Clinical value of wide-angle colonoscopy combined with narrow-band imaging in detecting sessile serrated lesions during colorectal cancer screening: A single-center retrospective observational study.

Sessile serrated lesions (SSLs) represent a clinically significant challenge in colorectal cancer screening due to their flat morphology and association with interval cancers. Advanced endoscopic techniques such as wide-angle colonoscopy (WAC) and narrow-band imaging (NBI) may enhance detection rates of SLs, but evidence regarding their combined efficacy remains limited. This study aimed to evaluate the effectiveness of WAC combined with NBI in detecting SSLs compared to NBI alone and standard white-light endoscopy (WLE) during colorectal cancer (CRC) screening. In this single-center retrospective observational cohort study, the clinical records of 342 eligible patients who underwent CRC screening at Rongchang District Hospital between January 4, 2024, and January 31, 2025, were reviewed. Data were extracted from the Epic-Hyperspace electronic medical record system and institutional endoscopy/pathology records. Patients were categorized according to the imaging strategy documented during colonoscopy: WAC + NBI, full procedure with 170° view and NBI, n = 114; WLE + NBI, white-light examination with selective NBI activation, n = 114; or WLE + WAC, 170° wide-angle without NBI, n = 114. The primary outcome was sessile serrated lesion detection rate. Endoscopic procedures were performed using Olympus 290 systems. Histopathological diagnosis was conducted by pathologists blinded to the imaging group. In unadjusted comparisons, the WAC + NBI group had a higher sessile serrated lesion detection rate (18.4%) than both the WLE + NBI group (11.4%, P < .05, and the WLE + WAC group (7.9%, P < .05. No significant differences were observed in most secondary outcomes. The exploratory adenoma miss rate in a 10% subsample was numerically lower in WAC + NBI (11.1%) than in WLE + WAC (27.8%, P > .05. Procedurally, WAC + NBI required longer withdrawal times (9.3 ± 1.5 minutes) than comparator groups (8.0-8.1 minutes, P < .05. The combination of WAC and NBI may offer clinical advantages in improving SSL detection during CRC screening. These findings could support broader adoption of advanced endoscopic technologies in population-based screening programs. These findings should be interpreted cautiously and validated in prospective multicenter studies.