. We found evidence that NBI might be better than standard definition WLC and equal to high definition WLC for detection the patients with colorectal polyps, or colorectal adenomas.
Gastro-oesophageal reflux disease (GERD) includes wide spectrum of symptoms caused by gastric aci... more Gastro-oesophageal reflux disease (GERD) includes wide spectrum of symptoms caused by gastric acid regurgitation through the incompetent lower oesophageal sphincter in oesophagus. Etiopathogenesis of GERD is multifactorial. Aim of this study: to establish the relationship between Helicobacter pylori eradication and appearance or aggravating of present GERD. If this relationship exist, the aim is to estimate its level and clinical consequences. Material and methods: 50 Helicobacter pylori positive patients with different endoscopic findings (ulcer disease, gastritis and non-ulcer dyspepsia) to whom eradication of Helicobacter pylori was done, were following next 6 months. Questionnaire, uppear GI endoscopy with verification changes of oesophagus in accordance to LA classification, histopathological examination of gastric and oesophageal mucosal biopsy specimens, and oesophageal manometry have been done to all patients. These examinations have been done before Helicobacter pylori erad...
Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) as progressive... more Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) as progressive form of the disease are associated with cardiovascular risk factors including obesity, dyslipidaemia, hyperglycaemia and hypertension. When NAFLD is associated with cardiovascular disease, mortality of NAFLD patients is increased due to cardiovascular disease. Prevalence of NAFLD and NASH is high, but it seems that epidemic of the disease is under-recognized and under-appreciated. Linking pathophysiological mechanisms are complex and still not well understood. The main related pathophysiological mechanisms are lipid factors, insulin resistance, inflammation, proinflammatory cytokines, oxidative stress, pro-coagulant status, hyperglycaemia and adipokines. First-line management focuses on lifestyle modifications in both diseases. Several therapeutic interventions, insulin sensitizer agents, lipid lowering drugs, antioxidants, such as vitamin E, have been proposed. Statins appear to be safe, but their use in the treatment of NAFLD and NASH is under-appreciated. Many different agents are being investigated as future drugs for the treatment of this clinical entity. The aim of the review is to examine the extent of the epidemic and the mediating mechanisms, to critically evaluate current guideline recommendations, and to consider current and future medications for this disease.
The expression of the human Ki-67 protein is strictly associated with cell proliferation. The cel... more The expression of the human Ki-67 protein is strictly associated with cell proliferation. The cell proliferation and kinetics of normal gastrointestinal tract are well known but the cell kinetics of adenoma in gastrointestinal tract is poorly understood. The aim of this study was to provide an immunohistochemical evaluation of the expression of Ki-67 antigen in different colorectal adenomas. In the prospective study, we analyzed 65 colorectal adenomas. Proliferation indexes were found to steadily increase from normal mucosa to adenoma (p < 0.05). There was also a difference in the expression of Ki-67 between adenomas smaller and larger than 10 mm (p < 0.05). The expression of Ki-67 was strongly more often in villous adenomas as opposed to the tubular adenomas (p < 0.05). Reaction for Ki-67 were strong in adenomas with high grade atypia compared to low grade adenomas (p < 0.001). The expression of Ki-67 clearly shows differences between advanced and nonadvanced adenomas. The strong reactions of Ki-67 in adenomas with severe dysplasia show a close association with colorectal carcinoma. The immunohistochemical analysis (Ki-67) may be included as a part of routine pathological evaluation with conventional prognostic factors.
Colorectal cancer (CRC) is important medical problem. Initially it can be present like solitary o... more Colorectal cancer (CRC) is important medical problem. Initially it can be present like solitary or multiple. Multiple primary CRC may be synchronous or metachronous depend on period between the diagnosis has been established. Metachronous CRC is primary CRC which arise certain period after diagnosis and removal of previous CRC. Synchronous CRC are discovered at the same time or inside a period of 6-12 months. We present a relative rare case of metachrono-synchronous colorectal cancer.
The study investigated whether intakes of fat and fatty acids are associated with the development... more The study investigated whether intakes of fat and fatty acids are associated with the development of gastric cancer. A case-control study was conducted in the Clinical Centre Nis (Serbia) from 2005 to 2006. A total of 102 patients with histologically confirmed gastric cancer were compared with 204 controls chosen among the subjects admitted to the same hospital as cases of acute non-neoplastic diseases. A food-frequency questionnaire (FFQ) was used to assess information on the frequency of consumption of foods in the course of one year prior to cancer diagnosis or hospital admission (for controls). Nutrient values in food were obtained from the Food composition table. We did not observe statistically significant association in frequency of consumption of visible fat (sunflower oil, olive oil, lard, margarine butter) between cases and controls (p>0.05). According to the univariate logistic regression analysis, total fat (OR for highest tertile 0.80, 95%CI: 0.28-2.25), saturated fatty acids (0.85, 95%CI: 0.31-2.35), monounsaturated fatty acids (0.57, 95%CI: 0.22-1.48) and cholesterol (0.79; 95%CI:0.37-2.28) intake were not associated, and polyunsaturated fatty acids were inversely associated with the risk of gastric cancer (0.32; 95%CI: 0.12-0.83). Our results suggest that dietary polyunsaturated fat intake may help to prevent gastric cancer. Further studies are needed to confirm these results.
Celiac disease (CD) is a genetically determined autoimmune enteropathy, induced by gluten ingesti... more Celiac disease (CD) is a genetically determined autoimmune enteropathy, induced by gluten ingestion. To date, different prevalences of CD in children with epilepsy have been reported. The aim of this study was to determine CD prevalence in our patients with epilepsy, using anti-tissue transglutaminase (tTG) antibodies as a screening test. One hundred twenty-five children (72 girls, 53 boys; age range: 2-18 years, mean age: 10.51 +/- 3.53) with idiopathic epilepsy from South East Serbia were tested for immunoglobulin (IgA) tTG antibodies. All positive patients were offered endoscopic small bowel biopsy. Biopsies were examined histopathologically in order to confirm the CD diagnosis. The control group consisted of 150 healthy children. Three patients with epilepsy were positive for IgA tTG antibodies. In all of them, small bowel biopsy was performed, and only one was proven to have CD by histopathology (Marsh IIIa grade). The prevalence of biopsy-proven CD in children with epilepsy was not significantly higher in the study group compared to controls (0.8% vs.0.6%, p > 0.05). The results of this study indicate that children with idiopathic epilepsy from our region should not be routinely tested for CD.
Purpose: To examine possible associations between dietary factors and gastric cancer risk among r... more Purpose: To examine possible associations between dietary factors and gastric cancer risk among residents in the area of Nis, Serbia. Methods: This hospital based case-control study was conducted at the Clinical Centre Nis between 2005 and 2006. Cases (n=102) with histologically confirmed gastric cancer and matched non-cancer patients (controls, n=204) were interviewed. Diet was assessed using a food frequency questionnaire and odds ratios (OR), 95% confidence interval (95% CI), and p-trends were calculated across tertiles of intake. Results: High intake of salt, salty meals and hot food were associated with higher risk of gastric cancer. After searching for potential confounders, multivariate logistic regression analysis showed elevated risk for the highest vs. the lowest tertile of intake for smoked and barbecue meat (OR 4.21; 95% CI 1.43-12.37), processed meat (OR 9.17; 95% CI 2.78-15.23), desert (OR 2.85; 95% CI 1.28-6.38), potatoes (OR 4.79; 95% CI 1.44-5.94), pickled vegetables (OR 2.02; 95% CI 1.21-3.0) and milk (OR 5.08; 95% CI 1.59-10.16) intake but reduced for citrus fruits (OR= 0.13, 95% CI 0.03- 0.53), other fruits (OR 0.05; 95% CI 0.02-0.18), allium vegetables (e.g. onion, garlic, leek) (OR 0.11; 95% CI 0.02-0.60) and cooked meat intake (OR 0.07; 95% CI 0.02-0.27). Intake of bread, dairy, fish, legumes and raw and cooked vegetables was not significantly related with gastric cancer risk. Conclusion: A low risk diet for gastric cancer in the area of Nis should include increased fruits and alliums vegetables consumption and limited processed meat, salt, preserved food, deserts, potatoes and milk intake.
It has been suggested that narrow band imaging colonoscopy (NBI) might be better for detection of... more It has been suggested that narrow band imaging colonoscopy (NBI) might be better for detection of colorectal polyps than white light colonoscopy (WLC). To compare standard or high definition white light colonoscopy with narrow band imaging colonoscopy for detection of colorectal polyps. We searched The Cochrane Library, MEDLINE, and EMBASE to August 2011. We scanned bibliographies of relevant publications and wrote to experts for additional trials. Two authors (NA and GB) independently applied the inclusion criteria and extracted the data to all potential studies without blinding. Authors extracted data independently. Trials with adequate randomisation, allocation concealment, and complete outcome data reporting, as well as without selective outcome reporting or other bias were classified as having a lowest risk of bias. Random-effects and fixed-effect meta-analyses were conducted. We identified 11 randomised trials comparing WLC with NBI for detection of colorectal polyps. In total eight randomised trials with 3673 participants provided data for our analyses. There was no statistically significant difference between WLC (standard definition and high definition pooled) and NBI for the detection of patients with colorectal polyps (6 trials, n = 2832, RR 0.97, 95% CI 0.91 to 1.04), patients with colorectal adenomas (8 trials, n = 3673, RR 0.94, 95% CI 0.87 to 1.02), or patients with colorectal hyperplastic polyps (2 trials, n = 645, RR 0.87, 95% CI 0.76 to 1.00). Number of patients with at least one colorectal adenoma was not significantly different between WLC and NBI group irrespective of adenoma size (< 5 mm:RR 0.95, 95% CI 0.84 to 1.08, I(2) = 56%; 6 to 9 mm: RR 1.06, 95% CI 0.81 to 1.39, I(2) = 0%; ≥ 10 mm: RR 1.06, 95% CI 0.77 to 1.45, I(2) = 0%). Number of patients with at least one colorectal polyp, or colorectal adenoma was significantly lower in the standard definition WLC group compared to NBI group in fixed-effect meta-analysis (RR 0.87, 95% CI 0.78 to 0.97, I(2) = 78%; RR 0.87, 95% CI 0.77 to 0.99, I(2) = 0%, respectively), but not significantly different in random-effects meta-analysis (RR 0.86, 95% CI 0.68 to 1.10, I(2) = 78%). There was no statistically significant difference between high definition WLC and NBI in the number of patiens with at least one colorectal polyp or colorectal adenoma (RR 1.10, 95% CI 0.95 to 1.28; RR 0.87, 95% CI 0.77 to 0.99, I(2) = 0%, respectively). We could not find convincing evidence that NBI is significantly better than high definition WLC for the detection of patients with colorectal polyps, or colorectal adenomas. We found evidence that NBI might be better than standard definition WLC and equal to high definition WLC for detection the patients with colorectal polyps, or colorectal adenomas.
Cochrane Database of Systematic Reviews, Feb 17, 2010
It has been suggested that narrow band imaging colonoscopy (NBI) might be better for detection of... more It has been suggested that narrow band imaging colonoscopy (NBI) might be better for detection of colorectal polyps than white light colonoscopy (WLC). To compare standard or high definition white light colonoscopy with narrow band imaging colonoscopy for detection of colorectal polyps. We searched The Cochrane Library, MEDLINE, and EMBASE to August 2011. We scanned bibliographies of relevant publications and wrote to experts for additional trials. Two authors (NA and GB) independently applied the inclusion criteria and extracted the data to all potential studies without blinding. Authors extracted data independently. Trials with adequate randomisation, allocation concealment, and complete outcome data reporting, as well as without selective outcome reporting or other bias were classified as having a lowest risk of bias. Random-effects and fixed-effect meta-analyses were conducted. We identified 11 randomised trials comparing WLC with NBI for detection of colorectal polyps. In total eight randomised trials with 3673 participants provided data for our analyses. There was no statistically significant difference between WLC (standard definition and high definition pooled) and NBI for the detection of patients with colorectal polyps (6 trials, n = 2832, RR 0.97, 95% CI 0.91 to 1.04), patients with colorectal adenomas (8 trials, n = 3673, RR 0.94, 95% CI 0.87 to 1.02), or patients with colorectal hyperplastic polyps (2 trials, n = 645, RR 0.87, 95% CI 0.76 to 1.00). Number of patients with at least one colorectal adenoma was not significantly different between WLC and NBI group irrespective of adenoma size (< 5 mm:RR 0.95, 95% CI 0.84 to 1.08, I(2) = 56%; 6 to 9 mm: RR 1.06, 95% CI 0.81 to 1.39, I(2) = 0%; ≥ 10 mm: RR 1.06, 95% CI 0.77 to 1.45, I(2) = 0%). Number of patients with at least one colorectal polyp, or colorectal adenoma was significantly lower in the standard definition WLC group compared to NBI group in fixed-effect meta-analysis (RR 0.87, 95% CI 0.78 to 0.97, I(2) = 78%; RR 0.87, 95% CI 0.77 to 0.99, I(2) = 0%, respectively), but not significantly different in random-effects meta-analysis (RR 0.86, 95% CI 0.68 to 1.10, I(2) = 78%). There was no statistically significant difference between high definition WLC and NBI in the number of patiens with at least one colorectal polyp or colorectal adenoma (RR 1.10, 95% CI 0.95 to 1.28; RR 0.87, 95% CI 0.77 to 0.99, I(2) = 0%, respectively). We could not find convincing evidence that NBI is significantly better than high definition WLC for the detection of patients with colorectal polyps, or colorectal adenomas. We found evidence that NBI might be better than standard definition WLC and equal to high definition WLC for detection the patients with colorectal polyps, or colorectal adenomas.
Gastro-oesophageal reflux disease (GERD) includes wide spectrum of symptoms caused by gastric aci... more Gastro-oesophageal reflux disease (GERD) includes wide spectrum of symptoms caused by gastric acid regurgitation through the incompetent lower oesophageal sphincter in oesophagus. Etiopathogenesis of GERD is multifactorial. Aim of this study: to establish the relationship between Helicobacter pylori eradication and appearance or aggravating of present GERD. If this relationship exist, the aim is to estimate its level and clinical consequences. Material and methods: 50 Helicobacter pylori positive patients with different endoscopic findings (ulcer disease, gastritis and non-ulcer dyspepsia) to whom eradication of Helicobacter pylori was done, were following next 6 months. Questionnaire, uppear GI endoscopy with verification changes of oesophagus in accordance to LA classification, histopathological examination of gastric and oesophageal mucosal biopsy specimens, and oesophageal manometry have been done to all patients. These examinations have been done before Helicobacter pylori erad...
Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) as progressive... more Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) as progressive form of the disease are associated with cardiovascular risk factors including obesity, dyslipidaemia, hyperglycaemia and hypertension. When NAFLD is associated with cardiovascular disease, mortality of NAFLD patients is increased due to cardiovascular disease. Prevalence of NAFLD and NASH is high, but it seems that epidemic of the disease is under-recognized and under-appreciated. Linking pathophysiological mechanisms are complex and still not well understood. The main related pathophysiological mechanisms are lipid factors, insulin resistance, inflammation, proinflammatory cytokines, oxidative stress, pro-coagulant status, hyperglycaemia and adipokines. First-line management focuses on lifestyle modifications in both diseases. Several therapeutic interventions, insulin sensitizer agents, lipid lowering drugs, antioxidants, such as vitamin E, have been proposed. Statins appear to be safe, but their use in the treatment of NAFLD and NASH is under-appreciated. Many different agents are being investigated as future drugs for the treatment of this clinical entity. The aim of the review is to examine the extent of the epidemic and the mediating mechanisms, to critically evaluate current guideline recommendations, and to consider current and future medications for this disease.
The expression of the human Ki-67 protein is strictly associated with cell proliferation. The cel... more The expression of the human Ki-67 protein is strictly associated with cell proliferation. The cell proliferation and kinetics of normal gastrointestinal tract are well known but the cell kinetics of adenoma in gastrointestinal tract is poorly understood. The aim of this study was to provide an immunohistochemical evaluation of the expression of Ki-67 antigen in different colorectal adenomas. In the prospective study, we analyzed 65 colorectal adenomas. Proliferation indexes were found to steadily increase from normal mucosa to adenoma (p < 0.05). There was also a difference in the expression of Ki-67 between adenomas smaller and larger than 10 mm (p < 0.05). The expression of Ki-67 was strongly more often in villous adenomas as opposed to the tubular adenomas (p < 0.05). Reaction for Ki-67 were strong in adenomas with high grade atypia compared to low grade adenomas (p < 0.001). The expression of Ki-67 clearly shows differences between advanced and nonadvanced adenomas. The strong reactions of Ki-67 in adenomas with severe dysplasia show a close association with colorectal carcinoma. The immunohistochemical analysis (Ki-67) may be included as a part of routine pathological evaluation with conventional prognostic factors.
Colorectal cancer (CRC) is important medical problem. Initially it can be present like solitary o... more Colorectal cancer (CRC) is important medical problem. Initially it can be present like solitary or multiple. Multiple primary CRC may be synchronous or metachronous depend on period between the diagnosis has been established. Metachronous CRC is primary CRC which arise certain period after diagnosis and removal of previous CRC. Synchronous CRC are discovered at the same time or inside a period of 6-12 months. We present a relative rare case of metachrono-synchronous colorectal cancer.
The study investigated whether intakes of fat and fatty acids are associated with the development... more The study investigated whether intakes of fat and fatty acids are associated with the development of gastric cancer. A case-control study was conducted in the Clinical Centre Nis (Serbia) from 2005 to 2006. A total of 102 patients with histologically confirmed gastric cancer were compared with 204 controls chosen among the subjects admitted to the same hospital as cases of acute non-neoplastic diseases. A food-frequency questionnaire (FFQ) was used to assess information on the frequency of consumption of foods in the course of one year prior to cancer diagnosis or hospital admission (for controls). Nutrient values in food were obtained from the Food composition table. We did not observe statistically significant association in frequency of consumption of visible fat (sunflower oil, olive oil, lard, margarine butter) between cases and controls (p>0.05). According to the univariate logistic regression analysis, total fat (OR for highest tertile 0.80, 95%CI: 0.28-2.25), saturated fatty acids (0.85, 95%CI: 0.31-2.35), monounsaturated fatty acids (0.57, 95%CI: 0.22-1.48) and cholesterol (0.79; 95%CI:0.37-2.28) intake were not associated, and polyunsaturated fatty acids were inversely associated with the risk of gastric cancer (0.32; 95%CI: 0.12-0.83). Our results suggest that dietary polyunsaturated fat intake may help to prevent gastric cancer. Further studies are needed to confirm these results.
Celiac disease (CD) is a genetically determined autoimmune enteropathy, induced by gluten ingesti... more Celiac disease (CD) is a genetically determined autoimmune enteropathy, induced by gluten ingestion. To date, different prevalences of CD in children with epilepsy have been reported. The aim of this study was to determine CD prevalence in our patients with epilepsy, using anti-tissue transglutaminase (tTG) antibodies as a screening test. One hundred twenty-five children (72 girls, 53 boys; age range: 2-18 years, mean age: 10.51 +/- 3.53) with idiopathic epilepsy from South East Serbia were tested for immunoglobulin (IgA) tTG antibodies. All positive patients were offered endoscopic small bowel biopsy. Biopsies were examined histopathologically in order to confirm the CD diagnosis. The control group consisted of 150 healthy children. Three patients with epilepsy were positive for IgA tTG antibodies. In all of them, small bowel biopsy was performed, and only one was proven to have CD by histopathology (Marsh IIIa grade). The prevalence of biopsy-proven CD in children with epilepsy was not significantly higher in the study group compared to controls (0.8% vs.0.6%, p > 0.05). The results of this study indicate that children with idiopathic epilepsy from our region should not be routinely tested for CD.
Purpose: To examine possible associations between dietary factors and gastric cancer risk among r... more Purpose: To examine possible associations between dietary factors and gastric cancer risk among residents in the area of Nis, Serbia. Methods: This hospital based case-control study was conducted at the Clinical Centre Nis between 2005 and 2006. Cases (n=102) with histologically confirmed gastric cancer and matched non-cancer patients (controls, n=204) were interviewed. Diet was assessed using a food frequency questionnaire and odds ratios (OR), 95% confidence interval (95% CI), and p-trends were calculated across tertiles of intake. Results: High intake of salt, salty meals and hot food were associated with higher risk of gastric cancer. After searching for potential confounders, multivariate logistic regression analysis showed elevated risk for the highest vs. the lowest tertile of intake for smoked and barbecue meat (OR 4.21; 95% CI 1.43-12.37), processed meat (OR 9.17; 95% CI 2.78-15.23), desert (OR 2.85; 95% CI 1.28-6.38), potatoes (OR 4.79; 95% CI 1.44-5.94), pickled vegetables (OR 2.02; 95% CI 1.21-3.0) and milk (OR 5.08; 95% CI 1.59-10.16) intake but reduced for citrus fruits (OR= 0.13, 95% CI 0.03- 0.53), other fruits (OR 0.05; 95% CI 0.02-0.18), allium vegetables (e.g. onion, garlic, leek) (OR 0.11; 95% CI 0.02-0.60) and cooked meat intake (OR 0.07; 95% CI 0.02-0.27). Intake of bread, dairy, fish, legumes and raw and cooked vegetables was not significantly related with gastric cancer risk. Conclusion: A low risk diet for gastric cancer in the area of Nis should include increased fruits and alliums vegetables consumption and limited processed meat, salt, preserved food, deserts, potatoes and milk intake.
It has been suggested that narrow band imaging colonoscopy (NBI) might be better for detection of... more It has been suggested that narrow band imaging colonoscopy (NBI) might be better for detection of colorectal polyps than white light colonoscopy (WLC). To compare standard or high definition white light colonoscopy with narrow band imaging colonoscopy for detection of colorectal polyps. We searched The Cochrane Library, MEDLINE, and EMBASE to August 2011. We scanned bibliographies of relevant publications and wrote to experts for additional trials. Two authors (NA and GB) independently applied the inclusion criteria and extracted the data to all potential studies without blinding. Authors extracted data independently. Trials with adequate randomisation, allocation concealment, and complete outcome data reporting, as well as without selective outcome reporting or other bias were classified as having a lowest risk of bias. Random-effects and fixed-effect meta-analyses were conducted. We identified 11 randomised trials comparing WLC with NBI for detection of colorectal polyps. In total eight randomised trials with 3673 participants provided data for our analyses. There was no statistically significant difference between WLC (standard definition and high definition pooled) and NBI for the detection of patients with colorectal polyps (6 trials, n = 2832, RR 0.97, 95% CI 0.91 to 1.04), patients with colorectal adenomas (8 trials, n = 3673, RR 0.94, 95% CI 0.87 to 1.02), or patients with colorectal hyperplastic polyps (2 trials, n = 645, RR 0.87, 95% CI 0.76 to 1.00). Number of patients with at least one colorectal adenoma was not significantly different between WLC and NBI group irrespective of adenoma size (< 5 mm:RR 0.95, 95% CI 0.84 to 1.08, I(2) = 56%; 6 to 9 mm: RR 1.06, 95% CI 0.81 to 1.39, I(2) = 0%; ≥ 10 mm: RR 1.06, 95% CI 0.77 to 1.45, I(2) = 0%). Number of patients with at least one colorectal polyp, or colorectal adenoma was significantly lower in the standard definition WLC group compared to NBI group in fixed-effect meta-analysis (RR 0.87, 95% CI 0.78 to 0.97, I(2) = 78%; RR 0.87, 95% CI 0.77 to 0.99, I(2) = 0%, respectively), but not significantly different in random-effects meta-analysis (RR 0.86, 95% CI 0.68 to 1.10, I(2) = 78%). There was no statistically significant difference between high definition WLC and NBI in the number of patiens with at least one colorectal polyp or colorectal adenoma (RR 1.10, 95% CI 0.95 to 1.28; RR 0.87, 95% CI 0.77 to 0.99, I(2) = 0%, respectively). We could not find convincing evidence that NBI is significantly better than high definition WLC for the detection of patients with colorectal polyps, or colorectal adenomas. We found evidence that NBI might be better than standard definition WLC and equal to high definition WLC for detection the patients with colorectal polyps, or colorectal adenomas.
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