Lapalus M-G, Helbert T, Napoleon B, Rey J F, Houcke P, Ponchon T
Fédération des Spécialités Digestives, Hôpital E. Herriot, Lyon, France.
Endoscopy. 2006 May;38(5):444-8. doi: 10.1055/s-2006-925265.
Colonoscopy is still considered the standard investigation for the detection of colorectal adenomas, but the miss rate, especially for small and flat lesions, remains unacceptably high. Chromoscopy has been shown to increase the yield for lesion detection in inflammatory bowel disease. The aim of this randomized prospective study was to determine whether a combination of chromoscopy and structure enhancement could increase the adenoma detection rate in high-risk patients.
All patients included in the trial had a personal history of colorectal adenomas and/or a family history of colorectal cancer (but excluding genetic syndromes). They were randomized to one of two tandem colonoscopy groups, with the first pass consisting of conventional colonoscopy for both groups, followed by either chromoscopy and structure enhancement (the "study" group) or a second conventional colonoscopy (the control group) for the second-pass colonoscopy. All detected lesions was examined histopathologically after endoscopic resection or biopsy. The principal outcome parameter was the adenoma detection rate; the number, histopathology, and location of lesions was also recorded.
A total of 292 patients were included in the study (146 patients in each group). The patients' demographic characteristics, the indications for colonoscopy, and the quality of bowel preparation were similar in the two groups. There was a significant difference between the two groups with respect to the median duration of the examination (18.9 minutes in the control group vs. 27.1 minutes for the study group, P < 0.001). Although more hyperplastic lesions were detected throughout the colon in the study group ( P = 0.033), there was no difference between the two groups in either the proportion of patients with at least one adenoma or in the total number of adenomas detected. Chromoscopy and structure enhancement diagnosed significantly more diminutive adenomas (< 5mm) in the right colon, compared with controls ( P = 0.039).
On the basis of our results we cannot generally recommend the systematic use of chromoscopy and structure enhancement in a high-risk patient population, although the detection of small adenomas in the proximal colon was improved.
结肠镜检查仍被视为检测结直肠腺瘤的标准检查方法，但漏诊率，尤其是对小的扁平病变的漏诊率，仍然高得令人无法接受。染色内镜检查已被证明可提高炎症性肠病中病变的检出率。这项随机前瞻性研究的目的是确定染色内镜检查与结构增强相结合是否能提高高危患者的腺瘤检出率。
纳入试验的所有患者均有结直肠腺瘤个人史和/或结直肠癌家族史（但不包括遗传综合征）。他们被随机分为两个串联结肠镜检查组之一，两组的首次检查均为传统结肠镜检查，随后第二次结肠镜检查时，一组进行染色内镜检查与结构增强（“研究”组），另一组进行第二次传统结肠镜检查（对照组）。所有检测到的病变在内镜切除或活检后进行组织病理学检查。主要结局参数是腺瘤检出率；还记录了病变的数量、组织病理学和位置。
共有292例患者纳入研究（每组146例）。两组患者的人口统计学特征、结肠镜检查指征和肠道准备质量相似。两组检查的中位持续时间有显著差异（对照组为18.9分钟，研究组为27.1分钟，P<0.001）。尽管研究组在整个结肠中检测到更多增生性病变（P=0.033），但两组中至少有一个腺瘤的患者比例或检测到的腺瘤总数均无差异。与对照组相比，染色内镜检查与结构增强在右结肠中诊断出的微小腺瘤（<5mm）明显更多（P=0.039）。
根据我们的研究结果，尽管近端结肠小腺瘤的检测有所改善，但我们一般不建议在高危患者人群中系统地使用染色内镜检查与结构增强。
