East J E, Stavrindis M, Thomas-Gibson S, Guenther T, Tekkis P P, Saunders B P
Wolfson Unit for Endoscopy, St Mark's Hospital, Imperial College London, London, UK.
Aliment Pharmacol Ther. 2008 Sep 15;28(6):768-76. doi: 10.1111/j.1365-2036.2008.03789.x.
Colonoscopy has a known miss rate for polyps and adenomas. High definition (HD) colonoscopes may allow detection of subtle mucosal change, potentially aiding detection of adenomas and hyperplastic polyps.
To compare detection rates between HD and standard definition (SD) colonoscopy.
Prospective, cohort study with optimized withdrawal technique (withdrawal time >6 min, antispasmodic, position changes, re-examining flexures and folds). One hundred and thirty patients attending for routine colonoscopy were examined with either SD (n = 72) or HD (n = 58) colonoscopes.
Groups were well matched. Sixty per cent of patients had at least one adenoma detected with SD vs. 71% with HD, P = 0.20, relative risk (benefit) 1.32 (95% CI 0.85-2.04). Eighty-eight adenomas (mean +/- standard deviation 1.2 +/- 1.4) were detected using SD vs. 93 (1.6 +/- 1.5) with HD, P = 0.12; however more nonflat, diminutive (<6 mm) adenomas were detected with HD, P = 0.03. Twenty-three proximal hyperplastic polyps (0.32 +/- 0.58) were detected with SD vs. 31 (0.53 +/- 0.86) with HD, P = 0.35. Overall prevalence of proximal large (>9 mm) hyperplastic polyps was 7% (0.09 +/- 0.36).
High definition did not lead to a significant increase in adenoma or hyperplastic polyp detection, but may help where comprehensive lesion detection is paramount. High detection rates appear possible with either SD or HD, when using an optimized withdrawal technique.
结肠镜检查对息肉和腺瘤存在已知的漏诊率。高清（HD）结肠镜可能有助于发现细微的黏膜变化，从而有可能辅助腺瘤和增生性息肉的检测。
比较高清结肠镜与标准清晰度（SD）结肠镜的检测率。
采用优化退镜技术（退镜时间>6分钟、使用解痉剂、改变体位、重新检查弯曲部和皱襞）的前瞻性队列研究。130例接受常规结肠镜检查的患者分别使用SD结肠镜（n = 72）或HD结肠镜（n = 58）进行检查。
两组匹配良好。SD结肠镜检查时60%的患者至少检测到一个腺瘤，而HD结肠镜检查时为71%，P = 0.20，相对风险（益处）为1.32（95%可信区间0.85 - 2.04）。使用SD结肠镜检测到88个腺瘤（平均±标准差1.2±1.4），而HD结肠镜检测到93个（1.6±1.5），P = 0.12；然而，HD结肠镜检测到更多的非扁平、微小（<6毫米）腺瘤，P = 0.03。SD结肠镜检测到23个近端增生性息肉（0.32±0.58），HD结肠镜检测到31个（0.53±0.86），P = 0.35。近端大（>9毫米）增生性息肉的总体患病率为7%（0.09±0.36）。
高清结肠镜检查并未导致腺瘤或增生性息肉检测率显著增加，但在全面病变检测至关重要的情况下可能有所帮助。当采用优化退镜技术时，使用SD或HD结肠镜似乎都有可能实现高检测率。
