Togashi Kazutomo, Hewett David G, Radford-Smith Graham L, Francis Leo, Leggett Barbara A, Appleyard Mark N
Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Level 9 Ned Hanlon Building, QLD, Australia.
J Gastroenterol. 2009;44(8):826-33. doi: 10.1007/s00535-009-0065-3. Epub 2009 May 16.
It remains controversial whether chromocolonoscopy using indigocarmine increases the detection of colorectal polyps. We aimed to assess the impact of indigocarmine dye spray on the detection rate of adenomas and the feasibility of learning the technique in a Western practice.
400 patients were prospectively allocated into 2 groups; A (n = 200): indigocarmine chromocolonoscopy was performed by a Japanese colonoscopist with expertise in chromoscopy; B (n = 200): initial 100 patients (B-1), a Western colonoscopist with no previous experience of chromoscopy performed conventional colonoscopy, but with at least 10 min observation during colonoscopy withdrawal. In the next 100 patients (B-2), he performed chromocolonoscopy. All polyps found were resected. Regression analysis was used to compare the numbers of polyps detected in groups A, B-1 and B-2, whilst controlling for gender, age, indication and history of colorectal cancer.
There were significant differences in the numbers of neoplastic polyps and flat adenomas between groups A and B-1 as well as between B-1 and B-2, but not between A and B-2. There was no significant difference in numbers of advanced lesions. Chromocolonoscopy (A and B-2) detected more neoplastic polyps of <or=5 mm.
Chromocolonoscopy increases the detection of neoplastic polyps and flat adenomas, particularly diminutive polyps, but does not increase the detection of advanced lesions.
使用靛胭脂进行染色结肠镜检查是否能提高大肠息肉的检出率仍存在争议。我们旨在评估靛胭脂喷洒对腺瘤检出率的影响以及在西方实践中学习该技术的可行性。
400例患者被前瞻性地分为两组；A组（n = 200）：由一位擅长染色内镜检查的日本结肠镜医师进行靛胭脂染色结肠镜检查；B组（n = 200）：最初的100例患者（B - 1），一位此前无染色内镜检查经验的西方结肠镜医师进行传统结肠镜检查，但在退镜过程中至少观察10分钟。在接下来的100例患者（B - 2）中，他进行染色结肠镜检查。所有发现的息肉均被切除。在控制性别、年龄、适应证和结直肠癌病史的同时，使用回归分析比较A组、B - 1组和B - 2组中检测到的息肉数量。
A组与B - 1组以及B - 1组与B - 2组之间的肿瘤性息肉和平坦腺瘤数量存在显著差异，但A组与B - 2组之间无显著差异。高级别病变数量无显著差异。染色结肠镜检查（A组和B - 2组）检测到更多直径小于或等于5mm的肿瘤性息肉。
染色结肠镜检查可提高肿瘤性息肉和平坦腺瘤的检出率，尤其是微小息肉，但不会增加高级别病变的检出率。
