Kiesslich Ralf, Goetz Martin, Lammersdorf Katharina, Schneider Constantin, Burg Juergen, Stolte Manfred, Vieth Michael, Nafe Bernhard, Galle Peter R, Neurath Markus F
I. Medical Clinic, Johannes Gutenberg University of Mainz, Germany.
Gastroenterology. 2007 Mar;132(3):874-82. doi: 10.1053/j.gastro.2007.01.048. Epub 2007 Jan 31.
Because of the large number of biopsy specimens, surveillance colonoscopy in ulcerative colitis (UC) is currently time consuming and significant flat lesions still may be missed. In this study we assessed the value of combined chromoscopy and endomicroscopy for the diagnosis of intraepithelial neoplasias in a randomized controlled trial.
A total of 161 patients with long-term UC in clinical remission were randomized at a 1:1 ratio to undergo conventional colonoscopy or chromoscopy with endomicroscopy. Eight patients were excluded because of insufficient bowel preparation. In the conventional colonoscopic group (n = 73), random biopsy examinations and targeted biopsy examinations were performed. In the endomicroscopy group (n = 80), circumscribed mucosal lesions were identified by chromoscopy and evaluated for targeted biopsy examination by endomicroscopy. The primary outcome analysis was based on the detection of neoplasias.
By using chromoscopy with endomicroscopy, 4.75-fold more neoplasias could be detected (P = .005) than with conventional colonoscopy, although 50% fewer biopsy specimens (P = .008) were required. If only circumscribed lesions would have been biopsied in the first group, the total number of biopsy specimens could have been reduced by more than 90%. A total of 5580 confocal endomicroscopic images from 134 circumscribed lesions were compared with histologic results. The presence of neoplastic changes could be predicted by endomicroscopy with high accuracy (sensitivity, 94.7%; specificity, 98.3%; accuracy, 97.8%).
Endomicroscopy based on in vivo histology can determine if UC lesions identified by chromoscopy should undergo biopsy examination, thereby increasing the diagnostic yield and reducing the need for biopsy examinations. Thus, chromoscopy-guided endomicroscopy may lead to significant improvements in the clinical management of UC.
由于活检标本数量众多，目前溃疡性结肠炎（UC）的监测性结肠镜检查耗时较长，且仍可能遗漏重要的扁平病变。在本项随机对照试验中，我们评估了染色内镜检查与内镜显微镜检查联合用于诊断上皮内瘤变的价值。
总共161例处于临床缓解期的长期UC患者按1:1比例随机分组，分别接受传统结肠镜检查或染色内镜检查与内镜显微镜检查。8例患者因肠道准备不充分被排除。在传统结肠镜检查组（n = 73）中，进行了随机活检检查和靶向活检检查。在内镜显微镜检查组（n = 80）中，通过染色内镜检查识别出局限性黏膜病变，并通过内镜显微镜检查评估是否需要进行靶向活检检查。主要结局分析基于瘤变的检测情况。
与传统结肠镜检查相比，使用染色内镜检查与内镜显微镜检查能多检测出4.75倍的瘤变（P = 0.005），尽管所需活检标本数量减少了50%（P = 0.008）。如果第一组仅对局限性病变进行活检，活检标本总数可减少90%以上。共将来自134个局限性病变的5580张共聚焦内镜显微镜图像与组织学结果进行了比较。内镜显微镜检查能够高精度地预测肿瘤性改变的存在（敏感性为94.7%；特异性为98.3%；准确性为97.8%）。
基于体内组织学的内镜显微镜检查能够确定经染色内镜检查发现的UC病变是否需要进行活检，从而提高诊断率并减少活检需求。因此，染色内镜引导下的内镜显微镜检查可能会显著改善UC的临床管理。
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