East J E, Suzuki N, Stavrinidis M, Guenther T, Thomas H J W, Saunders B P
Wolfson Unit for Endoscopy, St Mark's Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, UK.
Gut. 2008 Jan;57(1):65-70. doi: 10.1136/gut.2007.128926. Epub 2007 Aug 6.
Colonoscopic surveillance for hereditary non-polyposis colorectal cancer (HNPCC) reduces death rates, but early interval cancers still occur, probably due to missed small, aggressive adenomas. Narrow band imaging (NBI), a novel endoscopic technology, highlights superficial mucosal capillaries and improves contrast for adenomas. This study examined whether a second pass with NBI in the proximal colon helped detect additional adenomas in patients with HNPCC.
62 patients from HNPCC families (Amsterdam II or genetic criteria) attending for colonoscopic surveillance were examined twice from caecum to sigmoid-descending junction, first with high definition white light and then a second pass with NBI in a back-to-back fashion. All polyps detected were removed for histopathological analysis.
At least one adenoma in the proximal colon was detected during the initial white light pass in 17/62 (27%). NBI detected additional adenomas in 17/62 (27%). 26/62 (42%) patients had at least one adenoma detected after both white light and NBI; absolute difference 15% (95% CI 4-25%), p = 0.004 versus white light alone. The total number of adenomas increased from 25 before NBI to 46 after NBI examination, p<0.001. The proportion of flat adenomas detected in the NBI pass, 9/21 (45%), was higher than in the white light pass, 3/25 (12%), p = 0.03. Including white light examination of the sigmoid and rectum, overall 28/62 (45%) patients had at least one adenoma detected.
Use of NBI in the proximal colon for patients undergoing HNPCC surveillance appears to improve adenoma detection, particularly those with a flat morphology. NBI could help reduce interval cancer rates.
对遗传性非息肉病性结直肠癌（HNPCC）进行结肠镜监测可降低死亡率，但仍会出现早期间隔癌，这可能是由于遗漏了小的、侵袭性腺瘤。窄带成像（NBI）是一种新型内镜技术，可突出浅表黏膜毛细血管并改善腺瘤的对比度。本研究探讨了在近端结肠再次使用NBI是否有助于检测HNPCC患者的额外腺瘤。
对62名来自HNPCC家族（阿姆斯特丹II标准或基因标准）接受结肠镜监测的患者从盲肠至乙状结肠-降结肠交界处进行两次检查，首先采用高清白光检查，然后紧接着采用NBI再次检查。所有检测到的息肉均切除进行组织病理学分析。
在初始白光检查期间，62例患者中有17例（27%）在近端结肠检测到至少1个腺瘤。NBI在62例患者中的17例（27%）检测到额外腺瘤。62例患者中有26例（42%）在白光和NBI检查后均检测到至少1个腺瘤；与单独白光检查相比，绝对差异为15%（95%CI 4-25%），p = 0.004。腺瘤总数从NBI检查前的25个增加到NBI检查后的46个，p<0.001。在NBI检查中检测到的扁平腺瘤比例为9/21（45%），高于白光检查中的3/25（12%），p = 0.03。包括对乙状结肠和直肠进行白光检查，总体上62例患者中有28例（45%）检测到至少1个腺瘤。
对接受HNPCC监测的患者在近端结肠使用NBI似乎可提高腺瘤检测率，尤其是扁平形态的腺瘤。NBI可能有助于降低间隔癌发生率。
